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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 to enable us to keep a constant pulse on our program impact and cost-effectiveness throughout our scale-up.
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.
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.
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 1-4. The findings shared here are based on IDinsight’s analysis.
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 19 percentage points, Penta 1 by 21 percentage points, and Measles 1 by 16 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
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 21 percentage points after the program was rolled out.
Coverage of vaccines was higher for females at baseline (before program rollout); however, at the first follow-up surveys (after program rollout), coverage was higher among males.
Additionally, the change in vaccination coverage between baseline and first follow-up surveys was consistently higher for male children.
This data is useful as we seek to bridge the gap 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 no that groups are being left behind.
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.
The number of caregivers who reported a lack of knowledge about the schedule or location of vaccination services as the reason for missing out on vaccines went down at the first follow-up surveys.
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 two respondents at both baseline (before program rollout) and 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.
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.
