Working Paper: NBER ID: w21324
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: public health; subsidies; governance; agency problems; child mortality
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 (extortion, leakage, and shirking) (D82) | effectiveness of health subsidy distribution (H51) |
| Governance features (audits, compensation, and distribution mechanisms) (G38) | health worker behavior and program outcomes (I14) |
| Agency problems (G34) | cost-effectiveness of free distribution (D39) |
| Governance features (audits and compensation) (G38) | health worker performance (I15) |