New Incentives

New Incentives

New Incentives educates caregivers about the importance of vaccinating children and disburses cash incentives that are conditional on infants receiving four life-saving vaccines, which are provided through government clinics free of charge. New Incentives also works with government partners to improve vaccine supply. There is strong evidence that their program leads to more children being immunized from life-threatening but vaccine–preventable diseases.

Infants enrolled in the program
Cash transfers issued after verifying vaccinations
Retention rate through immunization cycle

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The problem: Low immunization rates

Childhood vaccines prevent an estimated 2 to 3 million deaths every year [1].  They are recognized as one of the most cost-effective child health interventions in low-income countries. Yet, in 2019, an estimated 14 million infants around the world were still not reached by vaccination services[2]. The problem of low immunization rates is especially clear and pressing in Nigeria. Nigeria is home to just 2.6% of the world’s population [3], yet it accounts for 16% of the world’s mortality of children under five [4]. As of 2019, Nigeria had the highest mortality rate in the world among children under five years [5](117 deaths per 1,000 live births)[6].  Strikingly, an estimated 40% of under-five deaths in Nigeria are from vaccine-preventable diseases [7]. North West Nigeria specifically has the highest under-five mortality rate in the country. It also has the lowest vaccination coverage in the country, with only around one quarter of the infants getting fully immunized, leaving a large population of infants vulnerable to disease outbreaks[8]. 

The problem of low vaccination coverage in Nigeria is further exacerbated by extreme poverty. This is especially true in North West Nigeria, where many mothers live on less than US$2 a day and cannot visit the clinic for various reasons. They face challenges such as affording the transportation cost to the clinic, associated loss in earnings from small-scale trading or farming, receiving permission from their partners, fear of vaccination side effects, cultural barriers to vaccination, or often a combination of these factors. Many of them are stuck in a cycle of poverty. Living at the bottom of the economic ladder forces them to make choices between their survival today and a better future for them and their children tomorrow [9].

The solution: Conditional cash transfers (CCTs)

Conditional cash transfer programmes (CCTs) give money to low-income households in return for fulfilling specific behavioral conditions. These conditions include, for example, children’s school attendance, up-to-date vaccinations or regular visits to a health care facility by pregnant women. CCTs have a direct effect on poverty by providing an immediate additional income for the poor, who can make their own choices as to how to spend or save this money. 

New Incentives is a pioneer in a growing movement committed to providing  small incentives to caregivers whose infants get immunized while also increasing awareness of the overall health benefits of childhood vaccinations. They offer cash transfers to caregivers who vaccinate their infants after verifying that their infant has gotten the latest vaccinations. New Incentives distributes a total of around US$11 for each infant — enough to cover transport, medicine, and food for their families [10] — across five separate cash transfers (disbursed over five separate visits to the clinic in the first year of the infant’s life). 

How New Incentives works

New Incentives runs a conditional cash transfer (CCT) program in North West Nigeria (Jigawa, Katsina, Zamfara) that disburses cash incentives to caregivers conditional on infants receiving four vaccines: BCG (against tuberculosis), PENTA (against diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenzae type b), PCV (against pneumococcal disease), and MCV (against measles). These vaccinations are part of the routine schedule for infant immunizations in Nigeria and are provided at no cost to the caregiver through government-supported clinics [11].

The New Incentives program trains field staff to attend immunization days at health clinics, disburse cash transfers after verifying that a vaccination was given, monitor clinics to ensure that vaccines are in stock and not expired, and provide photographic monitoring that cash transfers are given in the correct amount to parents whose infants have received a vaccine. The cash transfers are in the amount of 500 naira (~US$1.40) for each of the first four vaccine visits (from birth to 14 weeks) and 2,000 naira (~US$5.50)  for a fifth visit for the measles vaccine (at 9 months). In other words, caregivers can receive up to 4,000 Naira (~US$11) if the infant receives all doses in the routine immunization (RI) schedule over the course of five clinic visits [12].

