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Micro-Loans, Insecticide-Treated Bednets and Malaria: Evidence from a Randomized Controlled Trial in Orissa (India)

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  • Alessandro Tarozzi
  • Aprajit Mahajan
  • Brian Blackburn
  • Daniel Kopf
  • Lakshmi Krishnan
  • Joanne Yoong

Abstract

Many severe health risks in developing countries could be substantially reduced with access to appropriate preventive measures. However, the associated costs are often high enough to restrict access among poor households, and free provision through public health campaigns is often not financially feasible. We describe findings from the first large-scale cluster randomized controlled trial in a developing country context that evaluates the uptake of a health-protecting technology, insecticide-treated bednets (ITNs), through micro-consumer loans, as compared to free distribution and control conditions. Numerous studies have shown that widespread, regular use of ITNs is one the most effective preventive measures against malaria. However, ownership rates remain very low in most malarious areas, including our study areas in rural Orissa (India). Despite the un-subsidized price, 52 percent of sample households purchased at least one ITN, leading to 16 percent of individuals using a treated net the previous night, relative to only 2 percent in control areas where nets were not offered for sale. However, the increase fell significantly short of the 47 percent previous-night usage rate achieved with free distribution. Most strikingly, we find that neither micro-loans nor free distribution led to improvements in malaria and anemia prevalence, measured using blood tests. We examine and rule out several plausible explanations for this latter finding. We conjecture that insufficient ITN coverage is the most likely explanation, and discuss implications for public health policy.

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Bibliographic Info

Paper provided by Duke University, Department of Economics in its series Working Papers with number 11-13.

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Length: 58
Date of creation: 2011
Date of revision:
Handle: RePEc:duk:dukeec:11-13

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Keywords: Malaria; Bednets; Microfinance; Public Health;

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References

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  1. Edward Miguel & Michael Kremer, 2004. "Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities," Econometrica, Econometric Society, vol. 72(1), pages 159-217, 01.
  2. Brian Blackburn & Aprajit Mahajan & Alessandro Torozzi & Joanne Yoong, 2009. "Commitment Mechanisms and Compliance with Health-protecting Behavior: Preliminary Evidence from Orissa (India)," Discussion Papers 08-043, Stanford Institute for Economic Policy Research.
  3. Nava Ashraf & James Berry & Jesse M. Shapiro, 2010. "Can Higher Prices Stimulate Product Use? Evidence from a Field Experiment in Zambia," American Economic Review, American Economic Association, vol. 100(5), pages 2383-2413, December.
  4. Jessica Cohen & Pascaline Dupas & Simone G. Schaner, 2012. "Price Subsidies, Diagnostic Tests, and Targeting of Malaria Treatment: Evidence from a Randomized Controlled Trial," NBER Working Papers 17943, National Bureau of Economic Research, Inc.
  5. Michael Kremer & Edward Miguel, 2004. "The Illusion of Sustainability," NBER Working Papers 10324, National Bureau of Economic Research, Inc.
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Cited by:
  1. Pascaline Dupas & Jonathan Robinson, 2013. "Why Don't the Poor Save More? Evidence from Health Savings Experiments," American Economic Review, American Economic Association, vol. 103(4), pages 1138-71, June.
  2. Michael Grimm & Jörg Peters, 2012. "Improved Cooking Stoves that End up in Smoke?," RWI Positionen, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, pages 09, 09.
  3. Gianmarco León & Edward Miguel, 2013. "Transportation choices and the value of statistical life," Economics Working Papers 1389, Department of Economics and Business, Universitat Pompeu Fabra.
  4. Meredith, Jennifer & Robinson, Jonathan & Walker, Sarah & Wydick, Bruce, 2013. "Keeping the doctor away: Experimental evidence on investment in preventative health products," Journal of Development Economics, Elsevier, vol. 105(C), pages 196-210.
  5. Gunther Bensch & Jörg Peters, 2012. "A Recipe for Success? Randomized Free Distribution of Improved Cooking Stoves in Senegal," Ruhr Economic Papers 0325, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
  6. Grant Miller & A. Mushfiq Mobarak, 2013. "Gender Differences in Preferences, Intra-Household Externalities, and Low Demand for Improved Cookstoves," NBER Working Papers 18964, National Bureau of Economic Research, Inc.
  7. Jessica Cohen & Pascaline Dupas & Simone G. Schaner, 2012. "Price Subsidies, Diagnostic Tests, and Targeting of Malaria Treatment: Evidence from a Randomized Controlled Trial," NBER Working Papers 17943, National Bureau of Economic Research, Inc.

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