We use a randomized experiment to test whether and what information changes teenagers' sexual behavior in Kenya. Providing information on the relative risk of HIV infection by partner's age led to a ...28 percent decrease in teen pregnancy, an objective proxy for the incidence of unprotected sex. Self-reported sexual behavior data suggests substitution away from older (riskier) partners and toward same-age partners. In contrast, the official abstinence-only HIV curriculum had no impact on teen pregnancy. These results suggest that teenagers are responsive to risk information, but their sexual behavior is more elastic on the intensive than on the extensive margin.
Using data from a field experiment in Kenya, we document that providing individuals with simple informal savings technologies can substantially increase investment in preventative health and reduce ...vulnerability to health shocks. Simply providing a safe place to keep money was sufficient to increase health savings by 66 percent. Adding an earmarking feature was only helpful when funds were put toward emergencies, or for individuals that are frequently taxed by friends and relatives. Group-based savings and credit schemes had very large effects.
The disease burden in low-income countries is extremely high. Malaria, respiratory infections, diarrhea, AIDS, and other diseases are estimated to kill more than 15 million people each year, most of ...them children. Yet the great majority of these diseases can be prevented or treated. This article reviews microeconomic studies of health-seeking behavior in low-income countries. Factors examined include information, peers, liquidity constraints, and nonrational preferences, such as present bias. I then discuss the implications for policy, including the scope for mandates, subsidies, and incentives.
Does limited access to formal savings services impede business growth in poor countries? To shed light on this question, we randomized access to noninterest-bearing bank accounts among two types of ...self-employed individuals in rural Kenya: market vendors (who are mostly women) and men working as bicycle taxi drivers. Despite large withdrawal fees, a substantial share of market women used the accounts, were able to save more, and increased their productive investment and private expenditures. We see no impact for bicycletaxi drivers. These results imply significant barriers to savings and investment for market women in our study context.
It is often argued that cost-sharing—charging a subsidized, positive price— for a health product is necessary to avoid wasting resources on those who will not use or do not need the product. We ...explore this argument through a field experiment in Kenya, in which we randomized the price at which prenatal clinics could sell long-lasting antimalarial insecticide-treated bed nets (ITNs) to pregnant women. We find no evidence that cost-sharing reduces wastage on those who will not use the product: women who received free ITNs are not less likely to use them than those who paid subsidized positive prices. We also find no evidence that costsharing induces selection of women who need the net more: those who pay higher prices appear no sicker than the average prenatal client in the area in terms of measured anemia (an important indicator of malaria). Cost-sharing does, however, considerably dampen demand. We find that uptake drops by sixty percentage points when the price of ITNs increases from zero to $0.60 (i.e., from 100% to 90% subsidy), a price still $0.15 below the price at which ITNs are currently sold to pregnant women in Kenya. We combine our estimates in a cost-effectiveness analysis of the impact of ITN prices on child mortality that incorporates both private and social returns to ITN usage. Overall, our results suggest that free distribution of ITNs could save many more lives than cost-sharing programs have achieved so far, and, given the large positive externality associated with widespread usage of ITNs, would likely do so at a lesser cost per life saved.
A seven-year randomized evaluation suggests education subsidies reduce adolescent girls' dropout, pregnancy, and marriage but not sexually transmitted infection (STI). The government's HIV ...curriculum, which stresses abstinence until marriage, does not reduce pregnancy or STI. Both programs combined reduce STI more, but cut dropout and pregnancy less, than education subsidies alone. These results are inconsistent with a model of schooling and sexual behavior in which both pregnancy and STI are determined by one factor (unprotected sex), but consistent with a two-factor model in which choices between committed and casual relationships also affect these outcomes.
This paper examines the take-up of a new malaria control device by rural households in Kenya, and tests whether the demand curve for the device varies with the framing of marketing messages and with ...the gender of the person targeted by the marketing. The paper finds that the demand for malaria-preventing bed nets in Western Kenya is sensitive to price, but quite insensitive to other things tested. Women do not appear to have a different price elasticity than men and neither women nor men respond to framing. Liquidity constraints may be the main barrier to investments in malaria prevention, consistent with recent research in India showing that while 2% of households purchase an insecticide-treated bednet (ITN) in cash, 59% purchase at least one when ITNs are offered on credit.
To the extent that students benefit from high-achieving peers, tracking will help strong students and hurt weak ones. However, all students may benefit if tracking allows teachers to better tailor ...their instruction level. Lower-achieving pupils are particularly likely to benefit from tracking when teachers have incentives to teach to the top of the distribution. We propose a simple model nesting these effects and test its implications in a randomized tracking experiment conducted with 121 primary schools in Kenya. While the direct effect of high-achieving peers is positive, tracking benefited lower-achieving pupils indirectly by allowing teachers to teach to their level.
We experimentally test the impact of expanding access to basic bank accounts in Uganda, Malawi, and Chile. Over two years, 17, 10, and 3 percent of treatment individuals made five or more deposits, ...respectively. Average monthly deposits in treatment accounts were sizable among users, corresponding to the seventy-ninth, ninety-first, and ninety-sixth percentiles of baseline savings. Survey data show no discernible intention-to-treat effects on savings or any downstream outcomes, though we cannot reject large effect sizes for active users. Results suggest that policies merely focused on expanding access to basic accounts are unlikely to improve welfare noticeably on average.
Some education policymakers focus on bringing down pupil–teacher ratios. Others argue that resources will have limited impact without systematic reforms to education governance, teacher incentives, ...and pedagogy. We examine a program under which school committees at randomly selected Kenyan schools were funded to hire an additional teacher on an annual contract renewable conditional on performance, outside normal Ministry of Education civil-service channels, at one-quarter normal compensation levels. For students randomly assigned to stay with existing classes, test scores did not increase significantly, despite a reduction in class size from 82 to 44 on average. In contrast, scores increased for students assigned to be taught by locally-hired contract teachers. One reason may be that contract teachers had low absence rates, while centrally-hired civil-service teachers in schools randomly assigned contract teachers endogenously reduced their effort. Civil-service teachers also captured rents for their families, with approximately 1/3 of contract teacher positions going to relatives of existing teachers. A governance program that empowered parents within school committees reduced both forms of capture. The best contract teachers obtained civil service jobs over time, and we estimate large potential dynamic benefits from supplementing a civil service system with locally-hired contract teachers brought in on a probationary basis and granted tenure conditional on performance.
•We evaluate a program that provided randomly selected schools with an extra teacher on short-term contract.•Test scores did not increase significantly for students randomly assigned to be taught by regular (civil-service) teachers.•In contrast, scores increased by 0.24 std. dev. for students taught by contract teachers.•Regular teachers reduced effort in response to the program and captured rents by hiring their relatives as contract teachers.•A governance program that empowered parents within school committees reduced both forms of capture.
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