Type of Investment


Project Stage

Test & Transition

Length of Investment



Investment Overview

A $850,000 grant to support a three-year randomised controlled trial in Karachi, Pakistan designed to find the optimal incentive amount, schedule, and design needed to achieve high immunisation rates in a cost-effective way.


The Development Challenge

According to the WHO, an estimated 18.7 million infants worldwide were not reached with routine immunisation services in 2014. A particular problem is the decrease in immunisation rates over the duration of the immunisation programme. In many countries, higher immunisation rates early in infancy dip significantly by the end of the immunisation schedule. Studies indicate that in Pakistan alone, an estimated 9-13 million children under the age of 2 have not received age-appropriate immunisation coverage.


The Innovation

Prior research suggests that small incentives for parents can increase full immunisation rates six-fold. Interactive Research and Development will seek to find the most cost-effective policy for delivering such small nudges, by testing the effectiveness of different amounts and pay-out mechanisms.


Our Investment

With this investment, GIF supported Interactive Research and Development to carry out a three-year randomised controlled trial. The study occurred in a context where it has the potential to be integrated into long-term government programs: within an existing immunisation programme that uses a phone-based electronic registry for childhood immunisations in Karachi, Pakistan. The registry has been linked to an interactive SMS messaging system and to electronic mobile money transfers, which would be used to deliver SMS reminders and small cash transfers to parents.


Investment Objective

Use an RCT to devise the optimal incentive structure to cost-effectively promote immunisation.


Why we invested

This well-designed RCT addresses an important public health challenge with significant potential benefits on child mortality and morbidity.

A strong local team, with extensive technical expertise, positive track record, and good relations with local and national governments.

Strong support from funders of immunisation programmes (notably NORAD), strong additionality to current efforts in Pakistan, and initial political support of key Pakistani health officials.

Potential to address both financial and logistical scale-up constraints to immunisation programmes.


CCTs for Immunisations in numbers

1.5 million

Children die each year from vaccine-preventable diseases

Over 11,000

Children vaccinated in Karachi, Pakistan


CCTs for Immunisations Impact Brief

It is estimated that basic immunisation services do not reach over 19 million infants worldwide, and over 1.5 million children die from vaccine-preventable diseases (click here to read more). The majority of these children reside in low-and middle-income countries. Existing research suggests that small incentives for parents can increase full immunisation rates; however, there are still unknowns about the most effective way to structure incentives in terms of size, schedule, and design.

In 2016, GIF provided an $856,215 grant to IRD Global to conduct a three-year randomised controlled trial in Karachi, Pakistan, to understand how small conditional cash transfers (CCTs) can incentivize parents to have their children take up and complete vaccination schedules. Through this study, IRD seeks to understand the optimal design and delivery model for delivering these small cash incentives in a cost-effective and logistically simple way. This evidence is expected to be relevant to driving policy decisions that ultimately contribute to lowering child morbidity and mortality in low-income contexts.

Use of GIF funds

GIF’s funding of $856,215 is allocated to costs associated with delivering the randomised controlled trial, including research and implementation personnel, participant costs (e.g., incentive payouts), equipment, and other project costs.

In 2020, in response to the Covid-19 pandemic, GIF provided IRD with $307,658 in grant funding to support community-based Covid-19 response work in Pakistan. Funds are used to cover costs of Covid-19 screening, case management, adapting a health application for data management, remote contact tracing, mental health counselling, oxygen therapy at 208 GP clinics in Karachi, and a referral system grounded at the community level.


To conduct an experimental study in Karachi, Pakistan, to measure the relative effectiveness of different types of incentive structures (including the optimal amount, progressivity, and certainty of payment) on immunisation coverage rates and timeliness. Additionally, to identify the optimal model of delivering small incentives that has minimal associated costs, is logistically simple, and not subject to leakage.

Impact to Date

To date, the programme has vaccinated over 11,000 children in Karachi, Pakistan. Interim results suggest that small mobile-based incentives coupled with SMS reminders can significantly improve immunisation coverage in children (click here to read the progress of the study). The final results of the study are yet to be published.

Over 26,000 people were reached through Covid-19 response work delivered by IRD and its partners in the Sindh province of Pakistan.