One of the targets of our project; a pregnant woman near Lake Victoria, Kenya. Photo courtesy of Luciano Rizzello via flickr
Salamu sana! It wouldn’t be a good week on the project without learning a few hard lessons, and we have certainly had a good week! We have managed to meet with lots of potential partners, trying to find out where the best synergies and expertise lies. There have been some good connections made and once our agreements have been put in place we will be able to announce which organisations will be partnering with us locally. For those of you who don’t work in this area, local partners are essential for implementing a project such as this. They possess the knowledge, personnel and contacts necessary to actually do the work on the ground. We, as researchers based in Sweden are ‘out of the loop’ somewhat. The last thing we want to do is impose with our cultural values and risk losing the essence of the information we are trying to find out in a cloud of misunderstanding!
So why was this week so good? Well we realised that the value of our credits is way to high for the communities we will be working in. So much so that what we see as a good thing (as cash payment) may actually end up causing more problems than it solves. We received this comment from several angles so have decided to revisit the payments and reduce them to a level where they still represent an incentive, but don’t become the source of conflict. The good thing about this is that it might enable us to increase the amount of pregnant women we are able to include in this pilot phase.
The next big challenge for us is the ethics approval. Not that we are worried about our ethics, only that the ethics form is about 40 pages long, and the approval process can take up to 3 months. That would be a disaster for the project because no work can be started before we have been signed off. So cross your fingers and hope we get a bit of luck in getting it processed quickly.
Over the last week the Afya credit team have been getting prepared for the first trip out to Kisumu, Kenya. Trying to source ethically sound t-shirts isn’t such a simple task so we brought in our friend Miriam to help. We also had to go all the way to the US to find a supplier who could print the Afya credits themselves (see below). Each card has two numbers; an ID number and a secret number hidden behind a scratch-off panel. The second of these sets of numbers is very important because this is how we verify whether a card is genuine and due a payment or not, so its important we don’t make any mistakes with it. So to check, we have test-scratched a few cards and we are happy to say, no problems!The next part of the planning will be in and around Kisumu itself. Our task is to connect with local partners who can assist with the challenging task of recruiting and monitoring the participants. Its vital to the success of the scheme that we follow them and try to understand what makes them attend appointments. If they don’t come back then equally, we want to know why.
Matthew Fielding and Caroline Ochieng show off the printed cards and t-shirts for the project pilot launch
The project aims to test whether well-designed and targeted financial incentives can succeed in changing hard-to-change behaviours; in this case using maternal, newborn and child health (MNCH) services. The project has been developed in response to Bill and Melinda Gates Foundation’s “Grand Challenges in Global Health”, under the topic of “inciting healthy behaviours”.
In developing countries, many women give birth at home and rarely see a trained healthcare provider before or after the baby’s birth. This is true even when the health facilities are close to where the women live. Approximately 50 percent of newborn deaths occur on the first day of life; most of these are preventable if women attend clinics and give birth at health facilities. In this Explorations-phase project, we will test the role of cash incentives in overcoming the complex barriers to MNCH attendance and in sustaining a change towards health-seeking behaviour in the study population.
While the pilot focuses on MNCH services, the underlying concept is replicable to several other fields, including work on cookstoves and sanitation, where technologies for reducing health burdens exist but people do not use them.