Note: This page summarizes the rationale behind a GiveWell grant to New Incentives. New Incentives staff reviewed this page prior to publication.
In a nutshell
In October 2024, GiveWell recommended a $1.3 million grant to New Incentives to expand its conditional cash transfer program to parts of Niger and Yobe states in Nigeria. This grant, along with $8.6 million in budget surplus, should support operations in these new areas from roughly the end of 2024 through the end of 2027. Prior to this expansion, New Incentives was operating in 9 states in northern Nigeria (Bauchi, Gombe, Jigawa, Kaduna, Kano, Katsina, Kebbi, Sokoto, and Zamfara).
We are recommending the expansion of New Incentives' program into 14 local government areas (LGAs) in Niger and 6 LGAs in Yobe because we expect the program would be highly cost-effective in these areas (9-12x as cost-effective as unconditional cash transfers). The main factors driving high cost-effectiveness in these areas are: low existing vaccination coverage as measured by New Incentives' surveys and moderate to high mortality risk from vaccine-preventable diseases.
Our main reservations are uncertainty in the accuracy of the subnational mortality estimates we use in our model, the risk that introducing cash transfers in these areas may harm future vaccination rates after cash transfers are eventually discontinued, and uncertainty in how to interpret the wide variance in vaccination coverage rates in Niger reported by New Incentives' surveys.
Published: January 2025
Table of Contents
The organization
New Incentives runs a conditional cash transfer program in northern Nigeria that seeks to increase uptake of routine childhood vaccinations through cash transfers, raising public awareness of the benefits of vaccination, and partnering with the government to reduce the frequency of vaccine stockouts. New Incentives is a GiveWell Top Charity. In part, this means that we've directed significant funding to the organization and have seen it operate effectively,1 and we think further grants to New Incentives have a high likelihood of substantial impact (more about our criteria for Top Charities). For more information on New Incentives, including how it works and our qualitative assessment of the organization, see this page.
The intervention
New Incentives provides small cash transfers to caregivers who bring their children in for routine childhood vaccinations. As of July 2024, caregivers are eligible to receive 1,000 naira (about $0.60)2 at each of the six routine immunization visits in Nigeria's routine immunization schedule,3 plus an additional 5,000 naira at the last visit if their child completed the full immunization schedule.4 This brings the total incentive amount to 11,000 naira per caregiver (roughly $7).5
The program operates mainly in government health clinics that partner with New Incentives. Some children are also reached through vaccination outreach efforts targeting communities with particularly low vaccination rates. Clinic staff employed by the government conduct the vaccinations themselves, while New Incentives field officers check children’s eligibility, enroll children into the program, and distribute cash incentives.
New Incentives also conducts awareness-raising activities to increase demand for vaccination and various activities to identify and address bottlenecks in the vaccine supply chain. See our separate review of New Incentives for more details on these activities.
Do conditional cash transfers for vaccination work?
New Incentives' conditional cash transfer program was tested through a randomized controlled trial (RCT) in three states in northwest Nigeria in 2017-2020. That RCT found a 14 to 28 percentage point (pp) increase in the uptake of routine immunizations, ranging from 14pp for receipt of the first dose of the measles vaccine to 28pp for receipt of the third dose of the Pentavalent vaccine (for protection against diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b).6 We discuss these and other results informing our assessment of the cost-effectiveness of New Incentives' program in this technical report.
In brief, the main benefits we model from New Incentives' program are reduced mortality for children under age 5, reduced mortality for older children and adults, and long term income increases from averting disease during a sensitive developmental window in childhood. We also expect some small consumption benefits from receiving the cash incentives themselves. You can see how much of the program's value we attribute to these different benefits in the cost-effectiveness sketch below.
The grant
This $1.3 million grant,7 plus $8.6 million in surplus funding,8 will cover the cost of New Incentives' operations in 20 new local government areas (14 in Niger and 6 in Yobe) from roughly the end of 2024 through the end of 2027.9
Prior to this expansion, New Incentives was operating in 177 LGAs in nine states in northern Nigeria (Bauchi, Gombe, Jigawa, Kaduna, Kano, Katsina, Kebbi, Sokoto, and Zamfara).
