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

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  • 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 bed net 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.

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  • Dizon-Ross, Rebecca & Dupas, Pascaline & Robinson, Jonathan, 2017. "Governance and the effectiveness of public health subsidies: Evidence from Ghana, Kenya and Uganda," Journal of Public Economics, Elsevier, vol. 156(C), pages 150-169.
  • Handle: RePEc:eee:pubeco:v:156:y:2017:i:c:p:150-169
    DOI: 10.1016/j.jpubeco.2017.09.005
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    Cited by:

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    4. 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).
    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.

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    More about this item

    Keywords

    Leakage; Extortion; Shirking; Motivation;
    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

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