A balancing act: subsidising treatment for Malaria

Public subsidies may be an effective way to increase access to antimalarial drugs in sub-Saharan Africa, but large subsidies are accompanied by the risk of overtreatment – the use of subsidised drugs by malaria negative patients. Research from Kenya provides useful insights for policymakers considering these subsidie

Do Opposites Detract? Intrahousehold Preference Heterogeneity and Inefficient Strategic Savings

This paper uses a field experiment to test whether intrahousehold heterogeneity in discount factors leads to inefficient strategic savings behavior. I gave married couples in rural Kenya the opportunity to open both joint and individual bank accounts at randomly assigned interest rates. I also directly elicited discount factors for all individuals in the experiment. Couples who are well matched on discount factors are less likely to use costly individual accounts and respond robustly to relative rates of return between accounts, while their poorly matched peers do not. Consequently, poorly matched couples forgo significantly more interest earnings on their savings. (JEL D13, D14, J12, O12

Price Subsidies, Diagnostic Tests, and Targeting of Malaria Treatment: Evidence from a Randomized Controlled Trial

Both under- and over-treatment of communicable diseases are public bads. But efforts to decrease one run the risk of increasing the other. Using rich experimental data on household treatment- seeking behavior in Kenya, we study the implications of this trade-off for subsidizing life-saving antimalarials sold over-the-counter at retail drug outlets. We show that a very high subsidy (such as the one under consideration by the international community) dramatically increases access, but nearly one-half of subsidized pills go to patients without malaria. We study two ways to better target subsidized drugs: reducing the subsidy level, and introducing rapid malaria tests over-the-counter. (JEL D12, D82, I12, O12, O15

Barriers to the adoption and optimal use of savings and health technologies

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2011.Cataloged from PDF version of thesis.Includes bibliographical references (p. 177-184).This thesis studies Kenyan households' use of savings accounts and malaria testing and treatment technologies. The first chapter studies whether or not married couples use savings accounts strategically. In the absence of commitment, the availability of a "private" savings technology (a device that is only accessible by a single owner) may incite individuals to take costly strategic savings action in order to manipulate the time path of consumption. This chapter presents a model that formalizes this idea and derives several testable theoretical implications. In particular, households where husbands and wives are well matched in terms of time preference should make greater use of joint (public) accounts, less use of individual (private) accounts, and make more efficient investment choices as compared to their poorly matched peers. The model informed the design of a field experiment where married couples in rural Kenya were given the opportunity to open joint and individual bank accounts at randomly assigned interest rates. The behavior of individuals in the experiment is inconsistent with ex-ante Pareto efficiency and a variety of alternative models of intrahousehold resource allocation, but consistent with the proposed model of strategic savings. Savings misallocation due to strategic behavior may be substantial: in the experiment poorly matched couples forgo at least 64 percent more interest than well matched couples. The second chapter studies the impact of reducing bank account transaction costs. Free ATM cards were offered to a randomly selected subset of newly opened formal bank accounts in Western Kenya. The ATM card reduced withdrawal fees by over 50 percent (from $0.78 to$0.38) and enabled account holders to make withdrawals from their accounts at any time of the day. The cards also enabled accounts to be accessed without the in-person verification of a national identity card. Targeting ATM cards to joint accounts and accounts owned by men substantially increased savings rates (by 39 percent) and average daily balances (by 16 percent) in the bank accounts. In contrast, the intervention had a negative impact when targeted to individual accounts owned by women. This gender difference appears to be driven by differences in bargaining power within the household: the positive treatment effect for men is concentrated in households where men have above median bargaining power, whereas the negative treatment effect for women is concentrated in households where women have below median bargaining power. The final chapter (co-authored with Jessica Cohen and Pascaline Dupas) uses data from a randomized controlled trial conducted with over 2,900 households in rural Kenya to study the tradeoffs between the affordability of effective antimalarials (ACTs) and overuse. We compare a 95-percent ACT subsidy (currently under consideration by the global health community) to an alternative policy regime that explicitly acknowledges the problem of overuse by providing access to a subsidized rapid diagnostic test for malaria (RDT) in tandem with subsidized ACTs. We find that ACT access increases by 60 percent in the presence of an ACT subsidy of 80 percent of more. Under the proposed 95-percent ACT subsidy, however, only 56 percent of those buying an ACT at the drug shop test positive for malaria. We show that targeting could be substantially increased (without compromising access) when the ACT subsidy is reduced to 80 percent but accompanied by an RDT subsidy.by Simone Gabrielle Schaner.Ph.D

