In partnership with Grameen Foundation's AppLab, Google, Google.org, and MTN, IPA is examining the impact of a newly launched SMS-based health service. The service allows users to request reproductive and sexual health advice via SMS, as well as to query a directory of local clinics. The research project seeks to test the impact of the service on 1) knowledge of sexual and reproductive health, and 2) related behavior, both self-reported and observed (risky behavior, clinic visits, seeking preventive health services).
The service is available to the whole population; the treatment takes the form of marketing in a random selection of trading centers.
This project is one of the few to rigorously evaluate the impact of a microcredit program. It takes advantage of the expansion of Al Amana, Morocco's largest microfinance institution, into rural areas of Morocco where access to formal credit is very low. 50% of households sampled in initial surveys indicated that they were in need of credit in the previous year, but never actually requested it.
Microcredit is the most visible innovation in anti-poverty policy in the last half-century, and in three decades it has grown dramatically. Now with almost 130 million borrowers, microcredit has undoubtedly been successful in bringing formal financial services to the poor. Many believe it has done much more, and that by putting money into the hands of poor families (and often women) it has the potential to increase investments in health and education and empower women. Skeptics, however, see microcredit organizations as extremely similar to the old fashioned money-lenders, making their profits based on the inability of the poor to resist the temptation of a new loan. They point to the large number of very small businesses created, with few maturing into larger businesses, and worry that they compete against each other. Until recently there has been very little rigorous evidence to help arbitrate between these very different viewpoints.
Context of the Evaluation:
Those who live on less than 2 dollars a day represent 19% of the population in the dispersed rural areas of Morocco. In the past, most microfinance services in Morocco have been concentrated in the urban and peri-urban areas, while people in rural areas used various forms of informal credit. The level of access to formal credit from a bank or financial institution is very low in these locations: the initial surveys of this project have shown that only 2.5% of those in Morocco living on less than 2 dollars a day borrow from formal credit sources.
Between 2006 and 2007, Al Amana opened around 60 new branches in sparsely populated rural areas . The main product Al Amana offers in rural areas is a group-liability loan, and, since March 2008 , individual loans for housing and non-agriculture businesses were also introduced in these areas. Groups are formed by three to four members who agree to mutually guarantee the reimbursement of their loans, with amounts ranging from $124 to $1,855 USD per group member. Individual loans are also offered, usually for clients that can provide some sort of collateral.
Details of the Intervention:
Within the catchment areas of new MFI branches opened in areas that had previously no access to microcredit, 81 pairs of matched villages were selected. Within each pair, one village was randomly selected to receive microcredit services just after the branch opening, while the other received service two years later.
The baseline survey was grouped in four waves to follow Al Amana’s timeline of branch openings between 2006 and 2007 . Data on socio-economic characteristics, households’ production, members’ outside work, consumption, credit, and women’s role in the household was collected among a sample of households. An endline survey was administered two years after Al Amana intervention started in each wave.
By the time of the endline survey, 16% of surveyed households living in treatment villages had taken a loan from Al Amana. Three-fourths of those who had taken loans from Al Amana received group-liability loans, and borrowers were predominantly men. Households in areas where credit was offered had borrowed an average total of $117 USD from Al Amana at the endline, at an average of about $964 USD per loan.
Results and Policy Lessons:
Al Amana program increased access to credit significantly: households were more than twice as likely to have a loan of some kind in treatment villages relative to comparison villages. The main effect of improved access to credit was to expand the scale of existing self-employment activities of households, including both keeping livestock and agricultural activities.
Among livestock-rearing households, there was an increase in the stock of animals held, and households appeared to diversify the types of animals they held and the types of livestock products sold. This leads to an increase in sales and self-consumption, but no increase in profits. Agricultural sales and profits also increase, but households did not appear to expand into new sectors or create new businesses. A fraction of the extra profits were saved, while another fraction were offset by reduced wage earnings, and so on there was no average effect on consumption across all households.
Treatment effects vary significantly depending on whether a household had an existing self-employment activity at baseline. Households that had a pre-existing activity decrease their non-durable consumption (social expenditures) and consumption overall. This group saves more and borrows more from Al Amana, which is consistent with the need to fund the expansion of their activities. But households that did not have a pre-existing activity increased their food and durable expenditure (with no effect on overall consumption) and, did not see any change in their business outcomes.
Can financial incentives work to help people quit smoking? The CARES (Committed Action to Reduce and End Smoking) Program, creates a commitment contract that provides financial incentives for smokers who wish to quit smoking. Smokers offered the product were more likely to be smoke-free 6 and 12 months afterwards.
Despite detrimental effects, people throughout the world habitually engage in damaging or inefficient habits such as smoking, eating poorly, or failing to save money. Experts believe that this is because people’s preferences change over time: in the long-run an individual may wish to quit smoking, for example, but in the moment their preference for a cigarette may outweigh their desire to quit. Such behavior, known as time inconsistent preferences, may help to explain why people make inefficient choices that result in poor health or a lack of financial cushioning. Some researchers theorize that habits that have negative long-term effects can be discouraged by giving people commitment devices: contracts which constrain their future behavior, and may exact a financial penalty if they revert to bad habits.