Budget for grant activities
The funding for this expansion breaks down as follows:
- $3.5 million10 for Cohort 3211 (Niger)
- $3.1 million12 for Cohort 36 (Niger)
- $3.3 million13 for Cohort 33 (Yobe)
We estimate that New Incentives' cost per child reached, including an adjustment for some children being enrolled in the program more than once, is $18.21. Concretely, that means we would expect this funding to result in:
- 360,846 unique children reached in Niger (from both cohorts 32 & 36), 66,730 of which would not have been vaccinated without the program, and 1,119 deaths averted.
- 180,423 unique children reached in Yobe, 27,023 of which would not have been vaccinated without the program, and 715 deaths averted.
You can see the calculations behind these estimates in our simple cost-effectiveness analysis.
The case for the grant
We are recommending this grant because of:
- High cost-effectiveness: We estimate New Incentives' program would be highly cost-effective (9-12x cash) in these expansion areas. More below.
- Strong track record with expansion: New Incentives has managed expansion well in the past, and we do not have any reason to think that expansion to these new states would go differently.14 This expansion would also be relatively small compared to New Incentives' current scale (New Incentives currently operates in 177 LGAs and this expansion would add 20 more).
- Strong qualitative impression of New Incentives: New Incentives is a GiveWell Top Charity and we have a strong qualitative impression that it continuously aims to improve its program to maximize cost-effectiveness. In addition, we believe we have a fairly strong understanding of how the program works after many years of working with New Incentives, which contributes to our confidence in directing further funding to the program.
Cost-effectiveness
We estimate New Incentives' program would be 9-12x as cost-effective as unconditional cash transfers in the expansion cohorts.15 Intuitively, we believe this is a result of:
- Low existing vaccination coverage: Based on the results of New Incentives' coverage surveys, we estimate vaccination coverage (aggregated across the vaccines included in our analysis) is 56% in the two Niger cohorts and 62% in Yobe. These rates are comparable to those in the other nine states that we've funded, where baseline vaccination coverage ranges from 39% in Sokoto to 69% in Gombe.
- High expected impact from cash incentives: We believe low vaccination rates in northern Nigeria are partly a result of demand side barriers to vaccination (e.g., opportunity costs of taking children to clinics, low perceived benefit of vaccination, etc.). We think New Incentives' program will help address these barriers by providing cash incentives and raising awareness about the benefits of vaccination. Based on the evidence we have reviewed, we estimate the program will increase vaccination rates by 11-13 percentage points in the expansion states (11pp in Yobe and 13pp in Niger).
- Moderate to high mortality rates: Without vaccination, we expect many children in northern Nigeria could die from vaccine-preventable diseases. We estimate unvaccinated children have a 2.7% risk of dying before the age of five from vaccine-preventable diseases in Niger, and a 4% risk in Yobe. This is on the lower end of the mortality rates we estimate for the nine existing states (3.13% - 8.37%), but is still relatively high compared to other countries in the region.16
- High efficacy of routine vaccinations: We believe routine vaccination significantly reduces a child's likelihood of contracting, and dying from, vaccine-preventable diseases. We estimate that the vaccines incentivized by New Incentives' program reduce the risk of contracting the diseases targeted by those vaccines by 46% to 85%, depending on the vaccine, and 56% in aggregate.17 We assume that this reduction in disease incidence results in a similar reduction in associated mortality.18
Taken together, we believe those factors will make New Incentives' program highly cost-effective in Niger and Yobe. A sketch of our cost-effectiveness analysis for this grant is below. You can find the full version here.
