Funded research

Principal Investigators: Professor Mylène Lagarde (LSE), Dr. Isaac Mbiti (University of Virginia, J-PAL), Professor Godfrey Biemba (National Health Research Authority, Zambia)

Ongoing: 1/5/2024-31/3/2026

Co-Investigator(s):

Professor Felix Masiye (University of Zambia)

Lonnie Hackett (Healthy Learners)

Marta Grabowska (LSE)

Andrew Avitabile (University of Virginia)

Funding Stream: MRC Applied Global Health Research Grant (Round 2)

Co-funding: USAID DIV grant

School-aged children in Zambia face a high burden of preventable illness, yet remain underserved by health systems that prioritize children under five. In response, Healthy Learners has developed a low-cost, comprehensive school health programme (SHP) that leverages schools as a platform for delivering health education, preventive services, and first-line clinical assessments through trained School Health Workers (teachers). This study aims to rigorously evaluate the impact of the SHP on health and education outcomes via a large cluster-randomised controlled trial across 225 schools in Zambia’s Copperbelt and Luapula provinces. The intervention group will receive the comprehensive SHP; comparison arms will receive either standard or enhanced current health activities.

The research will assess health outcomes (timely access to care and morbidity), education outcomes (attendance and learning), and it will also examine broader system impacts on teachers, clinics, and households’ beliefs. A detailed process and economic evaluation will inform the programme's scalability and cost-effectiveness. The ultimate goal is to inform national school health policy in Zambia and other low-income countries by generating rigorous evidence on a scalable model for improving child health and education.

Principal Investigators: Professor Mylene Lagarde and Marta Grabowska

Co-Investigator(s): Nick Laing – Co-founder & Country Director, OneDay Health (Uganda)

Dates: 1/5/2024-31/3/2026

Funding Stream: LSE 100x Impact Accelerator – Research Grant (Social Venture Partnership, Health & Social Care theme)

In partnership with the social enterprise OneDay Health (1DH), the project will embed a cluster-randomised controlled trial into 1DH’s 2025 expansion of 20 new nurse-led clinics in “health-care black-hole” communities across south-west Uganda. Forty matched rural communities will be randomised so that half receive a new 1DH clinic (testing the effect of reduced distance), while, within treated villages, half of study households also receive cards for free child consultations (testing the effect of zero user fees). High-frequency pictorial health diaries over ten weeks plus an end-line household survey and malaria RDTs will measure (i) under-use and over-use of care, (ii) medical spending, and (iii) child morbidity and wider economic outcomes. Provider surveys will track how the entry of a formal clinic reshapes local drug-shop markets. The trial will deliver the first causal estimates that disentangle geographic from financial barriers, informing design of low-cost, scalable primary-care models for remote populations.

This project builds directly on the 2024 100x-funded study Quality of and demand for care in rural Uganda, leveraging established field infrastructure.

Principal Investigator: Professor Mylene Lagarde (LSE)

Co-Investigators:

• Dr Nick Stacey – Duke-NUS (ex PhD student at LSE)
• Dr Duane Blaauw – School of Public Health, University of the Witwatersrand

Dates: 1/5/2024-1/3/2025

Funding Stream: LSE Research & Innovation Support Fund (RISF) 2023-24

South Africa is preparing a National Health Insurance (NHI) that will contract private providers to extend free, high-quality care. The project investigates two critical unknowns for the reform: (1) whether patients actually choose providers on the basis of clinical quality rather than convenience or reputation, and (2) whether giving patients clear, credible information about provider quality alters those choices. Building on an existing MRC-funded study that gives 1,000 low-income parents in Soweto free access to a network of private clinics, the team will (a) deploy standardised patients to generate an objective quality score for 18 private practices, (b) randomise households to receive or not receive a simple, visual “report-card” on those quality scores, and (c) track weekly utilisation, costs and child-health outcomes, supplemented by an end-line survey and choice-model analysis. The experiment will reveal how strongly quality, distance, price and reputation each drive provider selection, and will simulate policy scenarios relevant to the NHI roll-out.

The trial is embedded in an existing study SOPRIMA, funded by the UK Medical Research Council (MRC).

Results will inform not only South Africa’s design of a National Health Insurance but also wider debates on using quality “report cards” to steer patient demand in low- and middle-income countries.

Principal Investigator(s): Professor Mylene Lagarde (LSE) and Dr Abu Siddique (Royal Holloway)

Co-Investigator(s):

• Professor Marcos Vera-Hernández – University College London
• Dr Fahmida Chowdhury – icddr,b, Bangladesh
• Nasrin Akter Mila – Society for Amelioration of Rural Communities and Households (SARCH), Bangladesh

Dates: 1/4/2024-31/3/2025

Funding Stream: LSE International Science Partnerships Fund (ISPF) 2024-25

Childhood diarrhoea in rural Bangladesh is still the second leading cause of under-five mortality, yet effective, low-cost oral rehydration salts (ORS) remain under-used while unnecessary antibiotics are routinely prescribed, fuelling antimicrobial resistance. The project will co-create an edutainment documentary with local filmmakers to correct treatment misconceptions among caregivers and informal drug sellers, and to expose profit-driven over-prescription incentives. A three-arm cluster-randomised controlled trial in 250 villages (≈3,750 households plus all local drug sellers) will compare a placebo film with two information treatments (private viewing vs. private + revealed patient expectations). Primary outcomes include changes in knowledge, beliefs, prescription patterns (ORS vs. antibiotics), treatment costs and child morbidity; an audit study using mystery clients will validate provider behaviour.