Evaluating Nationwide Health Interventions when Standard Before-After Doesn't Work: Malawi's ITN Distribution Program
AbstractNationwide health interventions are difficult to evaluate as contemporaneous control groups do not exist and before-after approaches are usually infeasible. We propose an alternative semi-parametric estimator that is based on the assumption that the intervention has no direct effect on the health outcome but influences the outcome only through its effect on individual behavior. We show that in this case the evaluation problem can be divided into two parts: (i) the effect of the intervention on behavior, for which a conditional before-after assumption is more plausible; and (ii) the effect of the behaviour on the health outcome, where we exploit that a contemporaneous control groups exists for behavior. The proposed estimator is used to evaluate one of Malawi’s main malaria prevention campaigns, a nationwide insecticide-treated-net (ITN) distribution scheme, in terms of its effect on infant mortality. We exploit that the program affects child mortality only via bed net usage. We find that Malawi’s ITN distribution campaign reduced child mortality by 1 percentage point, which corresponds to about 30% of the total reduction in infant mortality over the study period.
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Bibliographic InfoPaper provided by CESifo Group Munich in its series CESifo Working Paper Series with number 3036.
Date of creation: 2010
Date of revision:
treatment effect; semi-parametric estimation; health intervention;
Other versions of this item:
- Eva Deuchert & Conny Wunsch, 2010. "Evaluating Nationwide Health Interventions When Standard Before-After Doesn't Work: Malawi's ITN Distribution Program," University of St. Gallen Department of Economics working paper series 2010 2010-12, Department of Economics, University of St. Gallen.
- Deuchert, Eva & Wunsch, Conny, 2010. "Evaluating Nationwide Health Interventions When Standard Before-After Doesn't Work: Malawi's ITN Distribution Program," IZA Discussion Papers 4896, Institute for the Study of Labor (IZA).
- C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
- C21 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models
- I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
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