IDEAS home Printed from https://ideas.repec.org/p/cdl/ucscec/qt8352m5xv.html
   My bibliography  Save this paper

Governance and the effectiveness of public health subsidies: Evidence from Ghana, Kenya and Uganda

Author

Listed:
  • Dizon-Ross, Rebecca
  • Dupas, Pascaline
  • Robinson, Jonathan

Abstract

Distributing subsidized health products through existing health infrastructure could substantially and cost-effectively improve health in sub-Saharan Africa. There is, however, widespread concern that poor governance - in particular, limited health worker accountability - seriously undermines the effectiveness of subsidy programs. We audit targeted bednet distribution programs to quantify the extent of agency problems. We find that around 80% of the eligible receive the subsidy as intended, and up to 15% of subsidies are leaked to ineligible people. Supplementing the program with simple financial or monitoring incentives for health workers does not improve performance further and is thus not cost-effective in this context.

Suggested Citation

  • Dizon-Ross, Rebecca & Dupas, Pascaline & Robinson, Jonathan, 2017. "Governance and the effectiveness of public health subsidies: Evidence from Ghana, Kenya and Uganda," Santa Cruz Department of Economics, Working Paper Series qt8352m5xv, Department of Economics, UC Santa Cruz.
    • Handle: RePEc:cdl:ucscec:qt8352m5xv
    as

