Development in health and sanitation is one of the key areas which are crucial for economic growth. However, in developing countries like India the health indicators, especially immunization is lower than the required rates. It is in this context that the study by Abhijit Banerjee, Esther Duflo, Rachel Glennester, and Dhruva Kothari looks at the efficiency of incentive-based interventions in the health sector in order to increase the immunization rates.
In order to understand the same, the authors conducted a clustered randomized controlled trial of immunization camps in rural Rajasthan to assess the efficiency of modest, non-financial incentives on immunization rates of children between the age group 1 to 3, and compared it with the effect of improving the reliability of the supply of services (Banerjee et al., 1). The authors justify the usage of cluster level design as randomization at the individual level could have generated dislike against the non-governmental organization (Banerjee et al., 2).
The study was designed such that 134 villages in Udaipur, Rajasthan was randomly selected from Seva Mandir (the partner NGO) catchment area and divided into 3 categories using random sample generated in STATA. (Banerjee et al., 2) The categorization included: Intervention A – with 479 children from 30 villages who had a once a month reliable immunization camps that is regular and well-publicized, Intervention B – with 382 children from 30 villages who had once a month reliable immunization camp like Intervention A but in addition received small incentives like raw lentils and metal plates for completed immunization, and a control group with 860 children from 74 villages who did not have any interventions. (Banerjee et al., 1) In order to account for the possible leakage of the interventions, the authors also note that one village was randomly selected within 6 kilometres of each village within the intervention group. (Banerjee et al., 2)
In the surveys that were conducted in the randomly selected households at baseline (before intervention) and approximately 18 months after at the endline (after invention). At the endline, the key measure of outcome was the percentage of children between the age group 1-3 who were partially or completely immunized (Banerjee et al., 3). Using the statistical method of intention to treat analysis where every household is analyzed with the assumption that they remained in the treatment group to which they were initially assigned, the authors reported the values in the treatment group, difference across groups, and relative risk for the number of immunization (Banerjee et al., 4)
Analyzing the results of the 1640 children between the age group 1-3 at the endline, it is found that the rates of complete immunization stood at 39% in villages that received intervention B as opposed to 18% in villages which received intervention A and 6% in villages which received no intervention. In addition, the relative risk of complete immunization for Intervention B versus control group was 6.7 and for intervention B versus intervention, A was 2.2. It was also observed that children in areas close to the villages that received intervention B were also more likely to be completely immunized than those villages that were closer to the villages with intervention A (Banerjee et al., 1)
Therefore, from the results, it can be concluded that improving the dependability of services improves immunization rates. What’s more, modest (small-scale) non-financial incentives have a larger positive impact on the people in the rural areas by driving them to use the immunization services on a regular basis (Banerjee et al., 1). However, the authors suggest that in order to improve immunization and health sector as a whole, providing incentives is necessary but not sufficient. Apart from the supply of services, it is also required that we find effective methods to address other issues such as education that act as a barrier to the improvement of the healthcare. This will ensure that more people are able to access and use preventive health care thereby leading to larger positive impact on immunization rates. (Banerjee et al., 8)