Impact Evaluation of Triggerise's Tiko Platform

Health Impact Evaluation of Triggerise's Tiko Platform

Triggerise designed web and phone based Tiko platform to connect young girls and women to the health products, services and information. The platform uses principles of behaviour economics to motivate positive choices-including rewards, promotions, discounts, coupons, reminders, alerts etc. The platform was implemented in several cities from seven states of India to provide Sexual Reproductive Health (SRH) and maternal and child health (MCH) products and services. The consumers (called Rafikis) use Tiko card to get discounts and to earn 'Tiko miles' rewards at Tiko franchised healthcare providers and pharmacies. Tiko miles are redeemable towards lifestyle products or services (e.g., beauty salons). The local Tiko health promoter (celled Pro agent) can also buy health and hygiene products at bulk discounts and sell them at profit.

Triggerise appointed Network for Engineering, Economics Research and Management (NEERMAN) to conduct an independent impact assessment of the Tiko platform with multiple research objectives include health impact evaluation at the Rafiki level.

NEERMAN used an ex-post observational design to compare usage of SRH and MCH services and family planning (FP), antenatal care (ANC) and postnatal care (PNC) practices by comparing Users and Non-Users of Tiko platform, and accounting for the selection bias statistically. The structured questionnaire collected data on knowledge, practices, barriers, enablers for SRH and MCH services, exposure o Tiko platform, and how it helped or did not help. The survey participants were approx. 1200 users and 600 non-users being served by approx. 350 pro-agents in their respective operations area.

The association between use of Tiko platform and various outcomes were identified using a generalized linear model with fixed effects at pro-agent level and including a set of covariates. To evaluate the effect modification by type of pro agent - government community health worker (CHW) versus others - an interaction model was used. The standard errors were automatically clustered at pro-agent level due to fixed effects. Primary outcomes are proportion of married Rafikis currently using any contraceptives, currently using modern short-term contraceptives, proportion of Rafikis who delivered a child post Jan 2019 and received at least 4 ANC check-ups, consumed at least 100 iron folic acid (IFA( during pregnancy, and received a PNC check-up within 6 weeks of birth.

Study Overview

• Status: Completed
• Conditions: Contraception; Iron Deficiency Anemia of Pregnancy; Antenatal Care; Postnatal Care
• Intervention / Treatment: Behavioral: Tiko Platform Behavioural cum mHealth Intervention; Other: Standard of Care / Business as Usual

Detailed Description

See subsequent sections

• Study Type: Interventional
• Enrollment (Actual): 1708
• Phase: Not Applicable

Contacts and Locations

Study Locations

• India
  • Maharashtra
    • Mumbai, Maharashtra, India, 400014
      • NEERMAN

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 50 years (ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Women who are registered on Tiko Platform with Pro-agents active in 2020-21
• Age 18-50
• Address and contacts details are found with help of Pro-agent

Exclusion Criteria:

• Does not consent to participation
• Does not agree or confirm registering on Tiko Platform
• If a woman is never married, she is excluded from survey on family planning but surveyed for use of Tiko platform
• If a married woman does not have a child born on/after 1 January 2019, then she is excluded from the survey on antenatal care, delivery and postnatal care but surveyed for use of Tiko platform

Study Plan

How is the study designed?

