Table 4 Examples of interventions providing causal pathways

LARGE SCALE INTERVENTIONS

Aggarwal, 2018, Banerjee & Sachdev, 2015

Pradhan Mantri Gram Sadak Yojana

Authors have relied on literature to link access to all-weather roads with lowered transportation costs that could in turn improve access to health services. Provision of roads can also potentially improve health care supply, increase household income, increase awareness, and improve social interaction in the village. All of these factors together can additionally increase usage of preventive health care.

Alatas et al., 2019

When celebrities Speak, Twitter Experiment, Indonesia

The authors posit that hearing information from multiple different sources may be more powerful than hearing it from one person. Further, by linking online behavior to offline beliefs and behavior, authors felt that it is a step towards measuring, albeit in a limited and minimal way, policy impact.

Banerjee et al., 2010

Immunization Camps + Non-monetary incentives, India

The authors posit that by addressing small barriers to vaccination like irregular vaccination camps and costs of accessing vaccination, immunization uptake can be improved. Regular vaccination camps coupled with lentils that serve to provide food and nutrition to families could motivate caregivers to seek vaccination for their children.

Chen, Chindarkar & Xiao, 2019

Jyotigram Yogana - Rural Electrification Program

Authors cite literature in linking access to continuous electricity with receiving health information and utilization of health services and also as a supply-side prerequisite for health facilities to provide safe and good-quality health services.

Cristia et al., 2011, Cristia, Evans, Kim, 2015, Cristia, Prado, Peluffo, 2015

Contracting-out of Services in Guatemala

Authors cite literature on contracting-out and point that access would increase by allowing contractors to compete through results-based management and through strong incentives linking supplier payments to the achievement of predefined targets. The program was expected to surmount two significant barriers -- the lack of adequate transportation system, which generates high costs of seeking care for the poor rural population and information gaps among the target population regarding the medical benefits of the prioritized preventive health measures.

Janssens, 2011

Mahila Samakhya- Womens empowerment program, India

The Mahila Samakhya program was expected to mobilize marginalized women and disseminate information in their community through informal immunization campaigns and daily social interactions.

Kusuma et al., 2017

Kaluarga Harapan CCT, Indonesia

The authors relied on several theoretical pathways on Conditional Cash Transfers (CCT) improving vaccination. They hypothesized that according to the human capital theory, consumers are expected to invest in health if the expected private benefit exceeds the cost. In terms of vaccination, the cash element of CCT was expected to help with financial barriers and the conditionality element might be seen as a way to transfer health information on the benefit of vaccination and signal the importance of vaccination for both households and health workers.

Mohanan et al., 2020

Social Accountability Intervention in India

Social accountability interventions were expected to typically improve vaccine uptake by (a) providing information to community members on services they are entitled to receive; and (b) facilitating citizen engagement with service providers and local officials through community meetings where grievances with service providers or officials might be redressed publicly.

Okoli et al., 2014

CCT- SURE-P Program in Nigria

Pregnant women were thought to be likely to suffer because of user charges for health services or for unofficial payments, out-of-pocket expenditures, and travel costs, due to the expense of obstetric care and the lower financial resources generally available to women. To address these demand-side barriers, the Federal Government of Nigeria introduced a Conditional Cash Transfer for maternal and child health under the SURE-P MCH programme, conditioning regular payments to poor households on use of certain social services.

Pathak & Macours 2016

Womens Reservation in India

Reservation was expected to lead to greater local representation of women, their influence in decision making and in motivating parents to invest in girls.

Talukder et al., 2014

Demand Side Financing - Voucher Scheme in Bangladesh

DSF program was intended to transfer purchasing power to the poor, to allow them to choose services directly from accredited providers, while providers are reimbursed for their services from a special fund. It aimed to improve service utilization by providing financial vouchers that could reduce the transport costs incurred by mothers. It also provided skill training to providers to increase their motivation.

Weldemariam, 2010

Fiscal Decentralization in Ethiopia

The authors cited literature and theories pointing to the link between fiscal decentralization and the government’s ability to make more responsive to the communities’ demand by tailoring levels of consumption to local preferences with an equitable distribution of resources; and to serve as a market preserving device that help to enhance and implement pro-poor policies in far reaching environment, via local empowerment.

