Effects of team-based goals and non-monetary incentives on front-line health worker performance and maternal health behaviours: a cluster randomised controlled trial in Bihar, India
Autor: | Usha Kiran Tarigopula, Debarshi Bhattacharya, Anu Rangarajan, Hina Raheel, Gary L. Darmstadt, Shamik Trehan, Sridhar Srikantiah, Sunil Mohanty, Dana Rotz, Indrajit Chaudhuri, Evan Borkum, Anita Sivasankaran, Yamini Atmavilas, Swetha Sridharan, Kala M. Mehta, Wolfgang Munar, Rajani Kaimal, Yingjie Weng, Suzan L. Carmichael, Tanmay Mahapatra |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
coordination media_common.quotation_subject 03 medical and health sciences community health worker primary healthcare 0302 clinical medicine Intervention (counseling) medicine 030212 general & internal medicine Cluster randomised controlled trial performance-based incentives media_common Receipt Teamwork 030503 health policy & services Health Policy Research Public Health Environmental and Occupational Health Incentive Family planning Family medicine Community health teamwork 0305 other medical science Psychology Breast feeding |
Zdroj: | BMJ Global Health |
ISSN: | 2059-7908 |
Popis: | IntroductionWe evaluated the impact of a ‘Team-Based Goals and Incentives’ (TBGI) intervention in Bihar, India, designed to improve front-line (community health) worker (FLW) performance and health-promoting behaviours related to reproductive, maternal, newborn and child health and nutrition.MethodsThis study used a cluster randomised controlled trial design and difference-in-difference analyses of improvements in maternal health-related behaviours related to the intervention’s team-based goals (primary), and interactions of FLWs with each other and with maternal beneficiaries (secondary). Evaluation participants included approximately 1300 FLWs and 3600 mothers at baseline (May to June 2012) and after 2.5 years of implementation (November to December 2014) who had delivered an infant in the previous year.ResultsThe TBGI intervention resulted in significant increases in the frequency of antenatal home visits (15 absolute percentage points (PP), p=0.03) and receipt of iron-folic acid (IFA) tablets (7 PP, p=0.02), but non-significant changes in other health behaviours related to the trial’s goals. Improvements were seen in selected attitudes related to coordination and teamwork among FLWs, and in the provision of advice to beneficiaries (ranging from 8 to 14 PP) related to IFA, cord care, breast feeding, complementary feeding and family planning.ConclusionResults suggest that combining an integrated set of team-based coverage goals and targets, small non-cash incentives for teams who meet targets and team building to motivate FLWs resulted in improvements in FLW coordination and teamwork, and in the quality and quantity of FLW–beneficiary interactions. These improvements represent programmatically meaningful steps towards improving health behaviours and outcomes.Trial registration numberNCT03406221 |
Databáze: | OpenAIRE |
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