Information, Intermediaries, and International Migration

Job seekers face substantial information frictions, especially in international labor markets where intermediaries match prospective migrants with overseas employers. We conducted a randomized trial in Indonesia to explore how information about intermediary quality shapes migration outcomes. Holding access to information about the return to choosing a high-quality intermediary constant, intermediary-specific quality disclosure reduces the migration rate, cutting use of low-quality providers. Workers who do migrate receive better pre-departure preparation and have improved experiences abroad, despite no change in occupation or destination. These results are not driven by changes in beliefs about average provider quality or the return to migration. Nor does selection explain improved outcomes for those who migrate with quality disclosure. Together, our findings are consistent with an increase in the option value of search: with better ability to differentiate offer quality, workers search longer, select higher-quality intermediaries, and ultimately have better migration experiences

Mental Health, Work and Mental Health Service Use among Low-Income Mothers

This paper analyzes how mental health problems impede low-income mothers' ability to work and how health insurance improves access to mental health treatment services. According to data from the 2002 National Survey of America's Families, low-income mothers in poor mental health are significantly less likely to work and to work full time than those without these problems. Low-income mothers with public or private health insurance are significantly more likely to receive treatment than those without insurance. Mental health problems are an important barrier to work among low-income women, and access to treatment could be improved through increased health insurance coverage

On Her Own Account: How Strengthening Women's Financial Control Impacts Labor Supply and Gender Norms

Can greater control over earned income incentivize women to work and influence gender norms? In collaboration with Indian government partners, we provided rural women with individual bank accounts and randomly varied whether their wages from a public workfare program were directly deposited into these accounts or into the male household head’s account (the status quo). Women in a random subset of villages were also trained on account use. In the short run, relative to women just offered bank accounts, those who also received direct deposit and training increased their labor supply in the public and private sectors. In the long run, gender norms liberalized: women who received direct deposit and training became more accepting of female work, and their husbands perceived fewer social costs to having a wife who works. These effects were concentrated in households with otherwise lower levels of, and stronger norms against, female work. Women in these households also worked more in the long run and became more empowered. These patterns are consistent with models of household decision making in which increases in bargaining power from greater control over income interact with, and influence, gender norms

On Her Own Account: How Strengthening Women’s Financial Control Impacts Labor Supply and Gender Norms

Can greater control over earned income incentivize women to work and influence gender norms? In collaboration with Indian government partners, we provided rural women with individual bank accounts and randomly varied whether their wages from a public workfare program were directly deposited into these accounts or into the male household head’s account (the status quo). Women in a random subset of villages were also trained on account use. In the short run, relative to women just offered bank accounts, those who also received direct deposit and training increased their labor supply in the public and private sectors. In the long run, gender norms liberalized: women who received direct deposit and training became more accepting of female work, and their husbands perceived fewer social costs to having a wife who works. These effects were concentrated in households with otherwise lower levels of, and stronger norms against, female work. Women in these households also worked more in the long run and became more empowered. These patterns are consistent with models of household decisionmaking in which increases in bargaining power from greater control over income interact with, and influence, gender norms

On Her Own Account: How Strengthening Women’s Financial Control Impacts Labor Supply and Gender Norms

Can greater control over earned income incentivize women to work and influence gender norms? In collaboration with Indian government partners, we provided rural women with individual bank accounts and randomly varied whether their wages from a public workfare program were directly deposited into these accounts or into the male household head’s account (the status quo). Women in a random subset of villages were also trained on account use. In the short run, relative to women just offered bank accounts, those who also received direct deposit and training increased their labor supply in the public and private sectors. In the long run, gender norms liberalized: women who received direct deposit and training became more accepting of female work, and their husbands perceived fewer social costs to having a wife who works. These effects were concentrated in households with otherwise lower levels of, and stronger norms against, female work. Women in these households also worked more in the long run and became more empowered. These patterns are consistent with models of household decision making in which increases in bargaining power from greater control over income interact with, and influence, gender norms

Mobile money

The surge in access to mobile phones throughout the developing world has brought with it a wide range of benefits. One of the most noteworthy breakthroughs has been mobile money, enabling users to deposit, transfer, and withdraw funds from a digital account without owning a bank account Mobile money provides a dramatic reduction in transaction costs, as well as improvements in convenience, security, and time taken for the transaction. There is a growing literature that documents the benefits of mobile money, including improvements in the ability to smooth consumption better in the face of health and economic shocks, improving women’s empowerment, and reducing poverty. More recently, there has been a growth in digital financial services that use mobile money as the rails to deliver other products (largely credit). However, such innovations are few and far between with more research needed on their deployment and impact.otherpublishe