Learning, Misallocation, and Technology Adoption: Evidence from New Malaria Therapy in Tanzania

I show that malaria misdiagnosis, common in resource-poor settings, decreases the expected effectiveness of an important new therapy–since only a fraction of treated individuals have malaria–and reduces the rate of learning via increased noise. Using pilot program data from Tanzania, I exploit variation in the location and timing of survey enumeration to construct reference groups composed of randomly chosen, geographically and temporally proximate acutely ill individuals. I show that learning is stronger and adoption rates are higher in villages with more misdiagnosis. Subsidizing diagnostic tools or improving initial targeting of new technologies may thus accelerate uptake through learning.technology adoption, learning, malaria, Tanzania

Labor Complementarities and Health in the Agricultural Household

Models of the agricultural household have traditionally relied on assumptions regarding the complementarity or substitutability of family labor inputs. We show how data on time allocations, health shocks and corresponding treatment choices can be used to test these assumptions. Data from Tanzania provide evidence that complementarities exist and can explain the pattern of labor supply adjustments across household members and productive activities following acute sickness. In particular, we find that sick and healthy household members both shift labor away from self-employment and into farming when the sick recover more quickly. Infra-marginal adjustments within farming activity types provide further evidence of farm-specific complementarities.intra-household allocation, health shocks, complementarity

Healthcare Choices, Information and Health Outcomes

Self-selection into healthcare options on the basis of severity likely biases estimates of the effects of healthcare choice on health outcomes. Using an instrumental variables strategy which exploits exogenous variation in the cost of formal-sector care, we show that using such care to treat acute sickness decreases the incidence of fever and malaria in young children in Tanzania. Compared to the instrumental variables estimates, ordinary least squares estimates significantly understate the effects of formal-sector healthcare use on health outcomes. Improved information and more timely treatment, rather than greater access to medicines, seem to be the primary mechanisms for this effect.healthcare, information, child health, Tanzania

Endowments and Investment within the Household: Evidence from Iodine Supplementation in Tanzania

Standard theories of resource allocation within the household posit that parents’ investments in their children reflect a combination of children’s endowments and parents’ preferences for child quality. We study how changes in children’s cognitive endowments affect the distribution of parental investments amongst siblings, using data from a large-scale iodine supplementation program in Tanzania. We find that parents strongly reinforce the higher cognitive endowments of children who received in utero iodine supplementation, by investing more in vaccinations and early life nutrition. The effect of siblings’ endowments on own investments depends on the extent to which quality across children is substitutable in parents’ utility functions. Neonatal investments, made before cognitive endowments become apparent to parents, are unaffected. Fertility is unaffected as well, suggesting that inframarginal quality improvements can spur investment responses even when the quantity-quality tradeoff is not readily observable.endowments, intra-household, child health, Tanzania

The long-run impacts of adult deaths on older household members in Tanzania

HIV/AIDS is drastically changing the demographic landscape in high-prevalence countries in Africa. The prime-age adult population bears the majority of the mortality burden. These “missing” prime-age adults have implications for the socioeconomic well-being of surviving family members. This study uses a 13-year panel from Tanzania to examine the impacts of prime-age mortality on the time use and health outcomes of older adults, with a focus on long-run impacts and gender dimensions. Prime-age deaths are weakly associated with increases in working hours of older women when the deceased adult was co-resident in the household. The association is strongest when the deceased adult was living with the elderly individual at the time of death and for deaths in the distant past, suggesting that shorter-run studies may not capture the full extent of the consequences of adult mortality for survivors. Holding more assets seems to buffer older adults from having to work more after these shocks. Most health indicators are not worse for older adults when a prime-age household member died, although more distant adult deaths are associated with an increased probability of acute illness for the surviving elderly. For deaths of children who were not residing with their parents at baseline, the findings show no impact on hours worked or health outcomes.Population Policies,Health Monitoring&Evaluation,Gender and Health,Demographics,Gender and Social Development