Child Immunization Campaign with Incentives in India

Updated: Jan 25, 2018
Evidence Rating:
Near Top Tier


  • Program:

    Monthly, well-publicized immunization camps in poor villages in rural India, combined with small incentives for parents to have their children immunized (e.g., a $1 bag of lentils per immunization).

  • Evaluation Methods:

    A well-conducted randomized controlled trial (RCT).

  • Key Findings:

    Increased the percent of children age 1-3 fully immunized from 6% to 39%, at a cost of about $13 per targeted child; the small incentives were shown to be a key factor causing the increase.

  • Other:

    A study limitation is that villages in the sample were all located in one area of western India. Thus, corroboration of these findings in a second trial, in another setting, would be desirable to show that the effects generalize to other settings where the program might normally be implemented.

The program is a child immunization campaign for children age 0-3 conducted in an impoverished area of rural India with unreliable immunization services (e.g., high staff absenteeism). The program was provided by Seva Mandir, an Indian nonprofit, and included two main components –

  • Monthly, well-publicized, reliable immunization camps. Monitoring confirmed that 95% of the planned camps took place. Social workers publicized the camps, informing mothers of young children about the camps’ availability and the benefits of immunization.
  • Small incentives for parents to have their children age 0-3 immunized. These included: (a) a 1 kg bag of raw lentils – worth about $1 – for every immunization their child received; and (b) a set of metal plates used for meals – worth about $2 – for completion of their child’s full immunization course (requiring at least five visits).

The full immunization course provided protection against diphtheria, whooping cough, tetanus, tuberculosis, polio, and measles. The program’s cost was about $13 per targeted child (2017 dollars). [1]

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[1] The three largest cost components were the salaries of the nurses and assistants providing the immunizations (29% of total cost), the incentives (28%), and the monitoring to make sure the camps took place as planned (23%).  Monitoring was necessitated by the unusually poor health infrastructure in this part of India.

Banerjee, Abhijit, Esther Duflo, Rachel Glennerster, and Dhruva Kothari. “Improving Immunization Coverage in Rural India: Clustered Randomised Controlled Evaluation of Immunization Campaigns With and Without Incentives.” British Medical Journal, June 12, 2010, vol. 340, c2220. The full study is posted here.