These results only include cohorts 1-14, 16. Additional survey data will be added at a future date.

What Are Coverage Surveys?

New Incentives collects extensive data to monitor our program as we scale up to reach millions of infants.

Vaccination coverage surveys—also called rapid assessments—are a key component of our monitoring strategy. The surveys take place every six to 12 months to measure the proportion of children in a given geographic area who are vaccinated, along with other related indicators. The findings complement the positive findings we have from the randomized controlled trial of our program and enable us to keep a constant pulse on our program's impact and cost-effectiveness throughout our scale-up.

How Do Coverage Surveys Work?

We first conduct coverage surveys before expanding the program in a new local government area (LGA). We then conduct follow-up surveys approximately six months after operations begin and continue to monitor coverage every six months. New Incentives groups the LGAs it expands to within a given state at a given point in time into cohorts. Households are surveyed on self-reported vaccine coverage, perceptions of vaccines, barriers to vaccination, receipt of incentives, and other household characteristics.

How Do We Use Coverage Survey Data?

Coverage surveys allow us to answer two key questions:

1. Do vaccination coverage levels at follow-up surveys (at least 12 months post-baseline) suggest that New Incentives is achieving a level of success within a cohort that justifies the cost of operations there?

2. Are there specific cohorts that could benefit from greater outreach? We can then use these results to increase awareness efforts, engage stakeholders in developing and implementing solutions for identified gaps, or shift our strategy to target areas that have lower vaccination coverage.

Findings of Coverage Surveys

In 2021, New Incentives engaged IDinsight to design a measurement strategy to collect rigorous and accurate data with which to assess coverage levels over time. New Incentives later engaged IDinsight to analyze data from the baseline and the first follow-ups for cohorts 1-14, 16. The findings shared here are based on IDinsight’s analysis.

There were 5,892 baseline surveys and 6,356 first follow-up surveys conducted for these cohorts.

Change in Vaccination Coverage over Time

The chart below shows the change in vaccination coverage between the baseline surveys (before program rollout) and the first follow-up surveys (approximately 12 months post-baseline). The follow-up surveys took place six months after the rollout of the program. The chart below represents the increase in coverage for BCG, Penta 1, and Measles 1. 

BCG coverage increased by 15 percentage points, Penta 1 by 17 percentage points, and Measles 1 by 12 percentage points after the program was rolled out.

The chart below shows the change in vaccination coverage observed in the coverage surveys as compared to the randomized control trial as well as GiveWell’s estimates at the 12-month follow-up.

“We have set these guesses to be consistent with the coverage increases found in the New Incentives RCT, but expect coverage increases to be lower at earlier follow-up rounds because the New Incentives program won't yet be fully phased in.” - GiveWell

It’s important to note the limitations of these surveys and how they can be used in conjunction with the results from the RCT.

“The vaccine coverage assessments will not have a control group, as the randomized controlled trial (RCT) on which our top charity recommendation for New Incentives is based did, so they constitute lower-quality evidence of impact. We expect to use the newer data in conjunction with the results from the RCT to estimate New Incentives' impact as it expands to new locations and as time passes since the RCT was conducted.” - GiveWell

Change in Vaccination Coverage among Zero-Dose Children

Gavi, WHO, and other global immunization partners are committed to reducing the number of “zero-dose children,” which is defined as a child who has not received any doses of diphtheria-, tetanus-, and pertussis-containing vaccines. In Nigeria’s Routine Immunization Schedule, these are included in the Penta vaccine.

The percentage of zero-dose children decreased by a total of 17 percentage points after the program was rolled out.

Change in Vaccination Coverage by Sex

Sex-specific differences in coverage between baseline and first follow-up were also analyzed. While researchers observed variation by cohort and vaccine, the pooled results across all cohorts indicate the baseline rates of being fully vaccinated were slightly higher for females (25%) than males (22%).

Increases in full vaccination, based on a strict definition, for male and female children from baseline to the first follow-up was the same: an increase of 12 percentage points.

This data is useful as we seek to understand any gaps between female and male children, bringing vaccine equity to all infants in our operating areas. Equipped with this data, we can tailor awareness activities to ensure that all children have equal uptake regardless of their sex and that no groups are being left behind.

Caregiver Perceptions of Vaccines

When asked about the reason for missing one or more vaccines, a fairly high percentage fell into the “Other” or “Don’t know” category. This could indicate that caregivers who miss out on routine immunization visits don’t have a strong rationale for not vaccinating their child. 

Spouses or family members who are hesitant remain an enduring obstacle to overcome.

Caregivers who reported their children received at least one vaccine were asked why they chose to vaccinate their children. The most common answer was “to prevent disease or illness,” with the percentage being slightly higher after the rollout of New Incentives’ program.

The cash incentive was only cited by five respondents at baseline (before program rollout) and six respondents at first follow-up surveys (after program rollout), indicating that the incentive was not the main motivating factor. This suggests that change that is driven by the incentive enables caregivers to act on the positive motivations that already exist. 

Future Updates

We are continuing to conduct baseline surveys in areas we plan to expand to, as well as follow-up surveys in areas where we are currently operating. We will continue to do so to measure the impact of the program on immunization coverage over time and will update this page as additional data is published.