Can cash transfers decrease the no-show rate for surgical patients in low-resource settings?
| ISRCTN | ISRCTN80618786 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN80618786 |
| ClinicalTrials.gov (NCT) | Nil known |
| Clinical Trials Information System (CTIS) | Nil known |
| Protocol serial number | CI 91-17 |
| Sponsor | Massachusetts Eye and Ear Infirmary |
| Funder | Damon Runyon Cancer Research Foundation |
- 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
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
Scientific
Institute of Global Surgery
123 St. Stephen's Green
Dublin
D02
Ireland
 ORCID ID |
0000-0002-3546-9867 |
|---|---|
| shrime@mail.harvard.edu |
Study information
| Primary study design | Interventional |
|---|---|
| Study design | Single center interventional single-blinded randomized trial with three arms |
| Secondary study design | Randomised parallel trial |
| Study type | Participant information sheet |
| Scientific title | Cash transfers may decrease the no-show rate for surgical patients in low-resource settings: A randomized trial |
| Study acronym | CASH |
| Study objectives | Cash 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) studied | Utilization of surgical services by surgical patients in Guinea |
| Intervention | Three 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 type | Other |
| Primary outcome measure(s) |
Number of patients attending scheduled surgical appointment (measured throughout the study) |
| Key secondary outcome measure(s) |
There are no secondary outcome measures |
| Completion date | 01/06/2019 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | All |
| Sex | All |
| Target sample size at registration | 390 |
| Total final enrolment | 453 |
| Key inclusion criteria | Any 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 criteria | No diagnosed surgical disease |
| Date of first enrolment | 16/10/2018 |
| Date of final enrolment | 07/02/2019 |
Locations
Countries of recruitment
- Guinea
Study participating centre
Conakry
-
Guinea
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|---|
| IPD sharing plan summary | Not expected to be made available |
| IPD sharing plan | The 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? |
|---|---|---|---|---|---|
| Participant information sheet | Participant information sheet | 11/11/2025 | 11/11/2025 | No | Yes |
| 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.
