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Article History

Received: 21 January 2024

Accepted: 9 November 2025

First Online: 24 December 2025

Declarations

:

: Ethical clearance was granted by the University of Gondar’s Institutional Ethical Review Board (R.N.O.: V/P/RCS/05/861–2021). Identity details used for tracking mothers during data collection were deidentified throughout the analysis. Participants gave written informed consent. All methods adhered to relevant guidelines and regulations.The PBNI intervention was implemented as a group-based initiative within existing service delivery structures, rather than as an individual incentive scheme. All participating health workers underwent orientation on the intervention’s objectives, eligibility criteria, and award process, promoting transparency and fairness. Non-financial rewards were allocated based on consistent, performance-based criteria across facilities. Nominations were reviewed jointly by district managers and health-center heads to prevent favoritism. Ethical concerns about unequal access to incentives were addressed by highlighting the program’s goal of improving quality. The recognition system aimed to foster teamwork and enhance data quality, not to stigmatize non-recipients. Both intervention and comparison districts received the standard support package, ensuring no site was disadvantaged by the study design.

: Not applicable.

: The authors declare no competing interests.