IDEAS home Printed from https://ideas.repec.org/a/tpr/amjhec/v4y2018i3p358-382.html
   My bibliography  Save this article

Can At-Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa?

Author

Listed:
  • Adrienne M. Lucas

    (Department of Economics, University of Delaware, and NBER)

  • Nicholas L. Wilson

    (Department of Economics, Reed College, and Office of Evaluation Sciences Author email: nwilson@reed.edu)

Abstract

The single largest item in the US foreign aid health budget is antiretroviral therapy (ART) for the treatment of HIV/AIDS. Many supply- and demand-side factors in sub-Saharan Africa could cause smaller than expected epidemiological effects of this at-scale drug provision. We provide what appears to be the first quasi-experimental evidence on the effect of at-scale drug provision in a poor country, using the phased rollout of ART in Zambia, a setting where approximately one in six adults are HIV positive. Combining anthropometric data from national household surveys and a spatially based triple-difference specification, we find that local ART introduction increased the weight of high HIV likelihood adult women. This finding from a clinically difficult setting suggests that the generalized challenges of scalability of ART for adult health in sub-Saharan Africa are surmountable.

Suggested Citation

  • Adrienne M. Lucas & Nicholas L. Wilson, 2018. "Can At-Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa?," American Journal of Health Economics, MIT Press, vol. 4(3), pages 358-382, Summer.
  • Handle: RePEc:tpr:amjhec:v:4:y:2018:i:3:p:358-382
    as

    Download full text from publisher

    File URL: http://www.mitpressjournals.org/doi/pdf/10.1162/ajhe_a_00105
    Download Restriction: Access to PDF is restricted to subscribers.