Context of the Evaluation:
Despite its serious health effects, smoking is extremely commonplace in the Philippines: in 2009, 28.3 percent of Filipinos aged 15 years or older were current smokers, and 22.5 percent smoked on a daily basis. Smoking is also a considerable expense, with the average surveyed smoker spending approximately 100 pesos (US$2) per week on cigarettes, nearly 15 percent of their monthly income. Even though it is a common behavior, 72 percent of survey respondents reported that they wanted to stop smoking at some point in their life, and nearly 45 percent indicated that they had tried to stop smoking within the last year. Survey responses suggest that their lack of success may be due to time inconsistent preferences: though 72 percent reported that they wanted to stop smoking at some point, only about 18 percent of people said that they wanted to stop smoking now.
Details of the Intervention:
Committed Action to Reduce and End Smoking (“CARES”) is a voluntary commitment savings program. The basic design of the product allows a smoker to deposit a self-selected amount of his own money that will be forfeited unless he passes a biochemical test of smoking cessation. To enroll people in the CARES program, the Green Bank of Caraga identified regular smokers off the street and asked them if they wanted to participate in a short survey on smoking. All subjects received an informational pamphlet on the dangers of smoking, and a tip sheet on how to quit. After completing this baseline survey, subjects were randomly assigned to receive one of four offers:
CARES with deposit collection: A minimum balance of 50 pesos (about US$1) was required to open a CARES account, and individuals were encouraged by marketers to deposit the money they would normally spend on cigarettes into this account each week. This group also received weekly visits from deposit collectors, saving them the weekly trip to the bank. All CARES clients were able to deposit into, but not to withdraw from these accounts, and the accounts yielded no interest, to discourage non-smokers people from using them as a substitute for normal savings accounts.
CARES without deposit collection: Same as above, except these clients had to go to a bank branch themselves to make deposits.
Cue Cards: These individuals got to choose from among four wallet-sized cards depicting negative health consequences of smoking: premature babies, bad teeth, black lung, or a child hooked up to a respirator. They were encouraged by the marketers to keep them in a prominent location.
Comparison Group: These individuals received no additional information.
Six months after the baseline survey, all survey respondents took a urine test to determine if they were still smoking. Individuals in the CARES treatment groups would receive their entire balance back if they passed the test, but would forfeit it if they failed or refused to take the test. Non-clients (those assigned to the cues and comparison groups) were paid 30 pesos (US$0.60) for taking the six-month test, and all respondents were paid 30 pesos for taking another test 12 months after the baseline.
Results and Policy Lessons:
In total, about 11 percent of individuals who were offered CARES signed a contract. Individuals who reported wanting to quit, who were optimistic about quitting, and who already exhibited strategic behavior to manage their cravings (i.e. avoiding situations that made them want to smoke) were more likely to sign a contract. On the other hand, individuals who reported wanting to quite more than a year in the future, and who showed signs of being heavy smokers were less likely to sign a contract. Ninety percent of CARES clients opened with the minimum amount of 50 pesos, and 80 percent made additional contributions. The average client contributed about every two weeks, and after six months had a final balance of around 553 pesos, equal to approximately six months’ worth of cigarette spending.
Individuals who were offered a CARES contract were 3.3 to 5.8 percentage points more likely to pass a urine test for nicotine after six months than those in the comparison group, and were 3.4 to 5.7 percentage points more likely to pass after 12 months—a substantial effect considering that only 8.9 to 14.7 percent of comparison individuals passed the test. This represents an over 35 percent increase in the likelihood of smoking cessation compared to baseline. However, despite these large treatment effects, a surprisingly large proportion (66 percent) of smokers who voluntarily committed to CARES ended up failing to quit. Still, the results of the CARES program were far above the reductions in smoking associated with the cue card treatment, which had no effect on smoking cessation: though over 99 percent of clients offered the cue cards accepted them, fewer than half remembered the cards and knew where they had put them one year later, and only about 5 percent reported still using them to manage cravings. However, it is still not known how much of the CARES treatment effect was due to the financial commitment that all clients made, and how much was due to the frequent contact that some clients had with deposit collectors.
Aparna Dalal joins the Financial Access Initiative as Director of Special Projects. She has a Masters in Public Administration with a specialization in International Development from the Robert F. Wagner School of Public Service, New York University. At Wagner, she helped launch the NYU Microfinance Initiative a student-led forum that raises awareness about the latest developments and debates in the micofinance sector. Aparna brings a diverse set of management and technology consulting experience from the private and public sector.
NEW HAVEN, CT - Speaking at an event in Mexico City, Yale University economist Dean Karlan released the findings of two new studies examining microcredit loans for women in Mexico. Microcredit is the practice of offering small short-term loans to those typically outside the normal banking customer base. The new results show that offering the loans did not substantially change clients’ economic standing, but had some beneficial effects, including increased happiness. While microcredit has received widespread recognition as a tool to help the poor, including a Nobel Peace Prize for the innovators of microcredit at the Grameen Bank in Bangladesh, the expansion of for-profit banks into this market has sparked controversy, especially as interest rates for microlending can reach the equivalent of 100% APR or higher.