Working Paper: CEPR ID: DP10690
Authors: Rebecca Dizon-Ross; Pascaline Dupas; Jonathan Robinson
Abstract: Heavily subsidizing essential health products through existing health infrastructure has the potential to substantially decrease child mortality in sub-Saharan Africa. There is, however, widespread concern that poor governance and in particular limited accountability among health workers seriously undermines the effectiveness of such programs. We performed innovative audits on bed net distribution programs in three countries (Ghana, Kenya and Uganda) to investigate local agency problems and their determinants in the allocation of targeted subsidies. Overall, agency concerns appear modest. Around 80% of the eligible receive the subsidy as intended and leakage to the ineligible appears limited, even when the ineligible have a high willingness to pay. The estimated level of mistargeting only modestly affects the cost-effectiveness of free distribution.
Keywords: extortion; leakage; motivation; shirking
JEL Codes: D73; H11; I15; I38
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| agency problems in the distribution of health subsidies (H51) | effectiveness of the subsidy program (H53) |
| voucher scheme (H41) | health worker performance (I15) |
| voucher scheme (H41) | leakage to ineligible clients (H53) |