IDEAS home Printed from https://ideas.repec.org/a/aea/aejapp/v11y2019i3p155-92.html
   My bibliography  Save this article

Reducing Child Mortality in the Last Mile: Experimental Evidence on Community Health Promoters in Uganda

Author

Listed:
  • Martina Björkman Nyqvist
  • Andrea Guariso
  • Jakob Svensson
  • David Yanagizawa-Drott

Abstract

The delivery of basic health products and services remains abysmal in many parts of the world where child mortality is high. This paper shows the results from a large-scale randomized evaluation of a novel approach to health care delivery. In randomly selected villages, a sales agent was locally recruited and incentivized to conduct home visits, educate households on essential health behaviors, provide medical advice and referrals, and sell preventive and curative health products. Results after 3 years show substantial health impact: under 5-years child mortality was reduced by 27 percent at an estimated average cost of $68 per life-year saved.

Suggested Citation

  • Martina Björkman Nyqvist & Andrea Guariso & Jakob Svensson & David Yanagizawa-Drott, 2019. "Reducing Child Mortality in the Last Mile: Experimental Evidence on Community Health Promoters in Uganda," American Economic Journal: Applied Economics, American Economic Association, vol. 11(3), pages 155-192, July.
    • Handle: RePEc:aea:aejapp:v:11:y:2019:i:3:p:155-92
    Note: DOI: 10.1257/app.20170201
    as

