Governance and the Effectiveness of Public Health Subsidies: Evidence from Ghana, Kenya and Uganda

44 Pages Posted: 7 Mar 2019

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 11, 2017

Abstract

Distributing subsidized health products through existing health infrastructure could substantially and cost-effectively improve health in sub-Saharan Africa. There is, however, widespread concern that poor governance – in particular, limited health worker accountability – seriously undermines the effectiveness of subsidy programs. We audit targeted bednet distribution programs to quantify the extent of agency problems. We find that around 80% of the eligible receive the subsidy as intended, and up to 15% of subsidies are leaked to ineligible people. Supplementing the program with simple financial or monitoring incentives for health workers does not improve performance further and is thus not cost-effective in this context.

Keywords: leakage, extortion, shirking, motivation

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: Evidence from Ghana, Kenya and Uganda (July 11, 2017). University of Chicago, Becker Friedman Institute for Economics Working Paper No. 2019-39. Available at SSRN: https://ssrn.com/abstract=3348081 or http://dx.doi.org/10.2139/ssrn.3348081

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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