Multiple studies show that expanding vaccination reduces illness and death among young children. IDinsight, in coordination with Hanovia Limited and three Nigerian state governments, conducted a three-year randomized controlled trial studying the efficacy of New Incentives’ work. The study found that the program led to increased immunization, increased likelihood that immunization was received at the recommended age and better knowledge and attitudes among caregivers towards immunization. In addition, children in areas served by the program had higher coverage for all major injectable vaccines – including those not directly incentivized by the program – and were more likely to have visited a health clinic. In other words, by incentivizing four vaccines, New Incentives was able to indirectly promote all vaccines that are part of the routine immunization schedule in Nigeria. Finally, New Incentives supported program clinics were more likely to report no or rare stockouts (instances where a vaccination is out-of-stock and unavailable) than those clinics not supported by the program, a finding that suggests the program’s impact may go beyond stimulating vaccine demand to also reducing vaccine supply-side constraints [13].

What makes New Incentives so effective


On average, the total cost to immunize one child through the New Incentives program is US$47. Excluding vaccination–related costs paid for by the Nigerian government and Gavi, the total cost is US$38 [14].

Holistic Approach

New Incentives has a holistic approach to addressing the challenge of low immunization rates. Not only do they disburse cash transfers to caregivers who vaccinate their infants after verifying that their infant has gotten the latest vaccinations, but also increase demand for immunization services by raising awareness of the benefits of vaccination and improve vaccine supply by identifying and addressing bottlenecks in the vaccine supply chain. 

Proven Results

A randomized controlled trial (RCT) of the New Incentives program found strong evidence that the program increases vaccinations. The percentage of children who were fully immunized in the program areas was 27 percentage points higher than in the control areas. Other benefits of the program include improving timeliness for receiving vaccinations, indirectly promoting vaccines not directly incentivized by the program, increasing knowledge and improving attitudes among caregivers and reducing stockouts in government clinics that were part of the program[15].

New Incentives’ Accountability

New Incentives focuses on a program with very strong evidence of effectiveness and cost–effectiveness. The organization is transparent and has rigorous processes in place to monitor and ensure that its conditional cash transfers reach the intended recipients.

Frequently Asked Questions

The cash transfers are in the amount of 500 naira for each of the first four vaccine visits (at birth, 6 weeks, 10 weeks, and 14 weeks) and 2,000 naira for the 9-month measles vaccine. In sum, caregivers can receive up to 4,000 Naira (~ US$11) if the infant receives all doses in the routine immunization (RI) schedule.

New Incentives focuses on using evidence-based methods to make programmatic decisions and to do the most good possible. Some examples of how they do this: they designed their program to use conditional cash transfers (CCTs), an approach that has been proven to be effective in changing health behaviors; they focus on immunizations and operate in North West Nigeria, where only around 25% of infants are fully immunized thus leading to devastating disease outbreaks; and they take operational decisions internally based on data to increase program effectiveness.

Conditional cash transfers (CCTS) are different from microloans. CCTs are not loans, meaning the recipient does not have to repay the transfer amount and is not subject to a cycle of debt.

New Incentives encourages timely vaccination recordkeeping and reporting and frequent review of vaccine stock to help prevent vaccine stockouts. They also provide support to government stakeholders to submit vaccine utilization reports. To assess vaccine quality, New Incentives works with clinic staff to review vaccine vial monitors (VVMs), vaccine expiry dates, and call Local Cold Chain Officers (LCCOs) and State Cold Chain Officers (SCCOs) every other week to verify the stock and validity of vaccine supply. A documented review of availability of adequate stock is completed before each immunization day, and any issues with supply are escalated and resolved prior to the start of immunization day sessions. Stockouts that occur during any session are also reported and efforts are made to resolve before the next session. Their teams work with LCCOs and SCCOs to ensure at least a two-week supply of adequate vaccines at all times. 

New Incentives operates where it can have the biggest impact: rural Nigeria. Nigeria is home to just 2.6% of the world’s population but accounts for 16% of the world’s mortality of children under five. As of 2019, Nigeria had the highest mortality rate in the world among children under five years.

Fraud mitigation is one of New Incentives’ core responsibilities. They have comprehensive procedures and systems to prevent and detect fraud. They carry out post-transfer reviews of each disbursement, regularly perform unannounced program audits, and have robust data analytics that they continuously iterate based on lessons learned. They follow rigorous standards for recruiting, training, and managing their personnel.

We recommend New Incentives because it has been named a Top Charity by GiveWell, one of our charity evaluators. 

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