Improved Access to Quality Care and Healthcare Use
- Conditions
- Health Care UtilizationHealth Knowledge, Attitudes, PracticeHealth, Subjective
- Interventions
- Other: Free high-quality careOther: Far distanceOther: Close distance
- Registration Number
- NCT06275867
- Lead Sponsor
- London School of Economics and Political Science
- Brief Summary
This study is an individual-level randomised controlled trial which looks at the effect of providing free access to higher quality providers in urban South Africa. The study will recruit about 1,500 individuals with a child aged 5 or under. They will be randomly allocate to a control group (CONTROL) with the default free access to government facilities or one of the two treatment groups where they will have free access to private providers located either relatively close (CONVENIENT) by or relatively far (INCONVENIENT). The primary outcomes be overuse and underuse of healthcare services for children under 5
- Detailed Description
In many low-income settings, provision of social services by the public sector is plagued by problems of quality and low accountability to users. As a result, low expected benefits or fear of neglect by service providers may delay the use of needed services, even when those are free.
In South Africa, the health system is characterised by stark inequalities, with most of the population only able to seek care in free government facilities. The low quality of the public sector, where patients wait long times to be seen by nurses, is believed to lead many to delay needed care and prevent health outcome improvement. The government of South Africa is developing proposals to introduce a national health insurance scheme that would provide free access to private providers who deliver higher care quality. However, concerns about the unequal geographical distribution of private providers raise questions about the potential benefits of the reform. This study asks several questions to inform this reform:
1. Does access to higher-quality care reduce under-use of services for children but also increase overuse?
2. Does access to higher-quality care lead to improved health knowledge of parents and better health outcomes for children?
3. Are these effects mitigated by the distance to the contracted providers? A randomised controlled trial is used to answer these questions. The study will recruit about 1,500 individuals who are the primary caregiver of at least one child aged six or under. and randomly allocate them to a control group (CONTROL) with the default free access to government facilities or one of the two treatment groups where they will have free access to private providers located either relatively close (CONVENIENT) by or relatively far (INCONVENIENT).
The primary outcomes will be the proportion of visits that are considered unnecessary (overuse) and the number of days of illness where care-seeking is recommended by guidelines but not sought by the child's parent or guardian.
Secondary outcomes will include (1) the number of days with ill-health symptoms; (2) out-of-pocket expenditures; (3) health knowledge of parents; (4) subjective and (5) objective measures of child's health.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1500
- parent has a child aged under 6 years old and over 2 months old
- is planning to move out of the area in the next 3 months
- has private medical aid
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Inconvenient group Free high-quality care In this group, for the duration of the study, participants will be given free access to a small number of private providers located relatively far (about one hour). Inconvenient group Far distance In this group, for the duration of the study, participants will be given free access to a small number of private providers located relatively far (about one hour). Convenient group Close distance In this group, for the duration of the study, participants will be given free access to a small number of private providers located relatively close by (less than 30 minutes). Convenient group Free high-quality care In this group, for the duration of the study, participants will be given free access to a small number of private providers located relatively close by (less than 30 minutes).
- Primary Outcome Measures
Name Time Method Underuse 12 weeks number of days of illness where care-seeking is recommended by guidelines but not sought by the child's parent or guardian
Overuse 12 weeks proportion of primary health care visits that are considered unnecessary
- Secondary Outcome Measures
Name Time Method Out-of-pocket expenditures 12 weeks Direct (consultations, drugs) and indirect (transport) expenditures spent on health care
Illness duration 12 weeks number of days with ill-health symptoms
Health knowledge Endline survey (i.e. 12 weeks approximately after the start of the intervention) Index of knowledge of parents in relation to preventive and curative care. Parents will answer as series of knowledge questions relative to care-seeking patterns for children (with correct and incorrect responses). For each individual, a score will be computing by adding up all of the correct responses (1 point per correct response, 0 for incorrect), so a higher score will reflect a better knowledge.
Trial Locations
- Locations (1)
HDSS Soweto clusters
🇿🇦Soweto, Gauteng, South Africa