Design Details

• Primary Purpose: HEALTH_SERVICES_RESEARCH
• Allocation: NON_RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Users of Tiko Platform; These participants accessed various services on Tiko platform such as buying contraceptives, visiting doctors for ANC etc. They earned Tiko Miles/Points for such health seeking behaviours which they could then redeem at network of grocery shops, pharmacies, beauty salon etc. Tiko card also enabled them to get discounts at pharmacies and at health care providers. These participants were free to access any other government or private health care facility as free economic agents. Users of Tiko platform were identified by the backend system that recorded all health seeking behaviours / actions, reward point accumulation, and use of those reward points.	Behavioral: Tiko Platform Behavioural cum mHealth Intervention; Tiko platform is a mix of social franchising and social marketing concepts to promote health behaviours through rewards to health promoters (pro agents), healthcare providers (doctors and pharmacies), Beneficiaries (women needing FP and/or ANC services), and shop keepers and life-style service providers where beneficiaries, providers and promoters could use their rewards points. The health promoters could purchase from wholesale retailers products such as sanitary napkins, condoms and then resale these at profit. Beneficiaries were given discounts and their rewards points can be used as cash to avail certain lifestyle services at participating locations, and so did the health care providers. Pro agents also got incentives for recruiting the beneficiaries and after beneficiaries reached certain service access/use milestones. All this was integrated on a mHealth platform using smart phones and smart cards (for those without access to Tiko card).
ACTIVE_COMPARATOR: Non-Users of Tiko Platform; These participants registered on Tiko platform on basis of recruitment drive and pitch by Pro agents, but they did not access any service and became dormant. However, These participants were free to access any other government or private health care facility and could access fame family planning and ANC products and services. They could even access Tiko network doctors and pharmacies but they would not get any Tiko Miles/Points or discounts without the use of Tiko card. Non Users were identified as those registered women who did not have any record of using services using Tiko card as per the backend system	Other: Standard of Care / Business as Usual; Non-Users of Tiko did not use Tiko platform but they could access any health care provider or pharmacy to avail same services related to Family planning, antenatal care, postnatal care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of women currently using any contraceptives	Whether a woman used any contraceptive - traditional or modern methods, and permanent or temporary methods	Through survey completion, an average of 1 month
Proportion of women currently using modern short-term contraceptives	Whether a woman used modern and temporary contraception methods	Through survey completion, an average of 1 month
Proportion of women who consumed 100 or more Iron Folic Acid (IFA) tablets during last pregnancy	Whether the study participant recalled consuming 100 or more IFA tablets when pregnant with youngest child born after 1 January 2019	9 months during pregnancy with the youngest child
Proportion of women who received 4 or more antenatal check-ups during last pregnancy	Whether the study participant recalled receiving 4 or more ANC check-ups from any health care provider when pregnant with youngest child born after 1 January 2019	9 months during pregnancy with the youngest child
Proportion of women who received a postnatal check-up within 6 week of the delivery from a healthcare provider	Whether the study participant recalled receiving at least one postnatal health check up within 6 weeks of the youngest child's birth	Within 6 weeks after delivery of the youngest child

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Out of pocket expenditure on antenatal care, iron folic acid tablets, delivery, and postnatal check-ups	Reported expenditure in Indian Rupees for antenatal care, iron folic acid tablets, delivery, and postnatal check-ups associated with the youngest child born after 1 January 2019	9 months during pregnancy with the youngest child
Out of pocket expenditure on Family planning services and products	Reported expenditure in Indian Rupees for permanent or temporary contraceptive methods	Past 24 months (from survey date)
Proportion of women receiving Antenatal check-ups at (a) Tiko franchisee doctors, (b) other private doctors, or (c) government healthcare provider	Separate proportions are estimated for each of the three locations of antenatal check-ups when pregnant with youngest child born after 1 January 2019	9 months during pregnancy with the youngest child
Proportion of women receiving postnatal check-ups at (a) Tiko franchisee doctors, (b) other private doctors, or (c) government healthcare provider	Separate proportions are estimated for each of the three locations of postnatal check-ups within 6 weeks after delivery of the youngest child born after 1 January 2019	Within 6 weeks after delivery of the youngest child

Collaborators and Investigators

• Sponsor: Network for Engineering and Economics Research and Management
• Investigators: Principal Investigator: Sumeet Patil, PhD, Network for Engineering and Economics Research and Management

Study record dates

Study Major Dates

• Study Start (ACTUAL): February 15, 2021
• Primary Completion (ACTUAL): May 17, 2021
• Study Completion (ACTUAL): March 20, 2022

Study Registration Dates

• First Submitted: January 12, 2023
• First Submitted That Met QC Criteria: February 2, 2023
• First Posted (ACTUAL): February 13, 2023

Study Record Updates

• Last Update Posted (ACTUAL): February 13, 2023
• Last Update Submitted That Met QC Criteria: February 2, 2023
• Last Verified: February 1, 2023

More Information

Terms related to this study

• Keywords: mHealth; Community Health Workers; Antenatal Care; Family Planning; Impact Evaluation; Social Marketing; Social Franchising; Market-Driven
• Additional Relevant MeSH Terms: Metabolic Diseases; Hematologic Diseases; Anemia, Hypochromic; Anemia; Iron Metabolism Disorders; Anemia, Iron-Deficiency
• Other Study ID Numbers: Triggerise Protocol V2

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: While NEERMAN holds data use and publication rights from Triggerise, the data ownership rests with Triggerise so data access to de-identify observations and variables used in pit is unclear published papers can be made available under certain conditions

Drug and device information, study documents

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