IDEAS home Printed from https://ideas.repec.org/a/aea/aejapp/v11y2019i3p155-92.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: https://www.aeaweb.org/doi/10.1257/app.20170201
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/app.20170201.data
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/app.20170201.ds
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Auriol, Emmanuelle & Warlters, Michael, 2012. "The marginal cost of public funds and tax reform in Africa," Journal of Development Economics, Elsevier, vol. 97(1), pages 58-72.
    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.
    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. 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).
    2. 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).
    3. 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.
    4. 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.
    5. 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).
    6. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2023. "Community-based health programs and child vaccinations: Evidence from Madagascar," World Development, Elsevier, vol. 170(C).
    7. 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.
    8. 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).
    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. Pan, Yao & Singhal, Saurabh, 2019. "Agricultural extension, intra-household allocation and malaria," Journal of Development Economics, Elsevier, vol. 139(C), pages 157-170.
    11. 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.
    12. 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).
    13. 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).
    14. 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).
    15. 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.
    16. 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.
    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.

    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. Anup Malani & Cynthia Kinnan & Gabriella Conti & Kosuke Imai & Morgen Miller & Shailender Swaminathan & Alessandra Voena & Bartosz Woda, 2024. "Evaluating pricing health insurance in lower-income countries: A field experiment in India," IFS Working Papers W24/33, Institute for Fiscal Studies.
    2. Dwenger, Nadja & Kleven, Henrik & Rasul, Imran & Rincke, Johannes, 2014. "Extrinsic vs Intrinsic Motivations for Tax Compliance. Evidence from a Randomized Field Experiment in Germany," VfS Annual Conference 2014 (Hamburg): Evidence-based Economic Policy 100389, Verein für Socialpolitik / German Economic Association.
    3. Non, Arjan & Rohde, Ingrid & de Grip, Andries & Dohmen, Thomas, 2022. "Mission of the company, prosocial attitudes and job preferences: A discrete choice experiment," Labour Economics, Elsevier, vol. 74(C).
    4. Manuel E. Lago & Santiago Lago-Peñas & Jorge Martinez-Vazquez, 2024. "On the effects of intergovernmental grants: a survey," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 31(3), pages 856-908, June.
    5. Martin, Will, 2021. "Tools for measuring the full impacts of agricultural interventions," IFPRI-MCC technical papers 2, International Food Policy Research Institute (IFPRI).
    6. Fay, Marianne & Martimort, David & Straub, Stéphane, 2021. "Funding and financing infrastructure: The joint-use of public and private finance," Journal of Development Economics, Elsevier, vol. 150(C).
    7. Fuhai Hong & Dong Zhang, 2023. "Bureaucratic beliefs and law enforcement," Public Choice, Springer, vol. 196(3), pages 357-379, September.
    8. Patrizia Lattarulo & Marco Mariani & Laura Razzolini, 2017. "Nudging museums attendance: a field experiment with high school teens," Journal of Cultural Economics, Springer;The Association for Cultural Economics International, vol. 41(3), pages 259-277, August.
    9. Harris, Donna & Borcan , Oana & Serra, Danila & Telli, Henry & Schettini, Bruno & Dercon, Stefan, 2024. "Proud to Belong: The Impact of Ethics Training on Police Officers in Ghana," CEPR Discussion Papers 19141, C.E.P.R. Discussion Papers.
    10. Denis Cogneau & Yannick Dupraz & Justine Knebelmann & Sandrine Mesplé-Somps, 2021. "Taxation in Africa from Colonial Times to Present Evidence from former French colonies 1900-2018," Working Papers halshs-03420664, HAL.
    11. Sun-Moon Jung & Jae Yong Shin, 2022. "Social Performance Incentives in Mission-Driven Firms," Management Science, INFORMS, vol. 68(10), pages 7631-7657, October.
    12. 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.
    13. Singh, Prakarsh & Masters, William A., 2017. "Impact of caregiver incentives on child health: Evidence from an experiment with Anganwadi workers in India," Journal of Health Economics, Elsevier, vol. 55(C), pages 219-231.
    14. Ruben Enikolopov, 2011. "Are Bureaucrats Really Paid Like Bureaucrats?," Working Papers w0165, Center for Economic and Financial Research (CEFIR).
    15. 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).
    16. 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).
    17. Friedman, Willa & Wilson, Nicholas, 2022. "Can nudging overcome procrastinating on preventive health investments?," Economics & Human Biology, Elsevier, vol. 45(C).
    18. Bouoiyour, jamal, 2006. "Migration, Diaspora et développement humain [Migration, Diaspora and Human Development]," MPRA Paper 37014, University Library of Munich, Germany.
    19. Celine de Quatrebarbes & Bertrand Laporte & Stéphane Calipel, 2021. "Fighting the soaring prices of agricultural food products. VAT versus Trade tariffs exemptions in a context of imperfect competition in Niger : CGE and micro-simulation approach," CERDI Working papers hal-03138369, HAL.
    20. Dunsch, Felipe Alexander & Velenyi, Edit, 2019. "Job Preferences of Frontline Health Workers in Ghana - A Discrete Choice Experiment," SocArXiv bqx5k, Center for Open Science.

    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

    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:aea:aejapp:v:11:y:2019:i:3:p:155-92. 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: Michael P. Albert (email available below). General contact details of provider: https://edirc.repec.org/data/aeaaaea.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.