Niger - cohorts 32 & 36 |
Yobe | |
---|---|---|
Grant size | $6,571,936 | $3,285,966 |
Under-five mortality benefits | ||
Cost per child reached | $18.21 | $18.21 |
Proportion of reached children who would be vaccinated in the absence of the program | 82% | 85% |
Number of additional children vaccinated as a result of the program | 66,730 | 27,023 |
Probability that an unvaccinated child will die of vaccine-preventable causes before age 5 | 2.73% | 3.99% |
Effect of vaccination on under-five deaths attributable to vaccine-preventable disease | 53% | 56% |
Number of deaths averted before age five | 962 | 602 |
Initial cost-effectiveness estimate | ||
Cost per under-five death averted | $6,833 | $5,459 |
Moral weight of averting the death of a person under age five | 116 | 116 |
Initial cost-effectiveness in terms of multiples of GiveDirectly's unconditional cash transfer program19 | 5.1 | 6.3 |
Adjustments for other benefits | ||
Adjustment to account for mortalities averted after age 5 | 25% | 24% |
Adjustment to account for developmental benefits (long-term income increases) | 27% | 27% |
Adjustment to account for consumption benefits | 9% | 7% |
Percentage of program impact coming from different benefits | ||
Mortalities averted before age five | 58% | 59% |
Mortalities averted after age five | 14% | 14% |
Developmental benefits (long-term income increases) | 19% | 20% |
Consumption benefits | 8% | 7% |
Additional adjustments | ||
Adjustment for additional program benefits and downsides | 50% | 50% |
Adjustment for potential negative post-program effects We apply this adjustment only to prospective new states, not to existing states |
-11% | -11% |
Adjustment for grantee-level factors | -7% | -7% |
Adjustment for leverage | -9% | -6% |
Adjustment for funging | -9% | -9% |
Final cost-effectiveness estimate | ||
Final cost-effectiveness in terms of multiples of GiveDirectly's unconditional cash transfer program | 9.3 | 11.8 |
Final cost per life saved | $5,870 | $4,593 |
Risks and reservations
Our main reservations about this grant are:
- Uncertainty in subnational mortality estimates: Our cost-effectiveness analysis estimates that vaccine-preventable mortality among unvaccinated children differs a lot between states in Nigeria: from <1% under-5 mortality from vaccine-preventable diseases in six states to >5% in 5 states. Our model is quite sensitive to these figures. These estimates come from the Institute for Health Metrics and Evaluation's Global Burden of Disease Project (GBD), and GBD has to rely on quite sparse information about causes of death. We expect that a significant portion of the variation in GBD's estimates of subnational mortality rates reflects statistical noise, rather than real differences across states. We discuss these uncertainties in more detail in this section of our New Incentives' technical report. At the time of this writing, we are exploring updating our subnational mortality estimates by cross-referencing our existing estimates against other data sources. This work is still in progress, but we have not held off on approving this grant because we do not want to further delay expansion and we ultimately do not think this work would change our grant decision (our current best guess is that this update would slightly increase cost-effectiveness in Niger and Yobe).
- Potential negative post-program effects: We think it's possible that New Incentives' program could decrease caregivers' intrinsic motivation for getting their children vaccinated by shifting their motivation towards receiving the cash incentives, or cause long-term negative effects on vaccination rates through other means (e.g. by reducing trust in the healthcare system). By approving expansion to additional areas and exposing more caregivers to cash incentives, we run the risk that encouraging vaccination through cash incentives now will result in lower vaccination rates in these areas after cash incentives are discontinued.20 We include the potential for this negative post program effect in our cost-effectiveness analysis (by applying a -11% adjustment for the expansion cohorts21 ), but ultimately have concluded that in these areas the benefits of increased vaccination while the program operates are large enough that the potential for some decrease in vaccination rates after incentives are discontinued does not bring them below our funding bar. We discuss how we calculate this adjustment in this section of our New Incentives' technical report. Note that we think it is also possible that the converse would occur, and high vaccination rates could be sustained after New Incentives phases out cash incentives as a result of the program's efforts to increase awareness of the importance of vaccination. In late 2024-early 2025, we plan to discuss with New Incentives its plans for phasing-out the program if GiveWell and other funders do not renew funding for some locations in the future, and may update our adjustment for post program effects as a result.
