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Evaluating Nationwide Health Interventions When Standard Before-After Doesn't Work: Malawi's ITN Distribution Program

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  • Eva Deuchert
  • Conny Wunsch

Abstract

Nationwide health interventions are difficult to evaluate as contemporaneous control groups do not exist and before-after approaches are usually infeasible. We propose an alternative semi-parametric estimator that is based on the assumption that the intervention has no direct effect on the health outcome but influences the outcome only through its effect on individual behavior. We show that in this case the evaluation problem can be divided into two parts: (i) the effect of the intervention on behavior, for which a conditional before-after assumption is more plausible; and (ii) the effect of the behavior on the health outcome, where we exploit that a contemporaneous control groups exists for behavior. The proposed estimator is used to evaluate one of Malawi's main malaria prevention campaigns, a nationwide insecticide-treated-net (ITN) distribution scheme, in terms of its effect on infant mortality. We exploit that the program affects child mortality only via bed net usage. We find that Malawi's ITN distribution campaign reduced child mortality by 1 percentage point, which corresponds to about 30% of the total reduction in infant mortality over the study period.

Suggested Citation

  • Eva Deuchert & Conny Wunsch, 2010. "Evaluating Nationwide Health Interventions When Standard Before-After Doesn't Work: Malawi's ITN Distribution Program," University of St. Gallen Department of Economics working paper series 2010 2010-12, Department of Economics, University of St. Gallen.
  • Handle: RePEc:usg:dp2010:2010-12
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    as
    1. Pushkar Maitra & Ranjan Ray, 2004. "The Impact of Resource Inflows on Child Health: Evidence from Kwazulu-Natal, South Africa, 1993-98," Journal of Development Studies, Taylor & Francis Journals, vol. 40(4), pages 78-114.
    2. Jessica Cohen & Pascaline Dupas, 2008. "Free Distribution or Cost-Sharing? Evidence from a Malaria Prevention Experiment," NBER Working Papers 14406, National Bureau of Economic Research, Inc.
    3. Hansen, Lars Peter, 1982. "Large Sample Properties of Generalized Method of Moments Estimators," Econometrica, Econometric Society, vol. 50(4), pages 1029-1054, July.
    4. Magnus Lindelow, 2008. "Health as a Family Matter: Do Intra-household Education Externalities Matter for Maternal and Child Health?," Journal of Development Studies, Taylor & Francis Journals, vol. 44(4), pages 562-585, April.
    5. Joseph G. Altonji & Todd E. Elder & Christopher R. Taber, 2005. "Selection on Observed and Unobserved Variables: Assessing the Effectiveness of Catholic Schools," Journal of Political Economy, University of Chicago Press, vol. 113(1), pages 151-184, February.
    6. Jens Kovsted & Claus C. Pörtner & Finn Tarp, 2002. "Child Health and Mortality: Does Health Knowledge Matter?," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 11(4), pages 542-560.
    7. Newey, Whitney K., 1984. "A method of moments interpretation of sequential estimators," Economics Letters, Elsevier, vol. 14(2-3), pages 201-206.
    8. David E. Bloom & Jeffrey D. Sachs, 1998. "Geography, Demography, and Economic Growth in Africa," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 29(2), pages 207-296.
    9. D. Omariba & Roderic Beaujot & Fernando Rajulton, 2007. "Determinants of infant and child mortality in Kenya: an analysis controlling for frailty effects," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 26(3), pages 299-321, June.
    10. Geoffard, Pierre-Yves & Philipson, Tomas, 1996. "Rational Epidemics and Their Public Control," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 37(3), pages 603-624, August.
    11. Frolich, Markus, 2007. "Nonparametric IV estimation of local average treatment effects with covariates," Journal of Econometrics, Elsevier, vol. 139(1), pages 35-75, July.
    12. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    13. Imbens, Guido W & Angrist, Joshua D, 1994. "Identification and Estimation of Local Average Treatment Effects," Econometrica, Econometric Society, vol. 62(2), pages 467-475, March.
