Impact evaluation is an invaluable tool for policymakers, program implementers, and funders as they assess the social good of an intervention and the benefits of investing further to scale it up. IDinsight and Hanovia Limited have completed an independent cluster randomized control trial (RCT) to measure the impact of a conditional cash transfer (CCT) program implemented by New Incentives - All Babies Are Equal Initiative (NI-ABAE) in North West Nigeria on childhood immunization coverage. The RCT took place from August 2017 - February 2020 across 167 clinics (84 program clinics and 83 control clinics) in Katsina, Zamfara, and Jigawa States.
The RCT found that NI-ABAE’s CCTs for routine immunizations (RI) program increased immunization coverage for children between 12 and 16 months of age. Children living in the catchment areas of program clinics had 16 percentage points higher coverage of BCG vaccine, 21 percentage points higher coverage of the first dose of Pentavalent vaccine, and 14 percentage points higher coverage of Measles vaccine. Importantly, the percentage of children who were fully immunized (BCG, Penta 1-3, and Measles) in the program areas was 27 percentage points higher than in the control areas. The program generated this impact on top of underlying increases in vaccination coverage that occurred in both control and treatment areas, demonstrating that the NI-ABAE program complemented existing efforts. The RCT also found that the program had improved the timeliness (within 1 month) of the Measles vaccine, optimizing the protection of the vaccine. Additionally, program clinics were more likely to report no or rare stockouts than control clinics, suggesting that the program’s impact may go beyond stimulating vaccine demand to also reduce vaccine supply constraints.
These findings ultimately mean that more children are protected from vaccine-preventable diseases and the threat they pose to life.
The program also had positive effects on other immunization and health outcomes, including coverage for vaccinations not directly incentivized by the program, but that are part of the Nigerian RI schedule and first-time visits to health clinics. Caregivers in the areas where the program operates also had better knowledge of and more favorable attitudes toward immunization as compared to their counterparts not receiving the program. These are promising signs that the NI-ABAE program can help increase demand for routine immunization in the long term, though future research will be needed to confirm this.