- Wide variation in reported vaccination rates in Niger: We are recommending expansion to two out of three surveyed cohorts in Niger, as we estimate the cost-effectiveness of New Incentives' program would be 9.3x across cohorts 32 & 36 but only 5.6x in cohort 34. This difference comes down to a difference in the baseline vaccination rates measured during New Incentives' coverage surveys (with cohort 34 having markedly higher vaccination rates than the other two cohorts that New Incentives surveyed).22 For example, there is a gap of 19 percentage points in vaccination rates for BCG and 26pp for Penta 2 between the cohort with the highest reported coverage (cohort 34) and the cohort with the lowest (cohort 32). In Yobe state, the difference between the two surveyed cohorts is only 5pp for BCG and 8pp for Penta 2.23 Although we generally believe New Incentives' surveys are high quality, we find the wide variance in reported vaccination coverage in Niger to be surprising. If this difference is a result of errors in the surveys, rather than real differences on the ground, it's possible that we may be overestimating the cost-effectiveness of this expansion (if true vaccination rates are closer to cohort 34's results than either cohort 32 or cohort 36's).
We asked New Incentives and local officials in Niger about qualitative differences between the Niger cohorts that might explain the variation in vaccination rates, and we think there are plausible reasons why coverage might vary by a large amount across the state.24 Overall, we are confident enough in the quality of New Incentives' surveys that we consider it unlikely that the expansion in Niger would be below our funding bar of 8x based on true vaccination rates.
- Potentially crowded landscape for immunization incentives in Yobe: We're recommending expansion to only one cohort in Yobe (cohort 33) despite both surveyed cohorts looking cost-effective because we've learned of an RCT of nutritional incentives for immunization being conducted in the other cohort (cohort 35).25 We are not recommending New Incentives expand to that cohort due to a possibly lower need for cash incentives for immunization if caregivers are being incentivized already with nutritional incentives,26 and to avoid disrupting the RCT outcomes. We are recommending expansion to cohort 33 because we think it is far enough away from cohort 35 to avoid spillover.27 However, having New Incentives operate in one part of the state while a nutritional incentives RCT is operating in another part of the state could have downsides that we don't have much visibility into (e.g. possible coordination challenges for local stakeholders). We spoke with ALIMA, the implementing organization for the NutriVax RCT, about this risk and it did not express concerns about New Incentives operating in cohort 33 (but noted it would have been concerned about spillover in cohort 35). We believe ALIMA would have communicated any concerns if it had them, so we are not viewing spillover or coordination challenges as a major risk of this expansion. We plan to follow up with ALIMA a few months into New Incentives' expansion to check whether our assumptions about limited spillover have held true. We also plan to ask New Incentives during our routine monthly check-ins about the progress of the Yobe expansion and any differences it notes in program implementation or caregiver perceptions of the program in that state in particular.
Plans for follow up
We plan to regularly check in on the progress of New Incentives' expansion through our monthly calls and New Incentives' written program updates. Our monitoring plans for the program at large, including specific questions we plan to ask New Incentives and indicators of program quality that we will be checking over the course of the year, are recorded in this follow up plans spreadsheet.
We also plan to reach out to ALIMA again a few months into New incentives' expansion to discuss how the NutriVax program is going and to check our assumption that spillover effects between the two programs will be negligible. After that RCT has concluded, we plan to review the results and discuss with New Incentives whether there are any learnings that might be applicable to its program.
Internal forecasts
For this grant, we are recording the following forecasts:
Confidence | Prediction | By time |
---|---|---|
35% | If we communicate approval for expansion to New Incentives by October 31, New Incentives will be disbursing incentives at ≥85% of immunization sessions in the new cohorts in the month of January 2025 (New Incentives' program monitoring indicators are broken out by month) | January 2025 |
70% | If we communicate approval for expansion to New Incentives by October 31, New Incentives will be disbursing incentives at ≥85% of immunization sessions in the new cohorts in the month of March 2025. | March 2025 |
65% | At the end of March 2025, our combined cost-effectiveness estimate for Niger cohorts 32 & 36 will remain ≥8x | March 2025 |
60% | By May 2026, we will have extended funding through 2028 for at least two of the three expansion cohorts | May 2026 |
70% | By the end of 2027, New Incentives will report at least 200,000 children enrolled in cohort 32 in Niger28 | December 2027 |
70% | By the end of 2027, New Incentives will report at least 180,000 children enrolled in cohort 36 in Niger29 | December 2027 |
70% | By the end of 2027, New Incentives will report at least 210,000 children enrolled in cohort 33 in Yobe30 | December 2027 |
Our process
Since September 2021, New Incentives has been conducting baseline vaccination coverage surveys in areas for potential program expansion. During this grant investigation, we reviewed baseline coverage results for surveyed areas in the states of Niger, Yobe, and Taraba. We inputted these results into our cost-effectiveness analysis to identify which states, or portions of states, met our top charity funding bar of 8x cash.
