Impact Evaluation of Triggerise's Tiko Platform
Condition: Contraception; Iron Deficiency Anemia of Pregnancy; Antenatal Care; Postnatal Care
MeSH terms: Anemia, Iron-Deficiency; Iron Deficiencies
Study type: Interventional

Summary: 
      Triggerise designed web and phone based Tiko platform to connect young girls and women to the
      health products, services and information. The platform uses principles of behaviour
      economics to motivate positive choices-including rewards, promotions, discounts, coupons,
      reminders, alerts etc. The platform was implemented in several cities from seven states of
      India to provide Sexual Reproductive Health (SRH) and maternal and child health (MCH)
      products and services. The consumers (called Rafikis) use Tiko card to get discounts and to
      earn 'Tiko miles' rewards at Tiko franchised healthcare providers and pharmacies. Tiko miles
      are redeemable towards lifestyle products or services (e.g., beauty salons). The local Tiko
      health promoter (celled Pro agent) can also buy health and hygiene products at bulk discounts
      and sell them at profit.

      Triggerise appointed Network for Engineering, Economics Research and Management (NEERMAN) to
      conduct an independent impact assessment of the Tiko platform with multiple research
      objectives include health impact evaluation at the Rafiki level.

      NEERMAN used an ex-post observational design to compare usage of SRH and MCH services and
      family planning (FP), antenatal care (ANC) and postnatal care (PNC) practices by comparing
      Users and Non-Users of Tiko platform, and accounting for the selection bias statistically.
      The structured questionnaire collected data on knowledge, practices, barriers, enablers for
      SRH and MCH services, exposure o Tiko platform, and how it helped or did not help. The survey
      participants were approx. 1200 users and 600 non-users being served by approx. 350 pro-agents
      in their respective operations area.

      The association between use of Tiko platform and various outcomes were identified using a
      generalized linear model with fixed effects at pro-agent level and including a set of
      covariates. To evaluate the effect modification by type of pro agent - government community
      health worker (CHW) versus others - an interaction model was used. The standard errors were
      automatically clustered at pro-agent level due to fixed effects. Primary outcomes are
      proportion of married Rafikis currently using any contraceptives, currently using modern
      short-term contraceptives, proportion of Rafikis who delivered a child post Jan 2019 and
      received at least 4 ANC check-ups, consumed at least 100 iron folic acid (IFA( during
      pregnancy, and received a PNC check-up within 6 weeks of birth.
    

Detailed description: 
      See subsequent sections
    

Intervention name(s): Tiko Platform Behavioural cum mHealth Intervention; Standard of Care / Business as Usual
Intervention type(s): Behavioral; Other
Intervention description(s): Tiko platform is a mix of social franchising and social marketing concepts to promote health behaviours through rewards to health promoters (pro agents), healthcare providers (doctors and pharmacies), Beneficiaries (women needing FP and/or ANC services), and shop keepers and life-style service providers where beneficiaries, providers and promoters could use their rewards points. The health promoters could purchase from wholesale retailers products such as sanitary napkins, condoms and then resale these at profit. Beneficiaries were given discounts and their rewards points can be used as cash to avail certain lifestyle services at participating locations, and so did the health care providers. Pro agents also got incentives for recruiting the beneficiaries and after beneficiaries reached certain service access/use milestones. All this was integrated on a mHealth platform using smart phones and smart cards (for those without access to Tiko card).; Non-Users of Tiko did not use Tiko platform but they could access any health care provider or pharmacy to avail same services related to Family planning, antenatal care, postnatal care
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: The study compares family planning, antenatal care and postnatal care related outcomes (multiple) for women who had registered on Tiko Platform between those who used the platform and those who did not access any services on the platform. The comparison is done ex-post with a single cross sectional survey in March-April 2021. Model uses fixed effects at Pro-Agent level who is a local health promoter of a small geographical area and recruits and serves women in that area so that confounders at agent and levels beyond are controlled. For women/household level confounder control, a few socio-economic and demographic variables at the woman level were included in the model, and sensitivity of the results with and without adjusting for these control variables was investigated.
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: mHealth; Social Franchising; Social Marketing; Impact Evaluation; Market-Driven; Family Planning; Antenatal Care; Community Health Workers