With an estimated 72 million cases in 2017, India currently represents 49 per cent of the global diabetes burden. Lifestyle changes such as increased physical activity and dietary modifications can prevent the disease and help the diagnosed avert serious long-term complications like amputations, heart disease, kidney disease, and stroke. Offering rewards can trigger behaviour change among individuals, but little evidence exists on how incentives should be designed to make them work effectively, while maintaining low costs for governments.
This study grew from TCD’s partnership with Abdul Latif Jameel Poverty Action Lab (J-PAL), South Asia and the Government of Tamil Nadu (GoTN) to address a key policy concern for the Department of Health and Family Welfare: how to effectively manage the burden of NCDs, especially, diabetes?
A decision was taken to evaluate several interventions to daily disease management that have shown to be cost-effective in other contexts. The study, which covered more than 3,000 diabetics and pre-diabetics in Coimbatore, found that on average, providing incentives increases daily walking by 1,200 steps or roughly 12 minutes of brisk walking, and improves health indicators, including decrease in Hba1c by 0.1- 0.2 per cent, in RBS by 6-8 mg/dL, and decreased “health risk index”.
On average, providing incentives increases daily walking by 1,200 steps or roughly 12 minutes of brisk walking, and decreases the health risk factors for diabetes.
Given the positive initial findings, the GoTN has expressed interest in learning how to scale up the incentive scheme into a larger policy intervention. The ultimate goal is to turn this project into a publicly funded program, which would encourage positive lifestyle changes and improve daily disease management.
Researchers are working with GoTN to identify opportunities for improving cost-effectiveness through individually customizing incentives. The results of the study, which designs and evaluates the impact of incentivizing and monitoring healthy behavior on the management of diabetes, would be of interest not only for GoTN, but for state governments across India.