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Adrienne M. Lucas & Nicholas L. Wilson, 2013. "Adult Antiretroviral Therapy and Child Health: Evidence from Scale-Up in Zambia," American Economic Review, American Economic Association, vol. 103(3), pages 456-461, May.
    2. Harsha Thirumurthy & Joshua Graff Zivin, 2012. "Health and Labor Supply in the Context of HIV/AIDS: The Long-Run Economic Impacts of Antiretroviral Therapy," Economic Development and Cultural Change, University of Chicago Press, vol. 61(1), pages 73-96.
    3. Hilary W. Hoynes & Diane Whitmore Schanzenbach, 2009. "Consumption Responses to In-Kind Transfers: Evidence from the Introduction of the Food Stamp Program," American Economic Journal: Applied Economics, American Economic Association, vol. 1(4), pages 109-139, October.
    4. Douglas Almond & Hilary W. Hoynes & Diane Whitmore Schanzenbach, 2011. "Inside the War on Poverty: The Impact of Food Stamps on Birth Outcomes," The Review of Economics and Statistics, MIT Press, vol. 93(2), pages 387-403, May.
    5. Zivin, Joshua Graff & Thirumurthy, Harsha & Goldstein, Markus, 2009. "AIDS treatment and intrahousehold resource allocation: Children's nutrition and schooling in Kenya," Journal of Public Economics, Elsevier, vol. 93(7-8), pages 1008-1015, August.
    6. Seema Jayachandran & Adriana Lleras-Muney & Kimberly V. Smith, 2010. "Modern Medicine and the Twentieth Century Decline in Mortality: Evidence on the Impact of Sulfa Drugs," American Economic Journal: Applied Economics, American Economic Association, vol. 2(2), pages 118-146, April.
    7. A. Colin Cameron & Jonah B. Gelbach & Douglas L. Miller, 2008. "Bootstrap-Based Improvements for Inference with Clustered Errors," The Review of Economics and Statistics, MIT Press, vol. 90(3), pages 414-427, August.
    8. Baranov, Victoria & Bennett, Daniel & Kohler, Hans-Peter, 2015. "The indirect impact of antiretroviral therapy: Mortality risk, mental health, and HIV-negative labor supply," Journal of Health Economics, Elsevier, vol. 44(C), pages 195-211.
    9. Jonathan Gruber & Nathaniel Hendren & Robert M. Townsend, 2014. "The Great Equalizer: Health Care Access and Infant Mortality in Thailand," American Economic Journal: Applied Economics, American Economic Association, vol. 6(1), pages 91-107, January.
    10. Adrienne M. Lucas & Margaret Chidothe & Nicholas L. Wilson, 2016. "Effects of Adult Health Interventions at Scale on Children's Schooling: Evidence from Antiretroviral Therapy in Zambia," NBER Working Papers 22767, National Bureau of Economic Research, Inc.
    11. David Card & Carlos Dobkin & Nicole Maestas, 2009. "Does Medicare Save Lives?," The Quarterly Journal of Economics, Oxford University Press, vol. 124(2), pages 597-636.
    12. Harsha Thirumurthy & Joshua Graff Zivin & Markus Goldstein, 2008. "The Economic Impact of AIDS Treatment: Labor Supply in Western Kenya," Journal of Human Resources, University of Wisconsin Press, vol. 43(3), pages 511-552.
    13. Hoynes, Hilary & Page, Marianne & Stevens, Ann Huff, 2011. "Can targeted transfers improve birth outcomes?: Evidence from the introduction of the WIC program," Journal of Public Economics, Elsevier, vol. 95(7-8), pages 813-827, August.
    14. Grant Miller & Diana Pinto & Marcos Vera-Hernández, 2013. "Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor," American Economic Journal: Applied Economics, American Economic Association, vol. 5(4), pages 61-91, October.
    15. Collier, Paul & Dollar, David, 2002. "Aid allocation and poverty reduction," European Economic Review, Elsevier, vol. 46(8), pages 1475-1500, September.
    16. David Dollar & Craig Burnside, 2000. "Aid, Policies, and Growth," American Economic Review, American Economic Association, vol. 90(4), pages 847-868, September.
    17. Nicholas Wilson, 2015. "Erratum to: Can Disease Specific Funding Harm Health? Child Mortality in the Shadow of HIV/AIDS Service Expansion," Demography, Springer;Population Association of America (PAA), vol. 52(5), pages 1701-1701, October.
    18. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    19. William Easterly, 2003. "Can Foreign Aid Buy Growth?," Journal of Economic Perspectives, American Economic Association, vol. 17(3), pages 23-48, Summer.
    20. William Easterly, 2009. "Can the West Save Africa?," Journal of Economic Literature, American Economic Association, vol. 47(2), pages 373-447, June.
    21. Damien de Walque & Harounan Kazianga & Mead Over, 2012. "Antiretroviral Therapy Perceived Efficacy and Risky Sexual Behaviors: Evidence from Mozambique," Economic Development and Cultural Change, University of Chicago Press, vol. 61(1), pages 97-126.
    22. Bate, Roger & Jin, Ginger Zhe & Mathur, Aparna, 2011. "Does price reveal poor-quality drugs? Evidence from 17 countries," Journal of Health Economics, Elsevier, vol. 30(6), pages 1150-1163.
    23. World Bank, 2013. "World Development Indicators 2013," World Bank Publications, The World Bank, number 13191.
    24. Jane Fortson, 2008. "The gradient in sub-saharan Africa: Socioeconomic status and HIV/AIDS," Demography, Springer;Population Association of America (PAA), vol. 45(2), pages 303-322, May.
    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. repec:eee:ehbiol:v:30:y:2018:i:c:p:119-129 is not listed on IDEAS

    More about this item

    Keywords

    foreign aid; health; HIV/AIDS; PEPFAR; targeting; Zambia;

    JEL classification:

    • H40 - Public Economics - - Publicly Provided Goods - - - General
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

    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:tpr:amjhec:v:4:y:2018:i:3:p:358-382. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Ann Olson). General contact details of provider: https://www.mitpressjournals.org/ .

    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 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.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.