The study will randomly sample 258 public Health Dispensaries (with at least one officially
registered Community Health Worker (CHW) working at the facility) across all 7 districts (and
all 8 district councils) in the Dodoma region, Tanzania, to participate in a clustered
multi-arm Randomised Controlled Trial (cRCT). The 258 Health Dispensaries (HDs) will be
randomised to a (i) Control group (81 HDs) where CHWs deliver Early Childhood Development
(ECD) services as per existing government guidelines, (ii) Parenting group (88 HDs) where
existing CHWs will be trained to use an innovative digital application for the delivery of
integrated ECD services for a period of 15 months, from 5-7 months pregnancy onwards and,
(iii) an Unconditional Cash Transfer (UCT) only group (89 HDs) where CHWs deliver ECD
services as per existing government guidelines but where the study sample of families will
receive a bi-monthly UCT fixed amount of 109,000 TZS (equivalent to 47USD) for 15 months (7
transfers in total). The randomisation will be stratified by district council and by whether
there is more than one community in the HD catchment area.
Within each of the HD catchment areas in the Control group, one village (in rural areas) or
one 'mtaa' (in urban areas) served by the HD and where at least one officially registered CHW
is available to work will be randomly sampled. For the 88 Parenting HDs and the 89 UCT only
HDs, all villages/mtaas (with at least one available officially registered CHW) will be
included in their catchment area to become part of the study. In total, that will give 390
study villages/mtaas in the study sample.
Within each of the selected study villages/mtaas, one CHW will be selected whose catchment
area will become the geographic area of interest, i.e., the study community. The study
community can be the entire village, a hamlet (sub-village) or an mtaa, depending on the size
of the CHW's catchment area. This gives a total of 82 Control communities, 155 Parenting
communities, and 155 UCT communities in the study.
Within the Parenting and UCT only study groups, then second layer of randomisation will be
done. In the Parenting group (154 communities across 88 HDs), communities will be randomly
assigned, stratified by HD, to either one of the following two treatment arms: (i) Parenting
only (77 communities) and (ii) Parenting+UCT (77 communities) where the Parenting
Intervention will be delivered along with a bi-monthly unconditional mobile money transfer of
77,000 TZS (33 USD) from 5-7 months pregnancy over a period of 15 months (7 transfers in
total). In the UCT only group (155 communities across 89 HDs), study communities will be
randomly assigned, stratified by HDs, to either one of two treatment arms: (i) UCT only fixed
amount (80 communities) where families will receive a fixed bi-monthly cash transfers each of
109,000 TZS (47 USD) over a period of 15 months (7 transfers in total) and (ii) UCT only vary
amount where 77 communities will be randomly allocated to one of the following bi-monthly UCT
amounts: 32,000 TZS (14 USD), 77,000 TZS (33 USD), 109,000 TZS (47 USD) over a period of 15
months (7 transfers in total). In each of these two study arms, further randomisation will be
done whether the mobile money transfer is given to the father/spouse or the mother.
10 eligible women per community will de randomly sampled to participate in the study, except
the bi-monthly UCT vary amount group, where only 5 eligible women per community will be
randomly sampled.
Such a design allows to assess the relative cost-effectiveness of the Parenting and/or UCT
only fixed amount interventions, and indeed provide insights into the value of adding a
parenting component to a social protection program such as the Tanzania Social Action Fund
(TASAF).
Additionally, the study will also explore CHW performance, quality of care delivered and
other fidelity indicators to analyse impacts based on implementation effectiveness.