We also:
- Reviewed New Incentives' budgets for the states and cohorts in question
- Made a few updates to our cost-effectiveness analysis (most notably the new adjustment for post program effects)
- Confirmed the location of the NutriVax RCT in Yobe and reviewed the distances between New Incentives' surveyed cohorts and the RCT location
- Spoke with ALIMA about any spillover concerns or potential coordination challenges in Yobe
- Spoke with local officials in Niger to get insight into the local context and sense-check the variation in vaccination coverage reported in New Incentives' surveys
We did not conduct a monitoring review of the program during this investigation as we recently reviewed New Incentives' monitoring data as part of our program additions grant investigation from earlier this year.
Sources
- 1
See a table of all grants we have made or recommended to New Incentives here.
- 2
As of September 30, 2024, the Nigerian Central Bank reported a naira:USD market exchange rate of approximately 1,602 naira per $1. See here.
1,000 naira / 1,602 naira:USD = $0.62 - 3
See the vaccine timeline on New Incentives' "Our Work" page.
- 4
Required vaccinations for receipt of the 5,000 incentive: BCG, all three doses of Penta and PCV, at least one dose of Rota, and two doses of MCV. This information was confirmed by New Incentives during a review of this page.
- 5
11,000 naira / 1,602 naira:USD = $6.87
- 6
"The RCT found significant increases in vaccination rates in areas served by the program, as reported by their caregivers in household surveys…The impact measured varied from 14 percentage points (measles1) to 28 percentage points (Penta3)." GiveWell, New Incentives (Conditional Cash Transfers to Increase Infant Vaccination).
- 7
Exact amount: $1,292,138. New Incentives, Summary of Funding Gap Estimates, 2024.
- 8
New Incentives reported holding $8,565,764 in surplus funds following our most recent top charity grant and approval for additional program components in April 2024 (see this page).
Our understanding from conversations with New Incentives is that the majority of this surplus is a result of the devaluation of the naira increasing New Incentives' purchasing power. As of September 30, 2024, the Nigerian Central Bank reported a naira:USD market exchange rate of approximately 1,602 naira per $1. See here. The average foreign exchange rate New Incentives received in 2022 was approximately 668 naira per $1. See GiveWell's analysis of New Incentives' room for more funding [May 2023]. The ability to receive more naira for every dollar has left New Incentives with a large surplus of funding from prior GiveWell grants, which were sized based on previous foreign exchange rates and did not anticipate the large devaluation in the naira. Note that for this grant, we based our funding on the same foreign exchange rate used in the April 2024 grant, which was 1250 naira per dollar. - 9
New Incentives' budget lists the time frame covered as October 2024 - December 2027. However, we expect that time frame to be delayed by a few months given that we did not approve this grant until October 2024. New Incentives, Summary of Funding Gap Estimates, 2024
- 10
Exact amount: $3,471,967. New Incentives, Summary of Funding Gap Estimates, 2024.
- 11
The "cohort" unit is not a Nigerian administrative unit, but the groupings New Incentives uses when conducting vaccination coverage surveys. There are 7 local government areas (LGAs) in Cohort 32 in Niger, 7 LGAs in Cohort 36 in Niger, and 6 LGAs in Cohort 33 in Yobe. See the LGAs included in each cohort in this spreadsheet.
Cohort 32 in Niger also includes the local government areas of Agwara and Mashegu, and Cohort 33 in Yobe also includes the local government area of Gulani. These LGAs are not listed on the spreadsheet above because New Incentives did not conduct surveys in these LGAs as part of each cohort's baseline coverage surveys, due to high security risks at the time of surveying. However, New Incentives expects to be able to operate in some parts of these LGAs during the grant period. Thus the grant budget includes funds for operating in these LGAs. New Incentives, email to GiveWell, November 4, 2024 (unpublished). - 12
Exact amount: $3,099,969. New Incentives, Summary of Funding Gap Estimates, 2024.
