Can cash transfers decrease the no-show rate for surgical patients in low-resource settings?

ISRCTN ISRCTN80618786
DOI https://doi.org/10.1186/ISRCTN80618786
Secondary identifying numbers CI 91-17
Submission date
19/11/2020
Registration date
23/11/2020
Last edited
01/09/2021
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Other
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Surgical access is critically important for strong health systems. Although 30% of the world’s disease burden is surgical, five billion people are unable to access safe, affordable, and timely surgical care. An estimated 143 million necessary surgical procedures are not done every year.
Barriers to accessing surgical care are especially high among the poor worldwide and in low- and middle-income countries (LMICs).
A 2017 retrospective study of surgical patients in West Africa found that they were almost twice as likely to show up for their scheduled surgery if their transportation costs were paid for. Vouchers for transportation have also been successful at increasing facility delivery for mothers in Bangladesh, although the voucher system itself proved difficult to administer.
Cash transfers, in which participants are given small amounts of cash in exchange for salutary behavior, are simpler to administer than vouchers and have shown success in health, nutrition, and education. Cash transfers have not yet been studied in surgery.
Building on a prior study of cash transfers for surgical patients in Guinea, this paper undertook a randomized, controlled trial (RCT) of a cash transfer for surgical patients in the country. We hypothesized that cash transfers would improve patient compliance and that, specifically, cash transfers given before patients faced the barrier of transportation costs would have a significant positive effect.

Who can participate?
Any patient who had been determined to be eligible for surgery by a specialized surgical screening team. There was no age limit, although if the patient was a child, the parent was the participant.

What does the study involve?
Participants in this study were randomized to three trial arms. Group 1 patients received the cash transfer conditional on their arrival for their surgery. Patients in Group 2 received the transfer as a mobile banking deposit 2 – 4 days prior to the day they were scheduled to leave their homes to come to the screening city for transportation to Conakry. The transfer was “labelled” with a concurrent text message. Patients in the control arm received a bag of food and staples on the day of enrollment. No further assistance was given toward their transportation costs.

What are the possible benefits and risks of participating?
Benefits: The patients would be receiving free surgery plus a cash transfer.
Risks: Aside from the minimal risk of unmasking of patient information, no other risks were likely to occur.

Where is the study run from?
Mercy Ships, a surgical charity operating a hospital ship at Conakry (Guinea)

When is the study starting and how long is it expected to run for?
January 2017 to June 2019

Who is funding the study?
Damon Runyon Cancer Research Foundation (USA)

Who is the main contact?
Prof. Mark Shrime
mark.shrime@rcsi.com

Contact information

Prof Mark Shrime
Scientific

Institute of Global Surgery
123 St. Stephen's Green
Dublin
D02
Ireland

ORCiD logoORCID ID 0000-0002-3546-9867
Email shrime@mail.harvard.edu

Study information

Study designSingle center interventional single-blinded randomized trial with three arms
Primary study designInterventional
Secondary study designRandomised parallel trial
Study setting(s)Hospital
Study typeOther
Participant information sheet No participant information sheet available
Scientific titleCash transfers may decrease the no-show rate for surgical patients in low-resource settings: A randomized trial
Study acronymCASH
Study objectivesCash transfers will improve patient compliance with scheduled surgery and, specifically, cash transfers given before patients faced the barrier of transportation costs would have a significant positive effect.
Ethics approval(s)Approved 12/06/2017, Massachusetts Eye and Ear Infirmary (Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA; +1 617 523 7900; jan_trott@meei.harvard.edu), ref: 15-166H
Health condition(s) or problem(s) studiedUtilization of surgical services by surgical patients in Guinea
InterventionThree arms:
"Conditional cash transfer": these patients will receive 80,000 GNF (approx €7) conditional on them arriving for their scheduled surgical appointment, whether or not the surgery actually happened.

"Unconditional cash transfer": These patients received 80,000 GNF as a mobile banking deposit 2 – 4 days prior to the day they were scheduled to leave their homes to come to the screening city for transportation to Conakry. The transfer was “labeled” with a concurrent text message. If patients in this arm did not have a cell phone or a SIM card, these were provided. All transfer costs were covered.

"Control group": Patients in the control arm received a bag of food and staples on the day of enrollment. No further assistance was given toward their transportation costs.

Patients were recruited once they had been given an appointment for their on-ship screening. Allocation proceeded via simple randomization. Slips each containing a random study identification number and group allocation were concealed in an opaque envelope. Patients drew a number from the envelope in view of the researchers, local staff, and their families. The first author, who performed the data analysis, was blinded to the allocation and randomization.
Intervention typeOther
Primary outcome measureNumber of patients attending scheduled surgical appointment (measured throughout the study)
Secondary outcome measuresThere are no secondary outcome measures
Overall study start date04/01/2017
Completion date01/06/2019

Eligibility

Participant type(s)Patient
Age groupAll
SexBoth
Target number of participants390
Total final enrolment453
Key inclusion criteriaAny patient who had been determined to be eligible for surgery by a specialized surgical screening team. No age limit, although if the patient was a child, the parent was the participant.
Key exclusion criteriaNo diagnosed surgical disease
Date of first enrolment16/10/2018
Date of final enrolment07/02/2019

Locations

Countries of recruitment

  • Guinea

Study participating centre

Mercy Ships
m/v Africa Mercy
Conakry
-
Guinea

Sponsor information

Massachusetts Eye and Ear Infirmary
University/education

243 Charles Street
Boston
02114
United States of America

Phone +1 617 523 7900
Email jan_trott@meei.harvard.edu
Website http://www.masseyeandear.org/
ROR logo "ROR" https://ror.org/04g3dn724

Funders

Funder type

Charity

Damon Runyon Cancer Research Foundation
Government organisation / Trusts, charities, foundations (both public and private)
Alternative name(s)
Cancer Research Fund of the Damon Runyon-Walter Winchell Foundation, Damon Runyon, DAMON RUNYON CANCER RESEARCH FND, DRCRF
Location
United States of America

Results and Publications

Intention to publish date30/11/2020
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot expected to be made available
Publication and dissemination planPlanned publication in a high-impact peer-reviewed journal.
IPD sharing planThe datasets generated during and/or analysed during the current study are not expected to be made available due to lack of consent.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Preprint results 26/03/2021 01/09/2021 No No

Editorial Notes

01/09/2021: Preprint reference added.
04/06/2021: The contact details were updated.
23/11/2020: Trial’s existence confirmed by Massachusetts Eye and Ear REC.