    Download full text from publisher

    File URL: https://www.escholarship.org/uc/item/8352m5xv.pdf;origin=repeccitec
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Paul Niehaus & Sandip Sukhtankar, 2013. "Corruption Dynamics: The Golden Goose Effect," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 230-269, November.
    2. Nazmul Chaudhury & Jeffrey Hammer & Michael Kremer & Karthik Muralidharan & F. Halsey Rogers, 2006. "Missing in Action: Teacher and Health Worker Absence in Developing Countries," Journal of Economic Perspectives, American Economic Association, vol. 20(1), pages 91-116, Winter.
    3. Ernesto Dal Bó & Frederico Finan & Martín A. Rossi, 2013. "Strengthening State Capabilities: The Role of Financial Incentives in the Call to Public Service," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 128(3), pages 1169-1218.
    4. Rauch, James E. & Evans, Peter B., 2000. "Bureaucratic structure and bureaucratic performance in less developed countries," Journal of Public Economics, Elsevier, vol. 75(1), pages 49-71, January.
    5. Jakob Svensson, 2005. "Eight Questions about Corruption," Journal of Economic Perspectives, American Economic Association, vol. 19(3), pages 19-42, Summer.
    6. Martina Björkman & Jakob Svensson, 2009. "Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 735-769.
    7. Gertler, Paul & Vermeerch, Christel, 2013. "Using Performance Incentives to Improve Medical Care Productivity and Health Outcomes," Institute for Research on Labor and Employment, Working Paper Series qt9qn9q7ph, Institute of Industrial Relations, UC Berkeley.
    8. Paul Niehaus & Antonia Atanassova & Marianne Bertrand & Sendhil Mullainathan, 2013. "Targeting with Agents," American Economic Journal: Economic Policy, American Economic Association, vol. 5(1), pages 206-238, February.
    9. Vivian Hoffmann, 2009. "Intrahousehold Allocation of Free and Purchased Mosquito Nets," American Economic Review, American Economic Association, vol. 99(2), pages 236-241, May.
    10. Steffen Andersen & Seda Ertac & Uri Gneezy & Moshe Hoffman & John A. List, 2011. "Stakes Matter in Ultimatum Games," American Economic Review, American Economic Association, vol. 101(7), pages 3427-3439, December.
    11. Paul Glewwe & Nauman Ilias & Michael Kremer, 2010. "Teacher Incentives," American Economic Journal: Applied Economics, American Economic Association, vol. 2(3), pages 205-227, July.
    12. Vivi Alatas & Abhijit Banerjee & Rema Hanna & Benjamin A. Olken & Ririn Purnamasari & Matthew Wai-Poi, 2019. "Does Elite Capture Matter? Local Elites and Targeted Welfare Programs in Indonesia," AEA Papers and Proceedings, American Economic Association, vol. 109, pages 334-339, May.
    13. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
    14. Di Tella, Rafael & Schargrodsky, Ernesto, 2003. "The Role of Wages and Auditing during a Crackdown on Corruption in the City of Buenos Aires," Journal of Law and Economics, University of Chicago Press, vol. 46(1), pages 269-292, April.
    15. 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.
    16. Pascaline Dupas, 2014. "Short‐Run Subsidies and Long‐Run Adoption of New Health Products: Evidence From a Field Experiment," Econometrica, Econometric Society, vol. 82(1), pages 197-228, January.
    17. Markus Goldstein & Joshua Graff Zivin & James Habyarimana & Cristian Pop-Eleches & Harsha Thirumurthy, 2013. "The Effect of Absenteeism and Clinic Protocol on Health Outcomes: The Case of Mother-to-Child Transmission of HIV in Kenya," American Economic Journal: Applied Economics, American Economic Association, vol. 5(2), pages 58-85, April.
    18. Johannes Haushofer & Jeremy Shapiro, 2016. "The Short-term Impact of Unconditional Cash Transfers to the Poor: ExperimentalEvidence from Kenya," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1973-2042.
    19. Benjamin A. Olken & Rohini Pande, 2012. "Corruption in Developing Countries," Annual Review of Economics, Annual Reviews, vol. 4(1), pages 479-509, July.
    20. Adnan Q. Khan & Asim I. Khwaja & Benjamin A. Olken, 2016. "Tax Farming Redux: Experimental Evidence on Performance Pay for Tax Collectors," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(1), pages 219-271.
    21. Brock, J. Michelle & Lange, Andreas & Leonard, Kenneth L., 2015. "Esteem and social information: On determinants of prosocial behavior of clinicians in Tanzania," Journal of Economic Behavior & Organization, Elsevier, vol. 118(C), pages 85-94.
    22. repec:feb:framed:0088 is not listed on IDEAS
    23. Nazmul Chaudhury & Jeffrey S. Hammer, 2004. "Ghost Doctors: Absenteeism in Rural Bangladeshi Health Facilities," The World Bank Economic Review, World Bank, vol. 18(3), pages 423-441.
    24. Jessica Cohen & Pascaline Dupas, 2010. "Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(1), pages 1-45.
    25. Karthik Muralidharan & Venkatesh Sundararaman, 2011. "Teacher Performance Pay: Experimental Evidence from India," Journal of Political Economy, University of Chicago Press, vol. 119(1), pages 39-77.
    26. Benjamin A. Olken, 2007. "Monitoring Corruption: Evidence from a Field Experiment in Indonesia," Journal of Political Economy, University of Chicago Press, vol. 115(2), pages 200-249.
    27. Abhijit V. Banerjee & Esther Duflo & Rachel Glennerster, 2008. "Putting a Band-Aid on a Corpse: Incentives for Nurses in the Indian Public Health Care System," Journal of the European Economic Association, MIT Press, vol. 6(2-3), pages 487-500, 04-05.
    28. Van Rijckeghem, Caroline & Weder, Beatrice, 2001. "Bureaucratic corruption and the rate of temptation: do wages in the civil service affect corruption, and by how much?," Journal of Development Economics, Elsevier, vol. 65(2), pages 307-331, August.
    29. Jishnu Das & Jeffrey Hammer, 2014. "Quality of Primary Care in Low-Income Countries: Facts and Economics," Annual Review of Economics, Annual Reviews, vol. 6(1), pages 525-553, August.
    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. 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.
    2. Augsburg,Britta & Caeyers,Bet & Malde,Bansi Khimji, 2019. "Can Micro-Credit Support Public Health Subsidy Programs ?," Policy Research Working Paper Series 8846, The World Bank.
    3. Augsburg,Britta & Caeyers,Bet & Giunti,Sara & Malde,Bansi Khimji & Smets,Susanna, 2019. "Labelled Loans, Credit Constraints and Sanitation Investments," Policy Research Working Paper Series 8845, The World Bank.
    4. 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).
    5. Hamill, Heather & Hampshire, Kate & Mariwah, Simon & Amoako-Sakyi, Daniel & Kyei, Abigail & Castelli, Michele, 2019. "Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context," Social Science & Medicine, Elsevier, vol. 234(C), pages 1-1.
    6. Artur Nagapetyan & Alexander Drozd & Dmitry Subbotovsky, 2023. "How to Determine the Optimal Number of Cardiologists in a Region?," Mathematics, MDPI, vol. 11(21), pages 1-23, October.
    7. Zamboni, Yves & Litschig, Stephan, 2018. "Audit risk and rent extraction: Evidence from a randomized evaluation in Brazil," Journal of Development Economics, Elsevier, vol. 134(C), pages 133-149.
    8. De La O, Ana L. & Fernández-Vázquez, Pablo & Martel García, Fernando, 2023. "Federal and state audits do not increase compliance with a grant program to improve municipal infrastructure: A pre-registered field experiment," Journal of Development Economics, Elsevier, vol. 162(C).
    9. Mo, Di & Bai, Yu & Shi, Yaojiang & Abbey, Cody & Zhang, Linxiu & Rozelle, Scott & Loyalka, Prashant, 2020. "Institutions, implementation, and program effectiveness: Evidence from a randomized evaluation of computer-assisted learning in rural China," Journal of Development Economics, Elsevier, vol. 146(C).