- 13
Exact amount: $3,285,966. New Incentives, Summary of Funding Gap Estimates, 2024.
- 14
Since 2020, New Incentives has expanded its program from operating in 98 clinics in 53 LGAs across three states to operating in 6,380 clinics in 177 LGAs across nine states (New Incentives also works in an additional 10 LGAs in Katsina and Zamfara, operating only in clinics that were part of the pilot and RCT). New Incentives confirmed these figures during its review of this page.
The various grants we have made to fund New Incentives' expansion are listed in the table on this page.
In general, our annual review of New Incentives' monitoring data suggests the program has continued to be delivered at a high quality throughout its expansion. As examples, we have seen consistently high rates of compliance with New Incentives' data collection requirements such as the submission of caregiver photos, the percentage of disbursement days audited or supervised by a manager has remained stable, and retention rates (the proportion of children returning for subsequent vaccinations) have remained high. See our latest monitoring review.
A few exceptions are an increasing proportion of suspected repeat enrollments and an increase in vaccine stockouts. While we're monitoring those and discussing with New Incentives, we don't think either – at current levels – represent a major risk to the program benefits we model. You can read more about these issues in this section of our New Incentives top charity review. - 15
Note that a) our cost-effectiveness analyses are simplified models that are highly uncertain, and b) our cost-effectiveness threshold for directing funding to particular programs changes periodically. As of October 2024, our bar for directing funding is 8 times as cost-effective as unconditional cash transfers (8x) for top charities and 10x for non-top charities. See GiveWell’s Cost-Effectiveness Analyses webpage for more information about how we use cost-effectiveness estimates in our grantmaking.
Since both cohort 32 and cohort 36 in Niger meet our top charity funding bar of 8x cash, we have combined them into one column in our cost-effectiveness analysis. In the future, we may make funding decisions for these cohorts separately if their combined cost-effectiveness falls below our bar but we believe continued funding for one cohort would remain cost-effective. - 16
GiveWell, Global Vaccines CEA, 2024 (unpublished).
- 17
- See our estimates of vaccine efficacy here.
- Note that our estimates of vaccine efficacy do not include a few vaccines that are indirectly incentivized by the program (i.e., the polio, yellow fever, and meningitis A vaccines). These vaccines are considered "indirectly incentivized" because New Incentives does not provide cash transfers to caregivers whose children receive those vaccinations, but these vaccines are offered at the same time as other directly incentivized vaccines. See the routine vaccination schedule on New Incentives' website.
- "We identified a need to select the minimum vaccines required during each visit to be eligible for a cash incentive…The other vaccines in the schedule are indirectly incentivized." New Incentives, How We Encourage All Routine Childhood Vaccines, 2023.
- We do not directly model the benefits of these indirectly incentivized vaccines (except for the rotavirus vaccine) because we do not expect them to have as large of an impact on child mortality as the vaccines we directly model. Instead we include supplemental adjustments to account for the benefits from these vaccines.
- 18
See this cell note in our cost-effectiveness analysis.
- 19
This estimate of GiveDirectly's value per dollar donated is out of date as of 2024. We are continuing to use this outdated estimate for now to preserve our ability to compare across programs, while we reevaluate the benchmark we want to use to measure and communicate cost-effectiveness.
- 20
Note that we do not have any concrete plans to discontinue funding for the program, but we and New Incentives expect that vaccination rates will increase in northern Nigeria over time, which may eventually cause the program to fall below our funding bar.
- 21
The size of the adjustment varies by location because we calculate it based on our estimates of how many children will be vaccinated while the program is running who would not have been vaccinated otherwise, and how many subsequent siblings will not be vaccinated after the withdrawal of incentives (but who would have been vaccinated if the program never existed). This makes the size of the adjustment dependent on baseline vaccination rates in each location, among other factors. We discuss how we calculate this adjustment in this section of our technical report.
- 22
Results from the coverage surveys are here.
- 23
See the difference in vaccination rates recorded in this spreadsheet.