Basinga et al., 2011, Sherry et al., 2017

Pay-for-performance for healthcare in Rwanda

The P4P program was expected to supplement allocated budgets with bonus payments to facilities based on their performance on 24 output and quality indicators. P4P schemes provide financial incentives to health-care providers for improvements in utilisation and quality of specifi c care indicators, and can affect the provision of health care in two ways: by giving incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery of services.

Ryman et al., 2011

Reaching Every District (RED), Assam, india

Reaching Every District (RED) approach, is a strategy designed to improve immunization services, by strengthening core sub-national routine vaccination program functions. These include re-establishing outreach services; providing supportive supervision; monitoring and using data for action; improving planning and resource management; and increasing community links with service delivery [3].

SMALL/MEDIUM SCALE INTERVENTIONS

Banwat et al., 2015

Peer Education, Plateau State

Peer educators were used as ‘reminders’ to mothers to keep immunization clinic appointments. They acted as potent motivators to mothers as well since they were well respected members of the community. Postintervention, they were the main source of information on immunization to study subjects.

Busso et al., 2015

Reminders to caregivers

The authors hypothesized that individuals living in poverty must constantly manage limited resources and face difficult trade-offs; these constant preoccupations leave fewer cognitive resources available, which may, in turn, lead to poor decision-making. Simple public interventions, such as providing reminders, could be particularly helpful for individuals living in poverty to make better health decisions.

Dipeolu, 2017

Mobile-Phone Text Message Reminder, Nigeria

The health belief model was used where text message reminders were to serve as cues for action for mothers with children.

Ekhaguere et al., 2019

Automated phone call and text reminders

(PRIMM), Nigeria

With literacy being a limitation in some areas, automated audible reminders in the native languages was expected to provide added benefit to text reminders

Eze & Adeleye, 2015

Automated client Reminder-Recall systems, Nigeria

The authors hypothesized that reminders or recalls for those overdue to ensure that caregivers know the next appointments of their wards or are made aware when they miss appointments as it will help parents who think their vaccinations are up to date, but are either missing routine immunizations outright or confuse them for the periodic supplemental immunization given during National Immunization Days – not knowing that the latter is grossly incomplete.

Habib et al., 2017a

Community engagement and integration with polio vaccination campaign, Pakistan

The authors hypothesised that in polio-endemic areas of Pakistan with poorly functioning routine childhood immunisation systems, a strategy of enhanced community engagement together with the provision of supplementary immunisation activities would enhance overall OPV coverage by enhancing its acceptability in such populations.

Manyazewal et al., 2018

Continuous Quality Improvement Intervention, Ethiopia

A conceptual diagram of PDA cycle was given. This study hypothesized that employing continuous quality improvement (CQI) interventions to assess, improve, and continuously follow-up immunization programme and services is an effective and sustainable approach to achieve Ethiopia’s national immunization improvement plan.

More et al., 2017

Community Resource Centres, Mumbai, India

Community mobilization was aimed to foster peer learning, and engagement with local government was done to improve communication with communities and facilitate outreach.

Nasir et al., 2017

Mother Class Intervention - Indonesia

TOC was not provided but the rationale and impact of the intervention was linked to knowledge and practice by mothers

Powell-Jackson et al., 2018

Immunization Information, UP, india

The intervention design was informed by the theory behind previous research on framing in health, and extensive piloting to test how positively and negatively worded messages affect outcomes

Siddiqi et al., 2020

Vaccine reminder and tracker bracelets in Pakistan

The bracelet was designed with the rationale to motivate parents to make all six visits to the immunization center in order to reach the ‘star’ symbol on the bracelet.

Usman et al., 2011

Redesigned card and Centre based education for mohters in Pakistan

Redesigned card was hypothesized to address two shortcomings of the EPI card – difficulty in reading hand-written immunization date by the EPI staff and Center-based education to enforce a standardized procedure describing how the EPI staff should inform mothers about subsequent immunization visits.

Vaidyanathan, 2019

Information, Education and Communication Strategy, India

IEC strategy on immunization was expected to transfer message provided by a researcher to school students to his/her peers and parents living in his/her household and immediate neighbourhood with children under-5 child.