Fighting Tuberculosis through Community Based Counselors: A Randomized Evaluation of Performance Based Incentives

The study aims to evaluate the effectiveness of offering outcome-based monetary incentives to community DOTS (Directly Observed Treatment, Short-course) counselors. The research also seeks to determine if the impact of incentives varies based on characteristics of the counselors, the area of their operation, and patient characteristics. The study uses a randomized evaluation approach, where counselors are randomly allocated to either a fixed salary or financial incentives. The incentives are designed to encourage the detection of new patients and penalize health workers for defaults. The study will assess the impact of incentives on counselor performance, motivation, and job satisfaction, as well as the quality and scope of care and service delivery. The study will collect data from both health workers and patients through surveys and public data recorded in TB registers. The data will be collected at various points, including entry and endline surveys, midline surveys, and ongoing data collection on counselor performance and patient outcomes. The study will also assess the cost-effectiveness of the interventions by comparing the cost of providing incentives with their impact on detections and defaults. The cost-effectiveness calculation will be straightforward, as the cost of providing incentives is a variable cost determined by the number of additional detections or reduced defaults. The study is ongoing in two districts of Chhattisgarh, where six Field Extension Workers have been successfully randomized and enrolled in the study. The counselors are about to complete their fourth month of randomization, and preparations are underway for the transition to the default phase of the study. The study team has also conducted scoping visits to North Chhattisgarh and has established an operational plan with Care and their partner organizations for salary and incentives verification and disbursement. The study has faced significant delays in other aspects of the study, including the expansion of the project to the districts in the North of Chhattisgarh and the initiation of patient surveys. However, the study team is working to address these delays and ensure the successful completion of the study. The study's principal investigators are Thomas Bossuroy (World Bank), Clara Delavallade (IFPRI), and Vincent Pons (MIT), and the study is funded by a USAID fixed obligated grant (AID-OAA-G12-00010). The study's milestone #5 is July 2013, and the current status of the study is ongoing in Chhattisgarh.