Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial

Abstract

Objectives To test the impact of provider performance pay for anaemia reduction in rural China.Design A cluster randomised trial of information, subsidies, and incentives for school principals to reduce anaemia among their students. Enumerators and study participants were not informed of study arm assignment.Setting 72 randomly selected rural primary schools across northwest China.Participants 3553 fourth and fifth grade students aged 9-11 years. All fourth and fifth grade students in sample schools participated in the study.Interventions Sample schools were randomly assigned to a control group, with no intervention, or one of three treatment arms: (a) an information arm, in which principals received information about anaemia; (b) a subsidy arm, in which principals received information and unconditional subsidies; and (c) an incentive arm, in which principals received information, subsidies, and financial incentives for reducing anaemia among students. Twenty seven schools were assigned to the control arm (1816 students at baseline, 1623 at end point), 15 were assigned to the information arm (659 students at baseline, 596 at end point), 15 to the subsidy arm (726 students at baseline, 667 at end point), and 15 to the incentive arm (743 students at baseline, 667 at end point). Main outcome measures Student haemoglobin concentrations.Results Mean student haemoglobin concentration rose by 1.5 g/L (95% CI -1.1 to 4.1) in information schools, 0.8 g/L (-1.8 to 3.3) in subsidy schools, and 2.4 g/L (0 to 4.9) in incentive schools compared with the control group. This increase in haemoglobin corresponded to a reduction in prevalence of anaemia (Hb <115 g/L) of 24% in incentive schools. Interactions with pre-existing incentives for principals to achieve good academic performance led to substantially larger gains in the information and incentive arms: when combined with incentives for good academic performance, associated effects on student haemoglobin concentration were 9.8 g/L (4.1 to 15.5) larger in information schools and 8.6 g/L (2.1 to 15.1) larger in incentive schools.Conclusions Financial incentives for health improvement were modestly effective. Understanding interactions with other motives and pre-existing incentives is critical.Trial registration number ISRCTN76158086.

Pagos por desempeño para mejorar estado nutricional infantil: impacto de los convenios de apoyo presupuestario en tres regiones peruanas con alta prevalencia de desnutrición cronica infantil, 2010-2014

“…Según Miller y Singer (14) , su aplicación a los sistemas de salud a los países de ingreso medio y bajo se ha extendido durante los últimos quince años. En América Latina, Argentina (12) y Nicaragua (15) han implementado esquemas para mejorar la calidad y acceso de servicios de salud materno infantil, y a nivel mundial, en Ruanda (13) , China (16) India (17) , entre otros.…”

Cultura alimentaria: clave para el diseño de estrategias de mejoramiento nutricional de poblaciones rurales

“…Cada uno aborda problemas particulares; no obstante, el objetivo primordial es la seguridad alimentaria (Godfray et al, 2010). Su creación se da por diversas razones: controlar o reducir un problema en aumento, cumplir una política pública, evidenciar el gasto pú-blico, entre otras (Miller et al, 2012;Mishra et al, 2013). La causa por la que se crean dichos programas define el impacto sobre la población objetivo, así como en la metodología empleada para el diseño e implementación del programa.…”

“…La cultura alimentaria se puede conocer a través de un diagnóstico situacional, el cual es una etapa básica en primordial objective is food security (Godfray et al, 2010). Their creation takes place because of various reasons: to control or reduce an increasing problem, to fulfill a public policy, to evidence public spending, among others (Miller et al, 2012;Mishra et al, 2013). The reason why these programs are created defines the impact on the target population, as well as the methodology employed for the design and implementation of the program.…”

Intertemporal deprivation in rural china: income and nutrition

“…We also replaced linear intensification and mitigation effects (α = β = ϕ = 1) with an increased 31 It is notable that although nutritional poverty-reducing in the long-term, longer distance to the primary school is likely to raise intertemporal nutritional poverty in the short-term, reflected by significantly positive estimates of initial distance to primary schools in Columns 6-8 of Table 2 and 4-6 of Table 3. This may be ascribable to low quality of school meals and misaligned incentives of school heads to supply nutrition-rich and healthy diets in rural China, as cited before in Kleiman-Weiner et al (2012), Luo et al (2011) andMiller et al (2012). influence of both households' past poor and past affluent experiences (α = β = 2; ϕ = 1). These results are reported in Columns (2)-(3) and (6)-(7) of Table 4.…”

“…This may be understandable, considering that more initial human capital, especially primary education, promotes income growth for Chinese rural households in lagging regions (e.g., Sato, 2010;Song, 2012), which is in turn associated with a dietary shift towards low total calorie intake and unhealthier food consumption through a negative income effect (e.g., Du et al 2004). Moreover, insufficient diets and micronutrient supplementation, unsatisfactory or even non-existent catering infrastructure in rural schools, and misaligned supply-side incentives for health improvement programmes in rural China have been widely criticised as resulting in high prevalence of malnutrition among rural students (e.g., Kleiman-Weiner et al 2012;Luo et al 2011;Miller et al 2012), undermining human capital formation and resulting in undernutrition during adulthood.…”