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Can At-Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa?

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  • Adrienne M. Lucas

    (Department of Economics, University of Delaware, and NBER)

  • Nicholas L. Wilson

    (Department of Economics, Reed College, and Office of Evaluation Sciences Author email: nwilson@reed.edu)

Abstract

The single largest item in the US foreign aid health budget is antiretroviral therapy (ART) for the treatment of HIV/AIDS. Many supply- and demand-side factors in sub-Saharan Africa could cause smaller than expected epidemiological effects of this at-scale drug provision. We provide what appears to be the first quasi-experimental evidence on the effect of at-scale drug provision in a poor country, using the phased rollout of ART in Zambia, a setting where approximately one in six adults are HIV positive. Combining anthropometric data from national household surveys and a spatially based triple-difference specification, we find that local ART introduction increased the weight of high HIV likelihood adult women. This finding from a clinically difficult setting suggests that the generalized challenges of scalability of ART for adult health in sub-Saharan Africa are surmountable.

Suggested Citation

  • Adrienne M. Lucas & Nicholas L. Wilson, 2018. "Can At-Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa?," American Journal of Health Economics, MIT Press, vol. 4(3), pages 358-382, Summer.
    • Handle: RePEc:tpr:amjhec:v:4:y:2018:i:3:p:358-382
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    Cited by:

    1. Lucas, Adrienne M. & Chidothe, Margaret & Wilson, Nicholas L., 2019. "Effects of adult health interventions at scale on children’s schooling: Evidence from antiretroviral therapy in Zambia," Economics of Education Review, Elsevier, vol. 72(C), pages 107-120.
    2. Fitzpatrick, Anne & Beg, Sabrin & Derksen, Laura & Karing, Anne & Kerwin, Jason & Lucas, Adrienne M. & Ordaz Reynoso, Natalia & Squires, Munir, 2021. "Health knowledge and non-pharmaceutical interventions during the Covid-19 pandemic in Africa," Journal of Economic Behavior & Organization, Elsevier, vol. 190(C), pages 33-53.
    3. 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).
    4. Wilson, Nicholas, 2018. "Altruism in preventive health behavior: At-scale evidence from the HIV/AIDS pandemic," Economics & Human Biology, Elsevier, vol. 30(C), pages 119-129.
    5. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2023. "Community-based health programs and child vaccinations: Evidence from Madagascar," World Development, Elsevier, vol. 170(C).

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    More about this item

    Keywords

    foreign aid; health; HIV/AIDS; PEPFAR; targeting; Zambia;
    All these keywords.

    JEL classification:

    • H40 - Public Economics - - Publicly Provided Goods - - - General
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

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