Financially-Incentives to Improve Provider Compliance

NCT ID: NCT04634019

Last Updated: 2025-05-23

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 600 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-01-01
• Study Completion Date: 2025-12-31

Brief Summary

The main objective of this study is to assess whether making health financing streams conditional on provider performance on knowledge assessment can increase provider compliance with under-5 case management guidelines.

Detailed Description

The main idea of the intervention is to conduct quarterly provider knowledge assessments at health facilities and to pay facilities a bonus if providers perform well on these tests. For the intervention, 12 clinical vignettes were created. These vignettes cover typical patient cases such as malaria, diarrhea and respiratory infections, and assess providers' ability to correctly diagnose and treat hypothetical questions. All medical staff members were informed hat every 3 month there would be a knowledge assessment based on these vignettes and that the results would determine the total bonus payment made to the facility.

Each quarter, facilities receive a supervision visit. During the supervision visits, one provider is randomly chosen for the knowledge assessments, and is tested on two randomly chosen vignette cases.

In order to create a quarterly performance score, the scores on the two vignettes are then averaged. Fifty percent of the overall facility quality score is determined by the general quality checklist that captures basic structural and process features of the facility. The remaining fifty percent are directly determined by the providers' performance on the knowledge assessments. If the overall quality score is below 50%, no quality payments are made. If the quality score is >=50%, facilities can receive a top-up payment of up to 25% of the quantity-based payments. The total bonus percentage is determined by multiplying the quality score (with ranges between 0 and 100%) with the maximum 25% bonus.

Conditions

Compliant Behavior; Morbidity;Infant

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Control arm

Providers in control facilities will not receive any additional training or knowledge assessments.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Financial incentive arm

Providers in treatment facilities will be visited once a quarter for a knowledge assessment using vignettes. Facilities performing well in this assessment will receive a quarterly bonus payment, which will be distributed among providers.

Group Type: EXPERIMENTAL

Financially incentivized knowledge assessments

Intervention Type: BEHAVIORAL

We will conduct quarterly provider knowledge assessments at selected health facilities and will pay facilities a financial bonus if providers perform well on these tests. For the intervention, 12 clinical vignettes were created. These vignettes cover typical patient cases such as malaria, diarrhea and respiratory infections, and assess providers' ability to correctly diagnose and treat hypothetical questions. All medical staff members will be informed hat every 3 month there will be a knowledge assessment based on these vignettes and that the results will determine the total bonus payment made to the facility.

Interventions

Financially incentivized knowledge assessments

We will conduct quarterly provider knowledge assessments at selected health facilities and will pay facilities a financial bonus if providers perform well on these tests. For the intervention, 12 clinical vignettes were created. These vignettes cover typical patient cases such as malaria, diarrhea and respiratory infections, and assess providers' ability to correctly diagnose and treat hypothetical questions. All medical staff members will be informed hat every 3 month there will be a knowledge assessment based on these vignettes and that the results will determine the total bonus payment made to the facility.

Intervention Type: BEHAVIORAL

Other Intervention Names

Provider knowledge assessments

Eligibility Criteria

Inclusion Criteria

• all providers working at the 110 facilities selected for the study will be included in the study.

Exclusion Criteria

• none.

• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

World Bank

OTHER

Sponsor Role: collaborator

Swiss Tropical & Public Health Institute

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Gil Shapira, PhD

Role: PRINCIPAL_INVESTIGATOR

World Bank

Locations

Congo Ministry of Public Health

Kinshasa, , Democratic Republic of the Congo

Swiss Tropical and Public Health Institute

Basel, Canton of Basel-City, Switzerland

Countries

Democratic Republic of the Congo; Switzerland

References

Fink G, Fritsche G, Samaha H, Sese C, Shapira G. Financially incentivized knowledge assessments to improve provider compliance with treatment guidelines: a cluster-randomized controlled trial. Trials. 2022 Mar 21;23(1):227. doi: 10.1186/s13063-022-06129-8.

Reference Type: DERIVED

PMID: 35313932 (View on PubMed)

Other Identifiers

IncentLearn

Identifier Type: -

Identifier Source: org_study_id