Governance and the Effectiveness of Public Health Subsidies

53 Pages Posted: 8 Jul 2015

See all articles by Rebecca Dizon-Ross

Rebecca Dizon-Ross

University of Chicago

Pascaline Dupas

Stanford University

Jonathan Robinson

University of California, Santa Cruz

Date Written: July 2015


Heavily subsidizing essential health products through existing health infrastructure has the potential to substantially decrease child mortality in sub-Saharan Africa. There is, however, widespread concern that poor governance and in particular limited accountability among health workers seriously undermines the effectiveness of such programs. We performed innovative audits on bed net distribution programs in three countries (Ghana, Kenya and Uganda) to investigate local agency problems and their determinants in the allocation of targeted subsidies. Overall, agency concerns appear modest. Around 80% of the eligible receive the subsidy as intended and leakage to the ineligible appears limited, even when the ineligible have a high willingness to pay. The estimated level of mistargeting only modestly affects the cost-effectiveness of free distribution.

Keywords: extortion, leakage, motivation, shirking

JEL Classification: D73, H11, I15, I38

Suggested Citation

Dizon‐Ross, Rebecca and Dupas, Pascaline and Robinson, Jonathan, Governance and the Effectiveness of Public Health Subsidies (July 2015). CEPR Discussion Paper No. DP10690, Available at SSRN:

Rebecca Dizon‐Ross (Contact Author)

University of Chicago ( email )

1101 East 58th Street
Chicago, IL 60637
United States

Pascaline Dupas

Stanford University ( email )

Stanford, CA 94305
United States

Jonathan Robinson

University of California, Santa Cruz ( email )

1156 High St
Santa Cruz, CA 95064
United States

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