    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. Rebecca Dizon-Ross & Pascaline Dupas & Jonathan Robinson, 2015. "Governance and the Effectiveness of Public Health Subsidies," NBER Working Papers 21324, National Bureau of Economic Research, Inc.
    2. Gans-Morse, Jordan & Borges, Mariana & Makarin, Alexey & Mannah-Blankson, Theresa & Nickow, Andre & Zhang, Dong, 2018. "Reducing bureaucratic corruption: Interdisciplinary perspectives on what works," World Development, Elsevier, vol. 105(C), pages 171-188.
    3. Borcan, Oana & Lindahl, Mikael & Mitrut, Andreea, 2014. "The impact of an unexpected wage cut on corruption: Evidence from a “Xeroxed” exam," Journal of Public Economics, Elsevier, vol. 120(C), pages 32-47.
    4. Roberto Burguet & Juan-José Ganuza & José García-Montalvo, 2016. "The Microeconomics of Corruption. A Review of Thirty Years of Research," Working Papers 908, Barcelona School of Economics.
    5. Maximiliano Lauletta & Martín A. Rossi & Christian A. Ruzzier, 2022. "Audits and Government Hiring Practices," Economica, London School of Economics and Political Science, vol. 89(353), pages 214-227, January.
    6. De La O, Ana L. & González, Lucas I. & Weitz-Shapiro, Rebecca, 2023. "Voluntary audits: Experimental evidence on a new approach to monitoring front-line bureaucrats," World Development, Elsevier, vol. 162(C).
    7. Abhijit Banerjee & Rema Hanna, 2012. "Corruption [The Handbook of Organizational Economics]," Introductory Chapters,, Princeton University Press.
      • Hanna, Rema N. & Mullainathan, Sendhil & Banerjee, Abhijit, 2012. "Corruption," Scholarly Articles 8830779, Harvard Kennedy School of Government.
      • Banerjee, Abhijit & Hanna, Rema & Mullainathan, Sendhil, 2012. "Corruption," Working Paper Series rwp12-023, Harvard University, John F. Kennedy School of Government.
      • Abhijit Banerjee & Rema Hanna & Sendhil Mullainathan, 2012. "Corruption," Working Papers id:4952, eSocialSciences.
      • Abhijit Banerjee & Sendhil Mullainathan & Rema Hanna, 2012. "Corruption," NBER Working Papers 17968, National Bureau of Economic Research, Inc.
    8. Benjamin A. Olken & Rohini Pande, 2012. "Corruption in Developing Countries," Annual Review of Economics, Annual Reviews, vol. 4(1), pages 479-509, July.
    9. Pascaline Dupas & Edward Miguel, 2016. "Impacts and Determinants of Health Levels in Low-Income Countries," NBER Working Papers 22235, National Bureau of Economic Research, Inc.
    10. Andrew Dustan & Stanislao Maldonado & Juan Manuel Hernandez-Agramonte, 2018. "Motivating bureaucrats with non-monetary incentives when state capacity is weak: Evidence from large-scale field experiments in Peru," Working Papers 136, Peruvian Economic Association.
    11. Peters, Jörg & Langbein, Jörg & Roberts, Gareth, 2016. "Policy evaluation, randomized controlled trials, and external validity—A systematic review," Economics Letters, Elsevier, vol. 147(C), pages 51-54.
    12. Shuguang Jiang & Marie Claire Villeval, 2022. "Dishonesty in Developing Countries -What Can We Learn From Experiments?," Working Papers hal-03899654, HAL.
    13. Adnan Q. Khan & Asim I. Khwaja & Benjamin A. Olken, 2016. "Tax Farming Redux: Experimental Evidence on Performance Pay for Tax Collectors," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(1), pages 219-271.
    14. Dupas, Pascaline & Jain, Radhika, 2023. "Can beneficiary information improve hospital accountability? Experimental evidence from a public health insurance scheme in India," Journal of Public Economics, Elsevier, vol. 220(C).
    15. Karthik Muralidharan & Paul Niehaus, 2017. "Experimentation at Scale," Journal of Economic Perspectives, American Economic Association, vol. 31(4), pages 103-124, Fall.
    16. Callen, Michael & Gulzar, Saad & Hasanain, Ali & Khan, Muhammad Yasir & Rezaee, Arman, 2023. "The political economy of public sector absence," Journal of Public Economics, Elsevier, vol. 218(C).
    17. Valsecchi, Michele, 2016. "Corrupt Bureaucrats: The Response of Non-Elected Officials to Electoral Accountability," Working Papers in Economics 684, University of Gothenburg, Department of Economics.
    18. Friedman, Willa & Keats, Anthony & Mutua, Martin Kavao, 2022. "Disruptions to healthcare quality and early child health outcomes: Evidence from health-worker strikes in Kenya," Journal of Health Economics, Elsevier, vol. 86(C).
    19. van Veldhuizen, R., 2013. "The influence of wages on public officials’ corruptibility: A laboratory investigation," Journal of Economic Psychology, Elsevier, vol. 39(C), pages 341-356.
    20. 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.

    More about this item

    Keywords

    Economics; Applied Economics; Economic Theory; Cost Effectiveness Research; Health Services; Comparative Effectiveness Research; Clinical Research; Good Health and Well Being; Leakage; Extortion; Shirking; Motivation; extortion; leakage; motivation; shirking; Econometrics; Applied economics; Economic theory;
    All these keywords.

    JEL classification:

    • D73 - Microeconomics - - Analysis of Collective Decision-Making - - - Bureaucracy; Administrative Processes in Public Organizations; Corruption
    • H11 - Public Economics - - Structure and Scope of Government - - - Structure and Scope of Government
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

    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:cdl:ucscec:qt8352m5xv. 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: Lisa Schiff (email available below). General contact details of provider: https://edirc.repec.org/data/ecucsus.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.