IDEAS home Printed from
   My bibliography  Save this paper

Quality of Primary Care in Low-Income Countries: Facts and Economics


  • Jeffrey Hammer

    (Princeton University)

  • Jishnu Das

    (World Bank, Washington DC and Centre for Policy Research, New Delhi)


New research on the quality of care in public and private primary care facilities has significantly enriched our understanding of how health care is delivered in low and middle-income countries. This note first summarizes recent advances in the measurement of quality, distinguishing between measurements of provider knowledge and provider effort. Second, it looks at the determinants of practice quality variation in low-income settings, highlighting the limited role of structural constraints such as infrastructure, supply of materials including drugs and, provider training—the mainstay of much of global health policy today. In contrast, practice-quality variation is clearly linked to provider effort, an aspect of provider behavior that can be altered through a variety of means. Third, it provides a broad economic framework to interpret the findings. We look for evidence of specific market failures in the provision of primary care and emphasize that the key difficulty is (and always was) the transaction- specific nature of medical advice. Providers can do "too much" or "too little" (or both) and the extent of the "too much-ness" or the "too little-ness" depends on the specific patient and the specific disease. We document specific ways in which it is difficult for both consumers and governments to monitor every transaction to detect potentially errant behavior.

Suggested Citation

  • Jeffrey Hammer & Jishnu Das, 2014. "Quality of Primary Care in Low-Income Countries: Facts and Economics," Working Papers february2014, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
  • Handle: RePEc:pri:cheawb:february2014

    Download full text from publisher

    File URL:
    Download Restriction: no

    Other versions of this item:


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Paddy Carter & Alex Cobham, 2016. "Are taxes good for your health?," WIDER Working Paper Series wp-2016-171, World Institute for Development Economic Research (UNU-WIDER).
    2. Dizon-Ross, Rebecca & Dupas, Pascaline & Robinson, Jonathan, 2015. "Governance and the Effectiveness of Public Health Subsidies," CEPR Discussion Papers 10690, C.E.P.R. Discussion Papers.
    3. Rao, Krishna D. & Sheffel, Ashley, 2018. "Quality of clinical care and bypassing of primary health centers in India," Social Science & Medicine, Elsevier, vol. 207(C), pages 80-88.
    4. Paula González & Gabriel Montes-Rojas & Sarmistha Pal, 2017. "Dual Practice by Health Workers: Theory and Evidence from Indonesia," Working Papers 17.12, Universidad Pablo de Olavide, Department of Economics.
    5. I Ochoa-Moreno & S Bautista-Arredondo & S I McCoy & R Buzdugan & C Mangenah & N S Padian & F M Cowan, 2020. "Costs and economies of scale in the accelerated program for prevention of mother-to-child transmission of HIV in Zimbabwe," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-18, May.
    6. 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.
    7. Okeke, Edward N. & Abubakar, Isa S., 2020. "Healthcare at the beginning of life and child survival: Evidence from a cash transfer experiment in Nigeria," Journal of Development Economics, Elsevier, vol. 143(C).
    8. Mbiti, Isaac M. & Serra, Danila, 2018. "Health Workers' Behavior, Patient Reporting and Reputational Concerns: Lab-in-the-Field Experimental Evidence from Kenya," IZA Discussion Papers 11352, Institute of Labor Economics (IZA).
    9. Jigyasa Sharma & Hannah H Leslie & Francis Kundu & Margaret E Kruk, 2017. "Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-14, January.
    10. Anja Sautmann & Samuel Brown & Mark Dean, 2016. "Subsidies, Information, and the Timing of Children's Health Care in Mali," CESifo Working Paper Series 6057, CESifo.
    11. Cammett, Melani & Şaşmaz, Aytuğ, 2017. "Political Context, Organizational Mission, and the Quality of Social Services: Insights from the Health Sector in Lebanon," World Development, Elsevier, vol. 98(C), pages 120-132.
    12. Jorge Coarasa & Jishnu Das, 2015. "Primary Care for the Poor," World Bank Other Operational Studies 23657, The World Bank.
    13. Carolina Lopez & Anja Sautmann & Simone Schaner, 2018. "The Contribution of Patients and Providers to the Overuse of Prescription Drugs," NBER Working Papers 25284, National Bureau of Economic Research, Inc.
    14. Manoj Mohanan & Katherine Donato & Grant Miller & Yulya Truskinovsky & Marcos Vera-Hernández, 2019. "Different Strokes for Different Folks: Experimental Evidence on the Effectiveness of Input and Output Incentive Contracts for Health Care Providers with Varying Skills," NBER Working Papers 25499, National Bureau of Economic Research, Inc.
    15. Vinaytosh Mishra & Cherian Samuel & S. K. Sharma, 2019. "Patient’s Utility for Various Attributes of Diabetes Care Services," IIM Kozhikode Society & Management Review, , vol. 8(1), pages 1-9, January.
    16. Paddy Carter & Alex Cobham, 2016. "Are taxes good for your health?," WIDER Working Paper Series 171, World Institute for Development Economic Research (UNU-WIDER).
    17. Pascaline Dupas & Edward Miguel, 2016. "Impacts and Determinants of Health Levels in Low-Income Countries," NBER Working Papers 22235, National Bureau of Economic Research, Inc.

    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health


    Access and download statistics


    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:pri:cheawb:february2014. 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: (Bobray Bordelon). General contact details of provider: .

    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.

    We have no references for this item. You can help adding them by using 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.