    14. Heckman, James J. & Lalonde, Robert J. & Smith, Jeffrey A., 1999. "The economics and econometrics of active labor market programs," Handbook of Labor Economics, in: O. Ashenfelter & D. Card (ed.), Handbook of Labor Economics, edition 1, volume 3, chapter 31, pages 1865-2097, Elsevier.
    15. Michael A. Koenig & David Bishai & Mehrab Ali Khan, 2001. "Health Interventions and Health Equity: The Example of Measles Vaccination in Bangladesh," Population and Development Review, The Population Council, Inc., vol. 27(2), pages 283-302, June.
    16. Armecin, Graeme & Behrman, Jere R. & Duazo, Paulita & Ghuman, Sharon & Gultiano, Socorro & King, Elizabeth M. & Lee, Nannette, 2006. "Early childhood development through an integrated program : evidence from the Philippines," Policy Research Working Paper Series 3922, The World Bank.
    17. Uzma Iram & Muhammad S. Butt, 2008. "Socioeconomic determinants of child mortality in Pakistan: Evidence from sequential probit model," International Journal of Social Economics, Emerald Group Publishing, vol. 35(1), pages 63-76, January.
    18. Sebastian Galiani & Paul Gertler & Ernesto Schargrodsky, 2005. "Water for Life: The Impact of the Privatization of Water Services on Child Mortality," Journal of Political Economy, University of Chicago Press, vol. 113(1), pages 83-120, February.
    19. Alberto Minujin & Enrique Delamonica, 2003. "Mind the Gap! Widening Child Mortality Disparities," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 4(3), pages 397-418.
    20. Michael Marlow, 2008. "Determinants of state tobacco-control expenditures," Applied Economics, Taylor & Francis Journals, vol. 40(7), pages 831-839.
    21. Guilkey, David K. & Riphahn, Regina T., 1998. "The determinants of child mortality in the Philippines: estimation of a structural model," Journal of Development Economics, Elsevier, vol. 56(2), pages 281-305, August.
    22. Pascaline Dupas, 2009. "What Matters (and What Does Not) in Households' Decision to Invest in Malaria Prevention?," American Economic Review, American Economic Association, vol. 99(2), pages 224-230, May.
    23. Uzma Iram & Muhammad S. Butt, 2008. "Socioeconomic determinants of child mortality in Pakistan: Evidence from sequential probit model," International Journal of Social Economics, Emerald Group Publishing, vol. 35(1/2), pages 63-76, January.
    24. 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.
    25. Wang, Limin, 2002. "Health outcomes in poor countries and policy options : empirical findings from demographic and health surveys," Policy Research Working Paper Series 2831, The World Bank.
    26. Paul Glewwe, 1999. "Why Does Mother's Schooling Raise Child Health in Developing Countries? Evidence from Morocco," Journal of Human Resources, University of Wisconsin Press, vol. 34(1), pages 124-159.
    27. Wagstaff, Adam, 2007. "Health insurance for the poor : initial impacts of Vietnam's health care fund for the poor," Policy Research Working Paper Series 4134, The World Bank.
    28. Jeffrey Sachs & Pia Malaney, 2002. "The economic and social burden of malaria," Nature, Nature, vol. 415(6872), pages 680-685, February.
    29. Ray, R. & Maitra, P., 2001. "The Impact of Resource Inflows on Child Health: Evidence from South Africa," Papers 2001-05, Tasmania - Department of Economics.
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    Cited by:

    1. Carrie B Dolan & Ariel BenYishay & Karen A Grépin & Jeffery C Tanner & April D Kimmel & David C Wheeler & Gordon C McCord, 2019. "The impact of an insecticide treated bednet campaign on all-cause child mortality: A geospatial impact evaluation from the Democratic Republic of Congo," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-18, February.

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    More about this item

    Keywords

    Treatment effect; semi-parametric estimation; health intervention;
    All these keywords.

    JEL classification:

    • C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
    • C21 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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