Effects of Anti-Corruption Audits on Early-Life Mortality: Evidence from Brazil

Although various studies suggest that corruption affects public health systems, the literature lacks causal evidence about whether anti-corruption interventions can improve health outcomes. The present article provides novel evidence that one such intervention --- anti-corruption audits --- improved early-life mortality in Brazil. The Brazilian government conducted audits in 1,949 randomly selected municipalities between 2003 and 2015. To identify the causal effect of anti-corruption audits on early-life mortality, we analyze official data on health outcomes from individual-level vital statistics before and after the intervention. A randomly audited municipality is estimated to experience 0.48 fewer child deaths (95% CI: -0.81, -0.15) and 0.34 fewer infant deaths (-0.61, -0.07) per year, relative to never experiencing an audit. The audit program is estimated to have prevented the deaths of 7,014 (2,216, 11,813) children, including 5,028 (891, 9,165) infants. The observed mortality in audited municipalities is approximately 94 percent of the child deaths, and 95 percent of the infant deaths, that would have occurred in the absence of the intervention. Early-life mortality fell especially sharply for nonwhite Brazilians, who face significant health disparities. Effects are greater when examining deaths from preventable causes, and show temporal persistence with large effects even a decade after audits. In addition, the intervention led to a substantial increase in women receiving recommended levels of prenatal care; this effect is likewise concentrated among nonwhite Brazilians. This causal evidence suggests that government anti-corruption interventions have the potential to improve health outcomes, a finding that deserves investigation in other countries.