Economic Evaluation of the MEWE Intervention (MEWE-EE)

Economic Evaluation of the Men Engagement in Women Empowerment (MEWE) Intervention (MEWE-EE)

Cash transfers have shown promise in preventing intimate partner violence, and in reducing recipients' stress levels. Cash transfers with behavioral or psychological interventions have shown limited effectiveness at reducing stress in some African countries. Little is known of the cost-effectiveness of interventions delivered alongside cash transfer programs. The MEWE economic evaluation sub-study (MEWE-EE) runs alongside MEWE, a three-arm cluster-randomized controlled trial in Sindh, Pakistan. MEWE-EE will assess the costs and cost-effectiveness of delivering a cash-transfer program (BISP-CT) combined with a life-skills building curriculum (LSB curriculum), compared to the BISP-CT alone. The LSB curriculum is offered to either women who receive BISP-CT, or to women who receive BISP-CT and their husbands.

Study Overview

• Status: Completed
• Conditions: Depression; Domestic Violence; Intimate Partner Violence; Battered Women; Mental Health Issue; Gender-based Violence; Rape Sexual Assault
• Intervention / Treatment: Other: Cash transfer to adult females; Behavioral: Life Skills Building (LSB) curriculum for females; Behavioral: Life Skills Building (LSB) curriculum for males

• Study Type: Interventional
• Enrollment (Actual): 1536
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Sindh
    • Thatta, Sindh, Pakistan
      • Mirpur Sakro

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 13 years to 47 years (Child, Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• In receipt of Benazir Income Support Program (BISP) cash transfers (CTs)
• Parity: have at least one child, at least 18 months old

Exclusion Criteria:

• Plan for the family to migrate out of the village within the next 2 years

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Cash Transfers only; Participants allocated to this arm receive cash transfers. They are clients of a nation-wide cash transfer program.	Other: Cash transfer to adult females; The BISP intervention offers access to quarterly unconditional cash transfers to adult females.; Other Names: BISP-CT
Experimental: Cash Transfers + LSB curriculum for females clients only; Participants allocated to this arm receive cash transfers and access to LSB curriculum training. Female cash transfer recipients attend 10 life-skills building sessions. Sessions are held weekly and are 90 minutes long. Two trained facilitators run the session for groups of 10 women over a ten-week period.	Other: Cash transfer to adult females; The BISP intervention offers access to quarterly unconditional cash transfers to adult females.; Other Names: BISP-CT; Behavioral: Life Skills Building (LSB) curriculum for females; The LSB curriculum offers ten weekly 90-minute sessions. Topics include effective communication, gender roles, power dynamics in the household; work-life balance and time management; conflict resolution; household decision making. The LSB teachers are trained in facilitation techniques to deliver the sessions. All female study participants attending LSB curriculum classes are BISP-CT clients. For females, the MEWE intervention comprises access to LSB curriculum + BISP CTs.; Other Names: MEWE females
Experimental: Cash Transfers + LSB curriculum for females clients and their husbands; Participants allocated to this arm receive cash transfers and access to LSB curriculum training in gender-segregated groups. Men and women attend 10 life-skills building sessions in parallel. Sessions are held weekly and are 90 minutes long. Two trained facilitators, whose gender matches the participants', run the session for groups of 10 women or men over a ten-week period.	Other: Cash transfer to adult females; The BISP intervention offers access to quarterly unconditional cash transfers to adult females.; Other Names: BISP-CT; Behavioral: Life Skills Building (LSB) curriculum for females; The LSB curriculum offers ten weekly 90-minute sessions. Topics include effective communication, gender roles, power dynamics in the household; work-life balance and time management; conflict resolution; household decision making. The LSB teachers are trained in facilitation techniques to deliver the sessions. All female study participants attending LSB curriculum classes are BISP-CT clients. For females, the MEWE intervention comprises access to LSB curriculum + BISP CTs.; Other Names: MEWE females; Behavioral: Life Skills Building (LSB) curriculum for males; The LSB curriculum offers ten weekly 90-minute sessions. Topics include effective communication, gender roles, power dynamics in the household; work-life balance and time management; conflict resolution; household decision making. The LSB teachers are trained in facilitation techniques to deliver the sessions. All male study participants attending LSB curriculum classes are married to BISP-CT clients. For men, the MEWE intervention provides access to the LSB curriculum only.; Other Names: MEWE males

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incremental cost incurred per disability adjusted life year (DALY) averted: provider perspective	Incremental cost per disability-adjusted life year (DALY) averted by the intervention compared to the control group from a provider perspective at 12 months from baseline. DALYs and costs will also be modelled up to a ten-year horizon using a Markov model.	12 months post randomisation
Incremental cost incurred per disability adjusted life year (DALY) averted: societal perspective	Incremental cost per disability-adjusted life year (DALY) averted by the intervention compared to the control group from a societal perspective at 12 months from baseline. DALYs and costs will also be modelled up to a ten-year horizon using a Markov model.	12 months post randomisation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean cost of intervention delivery	Cost of intervention delivery for different intervention models per patient, by category, annuitised	12 months post randomisation
Mean cost of LSB session	Average cost of LSB session delivery for different intervention models, annuitised	12 months post randomisation
Total incremental cost of the intervention in a research setting	Total additional cost of the intervention compared to the BISP-CT only for the study population and by intervention type during the research period.	12 months post randomisation
Total incremental cost of the intervention in the modelling cohort	Total additional cost of the intervention for the modelling cohort by intervention type over a ten-year period.	12 months post randomisation
Incremental cost incurred per disability adjusted life year (DALY) averted at scale: provider perspective	Incremental cost per disability-adjusted life year (DALY) averted by the intervention compared to the control group from a provider perspective at scale.	12 months post randomisation
Incremental cost incurred per disability adjusted life year (DALY) averted at scale: societal perspective	Incremental cost per disability-adjusted life year (DALY) averted by the intervention compared to the control group from a societal perspective at scale.	12 months post randomisation

Collaborators and Investigators

• Sponsor: London School of Economics and Political Science
• Collaborators: Bill and Melinda Gates Foundation; Aga Khan University
• Investigators: Principal Investigator: Giulia Ferrari, PhD, London School of Economics & Political Science

Study record dates

Study Major Dates

• Study Start (Actual): September 15, 2021
• Primary Completion (Actual): June 30, 2022
• Study Completion (Actual): November 30, 2022

Study Registration Dates

• First Submitted: October 25, 2022
• First Submitted That Met QC Criteria: October 25, 2022
• First Posted (Actual): October 28, 2022

Study Record Updates

• Last Update Posted (Estimated): December 7, 2023
• Last Update Submitted That Met QC Criteria: December 6, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: abuse; women; violence; aggression; gender; physical; sexual; spouse; partner; psychological; coercion; assault; girl; wife; economic
• Additional Relevant MeSH Terms: Behavioral Symptoms; Depression
• Other Study ID Numbers: 108137

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No