Improved Access to Quality Care and Healthcare Use

NCT ID: NCT06275867

Last Updated: 2024-10-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-01-20

Study Completion Date

2024-08-30

Brief Summary

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This study is an individual-level randomised controlled trial which looks at the effect of providing free access to higher quality providers in urban South Africa. The study will recruit about 1,500 individuals with a child aged 5 or under. They will be randomly allocate to a control group (CONTROL) with the default free access to government facilities or one of the two treatment groups where they will have free access to private providers located either relatively close (CONVENIENT) by or relatively far (INCONVENIENT). The primary outcomes be overuse and underuse of healthcare services for children under 5

Detailed Description

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In many low-income settings, provision of social services by the public sector is plagued by problems of quality and low accountability to users. As a result, low expected benefits or fear of neglect by service providers may delay the use of needed services, even when those are free.

In South Africa, the health system is characterised by stark inequalities, with most of the population only able to seek care in free government facilities. The low quality of the public sector, where patients wait long times to be seen by nurses, is believed to lead many to delay needed care and prevent health outcome improvement. The government of South Africa is developing proposals to introduce a national health insurance scheme that would provide free access to private providers who deliver higher care quality. However, concerns about the unequal geographical distribution of private providers raise questions about the potential benefits of the reform. This study asks several questions to inform this reform:

1. Does access to higher-quality care reduce under-use of services for children but also increase overuse?
2. Does access to higher-quality care lead to improved health knowledge of parents and better health outcomes for children?
3. Are these effects mitigated by the distance to the contracted providers? A randomised controlled trial is used to answer these questions. The study will recruit about 1,500 individuals who are the primary caregiver of at least one child aged six or under. and randomly allocate them to a control group (CONTROL) with the default free access to government facilities or one of the two treatment groups where they will have free access to private providers located either relatively close (CONVENIENT) by or relatively far (INCONVENIENT).

The primary outcomes will be the proportion of visits that are considered unnecessary (overuse) and the number of days of illness where care-seeking is recommended by guidelines but not sought by the child's parent or guardian.

Secondary outcomes will include (1) the number of days with ill-health symptoms; (2) out-of-pocket expenditures; (3) health knowledge of parents; (4) subjective and (5) objective measures of child's health.

Conditions

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Health Care Utilization Health Knowledge, Attitudes, Practice Health, Subjective

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Caregivers

Study Groups

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Control group

In this group, participants will have free access to government facilities (usual care)

Group Type NO_INTERVENTION

No interventions assigned to this group

Convenient group

In this group, for the duration of the study, participants will be given free access to a small number of private providers located relatively close by (less than 30 minutes).

Group Type EXPERIMENTAL

Free high-quality care

Intervention Type OTHER

Participants are able to take their child to receive free consultations and treatment in a network of contracted private healthcare providers.

Close distance

Intervention Type OTHER

The network of contracted providers is located close to where participants live.

Inconvenient group

In this group, for the duration of the study, participants will be given free access to a small number of private providers located relatively far (about one hour).

Group Type EXPERIMENTAL

Free high-quality care

Intervention Type OTHER

Participants are able to take their child to receive free consultations and treatment in a network of contracted private healthcare providers.

Far distance

Intervention Type OTHER

The network of contracted providers is located far to where participants live.

Interventions

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Free high-quality care

Participants are able to take their child to receive free consultations and treatment in a network of contracted private healthcare providers.

Intervention Type OTHER

Close distance

The network of contracted providers is located close to where participants live.

Intervention Type OTHER

Far distance

The network of contracted providers is located far to where participants live.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* parent has a child aged under 6 years old and over 2 months old

Exclusion Criteria

* is planning to move out of the area in the next 3 months
* has private medical aid
Minimum Eligible Age

2 Months

Maximum Eligible Age

6 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Witwatersrand, South Africa

OTHER

Sponsor Role collaborator

London School of Economics and Political Science

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mylene Lagarde, PhD

Role: PRINCIPAL_INVESTIGATOR

London School of Economics and Political Science

Locations

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HDSS Soweto clusters

Soweto, Gauteng, South Africa

Site Status

Countries

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South Africa

Other Identifiers

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SOPRIMA//T023635

Identifier Type: -

Identifier Source: org_study_id

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