- 24
- Our understanding of the rough geographic dispersion of the surveyed cohorts:
- Cohort 32 (LGAs included: Borgu, Edati, Kontagora, Magama, Mokwa) is located in the northwest
- Cohort 34 (LGAs included: Chanchaga, Gurara, Lapai, Paikoro, Suleja, Tafa) is located in the southeast
- Cohort 36 (LGAs included: Agaie, Bida, Bosso, Gbako, Katcha, Lavun, Wushishi) is located in the southwest
- New Incentives reported higher security risks and lower vaccination acceptance in cohort 32, the latter potentially due to a difference in the predominant ethnic group in cohort 32. New Incentives, email to GiveWell, August 30, 2024 (unpublished)
- The local officials we spoke to confirmed that the risk of insecurity is higher in the northern part of the state, that the predominant ethnic group varies across the state (with different predominant groups in the north, east, and south), and that LGAs closer to FCT state (to the southeast of Niger) and the capital city of Niger have more urban areas. However, the local officials stressed that the surveys are an imperfect measure of vaccination coverage and true coverage in cohort 34 could be lower than the results suggest. Unpublished conversation with local officials in Niger.
- Our understanding of the rough geographic dispersion of the surveyed cohorts:
- 25
The Eleanor Crook Foundation, one of the funders of the NutriVax RCT, informed us that the study is taking place in the local government areas of Karasuwa and Nguru in the state of Yobe. New Incentives' cohort 35 included both of those LGAs, as well as the bordering LGAs of Machina, Jakusko, and Bade. See cohort list here. Due to the proximity of these LGAs to the areas where the NutriVax RCT is taking place, we believe the risk of spillover between areas eligible for cash incentives and nutritional incentives is fairly high and ultimately do not recommend New Incentives expand to these areas while the nutritional incentives are being offered. We may consider expansion to these areas in the future, after the NutriVax RCT has concluded.
- 26
Note that New Incentives has told us they believe ALIMA, the implementing organization for the NutriVax RCT, is operating in approximately 20 clinics in 2 LGAs, so there may still be a need for incentives for immunization in areas not covered by ALIMA's program. By not funding New Incentives' operations in cohort 35, we could be leaving impact on the table by missing birth cohorts not reached through ALIMA's program that could otherwise have been reached by New Incentives.
- 27
The NutriVax RCT is taking place in the northern part of Yobe, in the LGAs of Karasuwa and Nguru, whereas cohort 33 is located in the southern part of the state (in the LGAs of Potiskum, Nangere, Fune, Fika, and Damaturu; see cohort list here) and we estimate caregivers in the NutriVax-eligible areas would need to travel a minimum of 3 hours by car to visit health clinics in cohort 35. We think it is highly unlikely that a large number of caregivers would have the means and desire to travel that far to receive New Incentives' cash incentives.
See a map of Yobe state here. See an example route from Fune to Karasuwa here.
- 28
New Incentives' budget assumes 213,528 children will be enrolled in cohort 32 from October 2024 through December 2027, with roughly 5,600 children enrolled each month. We use an estimate of 200,000 children for this prediction to account for some delay in rolling out the program. New Incentives, Summary of Funding Gap Estimates, 2024.
Note that this prediction refers to the number of enrollments we predict New Incentives will record in this cohort, and does not include an adjustment for estimated repeat enrollments.
- 29
New Incentives' budget assumes 190,650 children will be enrolled in cohort 36 from October 2024 through December 2027, with roughly 5,000 children enrolled each month. We use an estimate of 180,000 children for this prediction to account for some delay in rolling out the program. New Incentives, Summary of Funding Gap Estimates, 2024.
Note that this prediction refers to the number of enrollments we predict New Incentives will record in this cohort, and does not include an adjustment for estimated repeat enrollments.
- 30
New Incentives' budget assumes 221,154 children will be enrolled in cohort 33 from October 2024 through December 2027, with roughly 5,800 children enrolled each month. We use an estimate of 210,000 children for this prediction to account for some delay in rolling out the program. New Incentives, Summary of Funding Gap Estimates, 2024.
Note that this prediction refers to the number of enrollments we predict New Incentives will record in this cohort, and does not include an adjustment for estimated repeat enrollments.