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

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  • 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
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    References listed on IDEAS

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    2. 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.
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    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. Baulia, Susmita, 2024. "Is household shock a boon or bane to the utilisation of preventive healthcare for children? Evidence from Uganda," Economics & Human Biology, Elsevier, vol. 52(C).
    3. 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.
    4. Bos, Johannes M. & Shonchoy, Abu S. & Ravindran, Saravana & Khan, Akib, 2024. "Early childhood human capital formation at scale," Journal of Public Economics, Elsevier, vol. 231(C).
    5. 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).
    6. 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.
    7. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2023. "Community-based health programs and child vaccinations: Evidence from Madagascar," World Development, Elsevier, vol. 170(C).
    8. 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).
    9. Erika Deserranno & Philipp Kastrau & Gianmarco León-Ciliotta, 2025. "Promotions and Productivity: The Role of Meritocracy and Pay Progression in the Public Sector," American Economic Review: Insights, American Economic Association, vol. 7(1), pages 71-89, March.
    10. 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).
    11. 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).
    12. Sayli Javadekar & Kritika Saxena, 2025. "The seen and unseen: the unintended impact of a conditional cash transfer program on prenatal sex selection," Journal of Population Economics, Springer;European Society for Population Economics, vol. 38(1), pages 1-34, March.
    13. 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.
    14. 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.
    15. 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.
    16. Pan, Yao & Singhal, Saurabh, 2019. "Agricultural extension, intra-household allocation and malaria," Journal of Development Economics, Elsevier, vol. 139(C), pages 157-170.
    17. Deserranno, Erika & Leon-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.

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    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

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