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


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


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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  • Alessandro Tarozzi & Aprajit Mahajan & Brian Blackburn & Daniel Kopf & Lakshmi Krishnan & Joanne Yoong, 2011. "Micro-Loans, Insecticide-Treated Bednets and Malaria: Evidence from a Randomized Controlled Trial in Orissa (India)," Working Papers 11-13, Duke University, Department of Economics.
  • Handle: RePEc:duk:dukeec:11-13

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    References listed on IDEAS

    1. Zwane, A. P. & Zinman, J. & Van Dusen, E. & Pariente, W. & Null, C. & Miguel, E. & Kremer, Michael R. & Karlan, D. S. & Hornbeck, Richard A. & Gine, X. & Duflo, E. & Devoto, F. & Crepon, B. & Banerjee, 2011. "Being Surveyed Can Change Later Behavior and Related Parameter Estimates," Scholarly Articles 11339433, Harvard University Department of Economics.
    2. Jessica Cohen & Pascaline Dupas & Simone Schaner, 2015. "Price Subsidies, Diagnostic Tests, and Targeting of Malaria Treatment: Evidence from a Randomized Controlled Trial," American Economic Review, American Economic Association, vol. 105(2), pages 609-645, February.
    3. Michael Kremer & Edward Miguel, 2007. "The Illusion of Sustainability," The Quarterly Journal of Economics, Oxford University Press, vol. 122(3), pages 1007-1065.
    4. Alessandro Tarozzi & Aprajit Mahajan & Joanne Yoong & Brian Blackburn, 2009. "Commitment Mechanisms and Compliance with Health-Protecting Behavior: Preliminary Evidence from Orissa, India," American Economic Review, American Economic Association, vol. 99(2), pages 231-235, May.
    5. 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.
    6. Adhvaryu, Achyuta, 2011. "Learning, Misallocation, and Technology Adoption: Evidence from New Malaria Therapy in Tanzania," Working Papers 92, Yale University, Department of Economics.
    7. 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, January.
    8. Alessandro Tarozzi & Aprajit Mahajan & Brian Blackburn & Dan Kopf & Lakshmi Krishnan & Joanne Yoong, 2014. "Micro-loans, Insecticide-Treated Bednets, and Malaria: Evidence from a Randomized Controlled Trial in Orissa, India," American Economic Review, American Economic Association, vol. 104(7), pages 1909-1941, July.
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    More about this item


    Malaria; Bednets; Microfinance; Public Health;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I3 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty

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