Clinical trial NCT06275867: Improved Access to Quality Care and Healthcare Use
Official title: The Impact of Access to Higher-quality Care Services on Health-seeking Patterns
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Health Care Utilization
Health Knowledge, Attitudes, Practice
Health, Subjective
Lead sponsor: London School of Economics and Political Science
Sponsor class: OTHER
Collaborators: name: University of Witwatersrand, South Africa
First posted: 2024-02-23
Enrollment: 1500
Sex: ALL
Minimum age (years): 2
Maximum age (years): 6
Standard ages: CHILD
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

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.

Eligibility criteria: 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

Primary outcomes:
measure: Underuse
timeFrame: 12 weeks
measure: Overuse
timeFrame: 12 weeks
Secondary outcomes:
measure: Illness duration
timeFrame: 12 weeks
measure: Out-of-pocket expenditures
timeFrame: 12 weeks
measure: Health knowledge
timeFrame: Endline survey (i.e. 12 weeks approximately after the start of the intervention)
Other outcomes:
Locations:
city: Soweto
country: South Africa
facility: HDSS Soweto clusters
state: Gauteng
Study officials:
affiliation: London School of Economics and Political Science
name: Mylene Lagarde, PhD
role: PRINCIPAL_INVESTIGATOR
References: