The New Incentives programme
Rees Calder · 28 April 2026 · 7 min read
In northern Nigeria, routine childhood vaccination rates hover around 30-40% in some states. The vaccines exist. The clinics exist. The health workers exist. But the children don't show up, because the journey costs money, the opportunity cost of a day's work is real, and the perceived risk of not vaccinating feels abstract compared to the concrete cost of getting there.
New Incentives solved this with a brutally simple idea: pay caregivers small cash transfers, conditional on bringing their children in for routine vaccinations. Not a new vaccine. Not a new clinic. Just a small financial nudge that tips the cost-benefit calculation for families living on the edge.
GiveWell added New Incentives to their list of top charities in 2021. By 2024, it was one of their largest funding recipients, receiving over $60 million in directed grants. The programme operates in six Nigerian states and has incentivised over 3 million vaccination visits since 2017.
How it works
The programme targets the five routine childhood vaccines recommended by the WHO for Nigeria: BCG (tuberculosis), OPV (polio), Penta (diphtheria, tetanus, pertussis, hepatitis B, Hib), PCV (pneumococcal), and measles.
The cash transfer. Caregivers receive roughly 500-1,000 Nigerian Naira (about $0.60-1.20) per vaccination visit. The amounts are small by Western standards but meaningful for families earning $1-2 per day. The total possible payout across all scheduled visits is roughly $4-6 per child.
The conditionality. Payment is conditional on bringing the child to the clinic for the scheduled vaccination. No vaccination, no payment. This isn't punitive; it's a simple alignment of incentives. The cash covers transport costs and compensates for lost work time.
The delivery. New Incentives staff work directly at government health clinics. They verify attendance, distribute payments, and track which children have been reached. The infrastructure piggybacks on the existing government health system rather than creating a parallel one.
The evidence
The programme's evidence base is unusually strong for a development intervention.
The RCT. IDinsight conducted a randomised controlled trial across 347 health clinics in Zamfara, Jigawa, and Katsina states (2017-2020). Clinics were randomly assigned to receive the New Incentives programme or continue as usual. The primary outcome: whether children received their full course of vaccinations.
Results. The programme increased full vaccination rates by roughly 17-24 percentage points depending on the state and vaccine. For measles specifically (often the hardest to reach because it's the last in the schedule), coverage increased by roughly 14 percentage points.
Cost-effectiveness. GiveWell's 2024 analysis estimates the cost per additional child fully vaccinated at roughly $40-60, which translates to roughly $5-7 per additional vaccination (since full vaccination requires multiple visits). When converted to GiveWell's standard "units of value" framework, New Incentives produces roughly 5-8x the impact per dollar compared to unconditional cash transfers to people in extreme poverty.
The comparison that matters. The IDinsight trial included a comparison arm that tracked what happened to vaccination rates without the programme. They stayed roughly flat. The cash transfers weren't replacing organic growth in vaccination; they were creating new vaccinations that wouldn't have happened otherwise.
Why cash incentives work here
Three features of the Nigerian context make conditional cash transfers particularly effective for vaccination.
Cost as the binding constraint. In areas where New Incentives operates, surveys consistently find that the primary barrier to vaccination isn't vaccine hesitancy or distrust of medicine. It's the direct cost of travel and the opportunity cost of time. The cash transfer directly addresses the binding constraint. This is why information campaigns alone haven't moved the needle in these regions.
Predictable schedule. Childhood vaccination follows a known timetable. Caregivers know when the next visit should be. This makes conditionality simple to administer: show up on the right day with your child, get paid. Compare this to conditional cash transfers for school attendance, where the conditionality is harder to verify and the timeline is less clear.
High return per visit. Each vaccination protects against diseases that kill hundreds of thousands of children annually in sub-Saharan Africa. The WHO estimates that childhood vaccination prevents roughly 2-3 million deaths per year globally. Each visit to the clinic produces a discrete, measurable health outcome, which makes the programme's impact relatively easy to track and verify.
The scale question
New Incentives currently operates in six of Nigeria's 36 states, all in the north where vaccination rates are lowest. The programme has delivered over 6 million cash transfers since inception.
Room for growth. Nigeria has roughly 7 million births per year, with particularly low vaccination rates in northern states. New Incentives estimates they could expand to 10-12 additional states if funding were available. GiveWell's 2024 room-for-more-funding analysis flagged New Incentives as having substantial room for additional grants, partly because the Nigerian government has been supportive of expansion.
Government partnership. The programme works within the existing government health system, not around it. This is a deliberate design choice. New Incentives staff operate at government clinics, government health workers administer the vaccines, and government data systems track coverage. The cash transfers are the only added element. This makes the programme cheaper to run (no parallel infrastructure), more sustainable (government ownership), and politically viable (the government takes credit for improved vaccination rates).
The sustainability question. Critics ask: what happens when the funding stops? Two responses. First, the evidence from similar conditional cash transfer programmes (notably Mexico's PROGRESA/Oportunidades) suggests that health behaviours often persist after incentives end, because caregivers see the benefits and develop the habit. Second, even if the behaviour doesn't persist, the children already vaccinated retain their immunity. The benefits are locked in.
How it compares
Within GiveWell's portfolio, New Incentives sits alongside three other top charities focused on different aspects of child health in low-income countries.
Against Malaria Foundation: distributes bed nets, roughly 4-7x cash in cost-effectiveness. Addresses a different problem (malaria prevention vs. vaccination uptake).
Malaria Consortium: seasonal malaria chemoprevention, roughly 7-10x cash. Also malaria-focused, complementary to New Incentives rather than substitutive.
Helen Keller International: vitamin A supplementation, roughly 8-12x cash. Addresses micronutrient deficiency, another dimension of child health entirely.
New Incentives is slightly less cost-effective per GiveWell's models than the malaria-focused charities, but it addresses a different disease burden. A diversified portfolio across these charities covers more of the child health landscape.
For your giving
New Incentives accepts donations directly and through GiveWell's Maximum Impact Fund, which allocates across top charities based on marginal cost-effectiveness.
The case for donating to New Incentives specifically (rather than letting GiveWell allocate): if you want to fund vaccination specifically, if you value the programme's strong RCT evidence, or if you believe vaccination programmes have positive externalities (herd immunity effects) that GiveWell's models undercount.
The case for GiveWell's Maximum Impact Fund instead: if you trust GiveWell's marginal allocation and want your money to go wherever the next dollar has the highest expected impact, which may or may not be New Incentives in any given quarter.
One sentence
New Incentives pays Nigerian caregivers small cash transfers to vaccinate their children, increasing full vaccination rates by 17-24 percentage points at a cost of roughly $5-7 per additional vaccination, making it one of the most cost-effective ways to save young lives.
Sources used: GiveWell New Incentives charity page and cost-effectiveness analysis (2024), IDinsight RCT results for New Incentives conditional cash transfer programme in Nigeria (2017-2020, published 2022), WHO global vaccination coverage estimates (2024), New Incentives annual report and programme data (2024), GiveWell Maximum Impact Fund allocation methodology (2024), PROGRESA/Oportunidades long-term follow-up evidence on behaviour persistence (multiple studies, synthesised in World Bank 2023). Full links in the planning doc.