    Download full text from publisher

    File URL: https://www.aeaweb.org/doi/10.1257/app.20170201
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/app.20170201.data
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/app.20170201.ds
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Ashraf, Nava & Bandiera, Oriana & Jack, B. Kelsey, 2014. "No margin, no mission? A field experiment on incentives for public service delivery," Journal of Public Economics, Elsevier, vol. 120(C), pages 1-17.
    2. Auriol, Emmanuelle & Warlters, Michael, 2012. "The marginal cost of public funds and tax reform in Africa," Journal of Development Economics, Elsevier, vol. 97(1), pages 58-72.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Wagner, Zachary & Asiimwe, John Bosco & Levine, David I., 2020. "When financial incentives backfire: Evidence from a community health worker experiment in Uganda," Journal of Development Economics, Elsevier, vol. 144(C).
    2. Darin Christensen & Oeindrila Dube & Johannes Haushofer & Bilal Siddiqi & Maarten Voors, 2021. "Building Resilient Health Systems: Experimental Evidence from Sierra Leone and The 2014 Ebola Outbreak," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(2), pages 1145-1198.
    3. Mansuri, Ghazala & Palaniswamy, Nethra & Rao, Vijayendra & Shrestha, Slesh A., 2023. "Money versus Kudos: The impact of incentivizing local politicians in India," Journal of Public Economics, Elsevier, vol. 224(C).
    4. Pascaline Dupas & Basimenye Nhlema & Zachary Wagner & Aaron Wolf & Emily Wroe, 2023. "Expanding Access to Clean Water for the Rural Poor: Experimental Evidence from Malawi," American Economic Journal: Economic Policy, American Economic Association, vol. 15(1), pages 272-305, February.
    5. Manjisha Sinha & R. Sendhil & B. S. Chandel & Ravinder Malhotra & Ajmer Singh & Sujeet Kumar Jha & Gopal Sankhala, 2022. "Are Multidimensional Poor more Vulnerable to Climate change? Evidence from Rural Bihar, India," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 162(1), pages 123-149, July.
    6. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2020. "Reducing the Cost of Remoteness: Community-Based Health Interventions and Fertility Choices," Journal of Health Economics, Elsevier, vol. 73(C).
    7. Erika Deserranno & Philipp Kastrau & Gianmarco León-Ciliotta, 2021. "Promotions and Productivity: The Role of Meritocracy and Pay Progression in the Public Sector," Working Papers 1239, Barcelona School of Economics.
    8. Sayli Javadekar & Kritika Saxena, 2021. "The Seen and the Unseen: Impact of a Conditional Cash Transfer Program on Prenatal Sex Selection," IHEID Working Papers 15-2021, Economics Section, The Graduate Institute of International Studies.
    9. Fracchia, Mattia & Molina-Millán, Teresa & Vicente, Pedro C., 2023. "Motivating volunteer health workers in an African capital city," Journal of Development Economics, Elsevier, vol. 163(C).
    10. Johannes M. Bos & Akib Khan & Saravana Ravindran & Abu S. Shonchoy, 2021. "Early Childhood Human Capital Formation at Scale," Working Papers 2115, Florida International University, Department of Economics.
    11. Pan, Yao & Singhal, Saurabh, 2019. "Agricultural extension, intra-household allocation and malaria," Journal of Development Economics, Elsevier, vol. 139(C), pages 157-170.
    12. Rubli, Adrian, 2023. "Trade-offs between access and quality in healthcare: Evidence from retail clinics in Mexico," Journal of Public Economics, Elsevier, vol. 224(C).
    13. Deserranno, Erika & León-Ciliotta, Gianmarco, 2022. "Promotions and Productivity: The Role of Meritocracy and Pay Progression in the Public Sector," CEPR Discussion Papers 15837, C.E.P.R. Discussion Papers.
    14. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2023. "Community-based health programs and child vaccinations: Evidence from Madagascar," World Development, Elsevier, vol. 170(C).
    15. Erika Deserranno & Aisha Nansamba & Nancy Qian, 2020. "The Unintended Consequences of NGO-Provided Aid on Government Services in Uganda," NBER Working Papers 26928, National Bureau of Economic Research, Inc.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ceyhun Elgin & Orhan Torul & Tugce Turk, 2022. "Marginal Cost of Public Funds under the Presence of Informality," Hacienda Pública Española / Review of Public Economics, IEF, vol. 241(2), pages 79-103, June.
    2. Dwenger, Nadja & Kleven, Henrik & Rasul, Imran & Rincke, Johannes, 2014. "Extrinsic vs Intrinsic Motivations for Tax Compliance. Evidence from a Randomized Field Experiment in Germany," VfS Annual Conference 2014 (Hamburg): Evidence-based Economic Policy 100389, Verein für Socialpolitik / German Economic Association.
    3. Pierre M. Picard & Ridwan D. Rusli, 2018. "State‐owned firms and private debt," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 20(5), pages 672-702, October.
    4. Jörg L. Spenkuch & Edoardo Teso & Guo Xu, 2023. "Ideology and Performance in Public Organizations," Econometrica, Econometric Society, vol. 91(4), pages 1171-1203, July.
    5. Caria, Stefano & Deserranno, Erika & León-Ciliotta, Gianmarco & Kastrau, Philipp, 2022. "The Allocation of Incentives in Multi-Layered Organizations," CEPR Discussion Papers 17303, C.E.P.R. Discussion Papers.
    6. Andrew Dustan & Juan Manuel Hernandez-Agramonte & Stanislao Maldonado, 2018. "Motivating bureaucrats with non-monetary incentives when state capacity is weak: Evidence from large-scale," Natural Field Experiments 00664, The Field Experiments Website.
    7. Luca Picariello, 2019. "Promotions and Training: Do Competitive Firms Set the Bar too High?," CSEF Working Papers 552, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
    8. Alberto Chong & Marco Gonzalez-Navarro & Dean Karlan & Martín Valdivia, 2020. "Do Information Technologies Improve Teenagers’ Sexual Education? Evidence from a Randomized Evaluation in Colombia," The World Bank Economic Review, World Bank, vol. 34(2), pages 371-392.
    9. Christiane Bradler & Robert Dur & Susanne Neckermann & Arjan Non, 2013. "Employee Recognition and Performance: A Field Experiment," Tinbergen Institute Discussion Papers 13-038/VII, Tinbergen Institute.
    10. Hörcher, Daniel & Tirachini, Alejandro, 2021. "A review of public transport economics," Economics of Transportation, Elsevier, vol. 25(C).
    11. Non, Arjan & Rohde, Ingrid & de Grip, Andries & Dohmen, Thomas, 2022. "Mission of the company, prosocial attitudes and job preferences: A discrete choice experiment," Labour Economics, Elsevier, vol. 74(C).
    12. Clare Leaver & Owen Ozier & Pieter Serneels & Andrew Zeitlin, 2021. "Recruitment, Effort, and Retention Effects of Performance Contracts for Civil Servants: Experimental Evidence from Rwandan Primary Schools," American Economic Review, American Economic Association, vol. 111(7), pages 2213-2246, July.
    13. Ramos, Raúl & Silva, Hugo E., 2023. "Fare evasion in public transport: How does it affect the optimal design and pricing?," Transportation Research Part B: Methodological, Elsevier, vol. 176(C).
    14. Sylvia, Sean & Ma, Xiaochen & Shi, Yaojiang & Rozelle, Scott, 2022. "Ordeal mechanisms, information, and the cost-effectiveness of strategies to provide subsidized eyeglasses," Journal of Health Economics, Elsevier, vol. 82(C).
    15. Daubanes, Julien Xavier & Lasserre, Pierre, 2023. "How should the use of nonrenewables be taxed under a public budget constraint?," Resource and Energy Economics, Elsevier, vol. 73(C).
    16. Oriana Bandiera & Iwan Barankay & Imran Rasul, 2011. "Field Experiments with Firms," Journal of Economic Perspectives, American Economic Association, vol. 25(3), pages 63-82, Summer.
    17. Greer K. Gosnell & John A. List & Robert Metcalfe, 2016. "A New Approach to an Age-Old Problem: Solving Externalities by Incenting Workers Directly," NBER Working Papers 22316, National Bureau of Economic Research, Inc.
    18. Martin, Will, 2021. "Tools for measuring the full impacts of agricultural interventions," IFPRI-MCC technical papers 2, International Food Policy Research Institute (IFPRI).
    19. Gjedrem, William Gilje & Rege, Mari, 2017. "The effect of less autonomy on performance in retail: Evidence from a quasi-natural field experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 136(C), pages 76-90.
    20. Fay, Marianne & Martimort, David & Straub, Stéphane, 2021. "Funding and financing infrastructure: The joint-use of public and private finance," Journal of Development Economics, Elsevier, vol. 150(C).

    More about this item

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • O15 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Economic Development: Human Resources; Human Development; Income Distribution; Migration
    • O18 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Urban, Rural, Regional, and Transportation Analysis; Housing; Infrastructure

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:aea:aejapp:v:11:y:2019:i:3:p:155-92. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Michael P. Albert (email available below). General contact details of provider: https://edirc.repec.org/data/aeaaaea.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.