Improved Access to Quality Care and Healthcare Use

Health Knowledge, Attitudes, Practice Clinical Trial

Official title:

The Impact of Access to Higher-quality Care Services on Health-seeking Patterns

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06275867
• Other study ID #: SOPRIMA//T023635
• Status: Recruiting
• Phase: N/A
• Start date: January 20, 2024
• Est. completion date: August 30, 2024

Study information

• Verified date: February 2024
• Source: London School of Economics and Political Science
• Contact: Mylene Lagarde, PhD
• Phone: +447595911011
• Email: M.Lagarde[@]lse.ac.uk
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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

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 information / eligibility

• Status: Recruiting
• Enrollment: 1500
• Est. completion date: August 30, 2024
• Est. primary completion date: June 10, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 2 Months to 6 Years

Eligibility

Inclusion Criteria:

• parent has a child aged under 6 years old and over 2 months old

Exclusion Criteria:

• is planning to move out of the area in the next 3 months

• has private medical aid

Related Conditions & MeSH terms

• Health Care Utilization
• Health Knowledge, Attitudes, Practice
• Health, Subjective

Intervention

Other:
• Free high-quality care
Participants are able to take their child to receive free consultations and treatment in a network of contracted private healthcare providers.
• Close distance
The network of contracted providers is located close to where participants live.
• Far distance
The network of contracted providers is located far to where participants live.

Locations

Country	Name	City	State
South Africa	HDSS Soweto clusters	Soweto	Gauteng

Sponsors (2)

Lead Sponsor	Collaborator
London School of Economics and Political Science	University of Witwatersrand, South Africa

Country where clinical trial is conducted

South Africa, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Underuse	number of days of illness where care-seeking is recommended by guidelines but not sought by the child's parent or guardian	12 weeks
Primary	Overuse	proportion of primary health care visits that are considered unnecessary	12 weeks
Secondary	Illness duration	number of days with ill-health symptoms	12 weeks
Secondary	Out-of-pocket expenditures	Direct (consultations, drugs) and indirect (transport) expenditures spent on health care	12 weeks
Secondary	Health knowledge	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.	Endline survey (i.e. 12 weeks approximately after the start of the intervention)