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We evaluate the impact of a large-scale information and mobilization intervention designed to improve health service delivery in rural Uganda by increasing citizens’ ability to monitor and apply bottom-up pressure on underperforming health workers. Modeled closely on the landmark “Power to the People” study (Bjorkman and Svensson, 2009), the intervention was undertaken in 376 health centers in 16 districts and involved a three wave panel of more than 14,000 households. We find that while the intervention had a modest positive impact on treatment quality and patient satisfaction, it had no effect on utilization rates or health outcomes (including child mortality). We also find no evidence that the channel through which the intervention affected treatment quality was citizen monitoring. The results hold in a wide set of pre-specified subgroups and also when, via a factorial design, we break down the complex intervention into its two most important components. Our findings cast doubt on t...
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January 08, 2019
Around the world, 152 million children are engaged in child labor. Because poverty is thought to be the root cause of child labor, policymakers have aimed to reduce child labor by improving the economic welfare of poor households where children are engaged in child labor. In the Philippines, researchers partnered with the Philippine Department of Labor and Employment (DOLE) to conduct a randomized evaluation of the impact of a program that provided a one-time productive asset transfer of PHP 10,000 (equivalent to US$518) on economic well-being and child labor outcomes. Key Findings  Approximately 15 months after the program started: The assets increased household business activity, both fostering new activities and helping older business activities persist. The program increased food security and improved some measures of child welfare, including children’s life satisfaction. The program had a positive rate of return on family-firm generated income. However, the program also led to an...
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January 07, 2019
We present results from a large-scale randomized experiment across 350 schools in Tanzania that studied the impact of providing schools with (a) unconditional grants, (b) teacher incentives based on student performance, and (c) both of the above. After two years, we find (a) no impact on student test scores from providing school grants, (b) some evidence of positive effects from teacher incentives, and (c) significant positive effects from providing both programs. Most importantly, we find strong evidence of complementarities between the two programs, with the effect of joint provision being significantly greater than the sum of the individual effects. Our results suggest that combining spending on school inputs (which is the default policy) with improved teacher incentives could substantially increase the cost-effectiveness of public spending on education.
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January 01, 2019
This paper studies strategic default on forward sale contracts in the international coffee market. To test for strategic default, we construct contract-specific measures of unanticipated changes in market conditions by comparing spot prices at maturity with the relevant futures prices at the contracting date. Unanticipated rises in market prices increase defaults on fixed price contracts but not on priceindexed ones. We isolate strategic default by focusing on unanticipated rises at the time of delivery after production decisions are sunk and suppliers have been paid. Estimates suggest that roughly half of the observed defaults are strategic. We model how strategic default introduces a trade-off between insurance and counterparty risk: relative to indexed contracts, fixed-price contracts insure against price swings but create incentives to default when market conditions change. A model calibration suggests that the possibility of strategic default causes 15.8% average losses in output,...
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Working Paper
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December 14, 2018
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In Uganda, researchers conducted a large-scale randomized evaluation of a program called Accountability Can Transform (ACT) Health. The program provided community members and health care workers information about the quality of their local health services and brought them together to create action plans for how to improve local health service accountability, delivery, and quality. The study built on previous research of a similar program called Power to the People, which was found to greatly improve child health. Key Findings Twenty months after the program began:1 The program marginally improved the quality of treatment patients received and increased patient satisfaction. However, the program did not affect how often people sought health care (utilization rates) or improve health outcomes; child mortality rates were unchanged. Results were similar one and two years into the program and were consistent across different groups; no health effects were found in any subgroup. Contrary to...
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December 14, 2018
Individuals care about how they are perceived by others, and take visible actions to signal their type. This paper investigates social signaling in the context of childhood immunization in Sierra Leone. Despite high initial vaccine take-up, many parents do not complete the five immunizations that are required in a child’s first year of life. I introduce a durable signal - in the form of differently colored bracelets - which children receive upon vaccination, and implement a 22-month-long experiment in 120 public clinics. Informed by theory, the experimental design separately identifies social signaling from leading alternative mechanisms. In a first main finding, I show that individuals use signals to learn about others’ actions. Second, I find that the impact of signals varies significantly with the social desirability of the action. In particular, the signal has a weak effect when linked to a vaccine with low perceived benefits and a large, positive effect when linked to a vaccine wi...
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Working Paper
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November 21, 2018
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IPA Zambia is pleased to share its Q1-Q3 bulletin from 2018. This bulletin highlights IPA Zambia's participation in research dissemination and conference events, including the Evidence for Impact Symposium and the Third National Food and Nutrition Summit.
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November 19, 2018
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Background: Helminth and protozoan infections affect >1 billion children globally. Improved water, sanitation, handwashing, and nutrition could be more sustainable control strategies for parasite infections than mass drug administration (MDA), while providing other quality of life benefits. Methods and Findings: We enrolled geographic clusters of pregnant women into a cluster-randomized controlled trial that tested six interventions: disinfecting drinking water(W), improved sanitation(S), handwashing with soap(H), combined WSH, improved nutrition(N), and combined WSHN. We assessed intervention effects on parasite infections by measuring Ascaris lumbricoides, Trichuris trichiura, hookworm, and Giardia duodenalis among individual children born to enrolled mothers and their older siblings (ClinicalTrials.gov NCT01704105). We collected stool specimens from 9077 total children in 622 clusters, including 2346 children in control, 1117 in water, 1160 in sanitation, 1141 in handwashing, 106...
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November 09, 2018
We assessed the impacts of a teacher professional development program for public and private kindergartens in the Greater Accra Region of Ghana. We examined impacts on teacher professional well-being, classroom quality, and children’s readiness during one school year. This cluster-randomized trial included 240 schools (teachers N = 444; children N = 3,345, Mage = 5.2) randomly assigned to one of three conditions: teacher training (TT), teacher training plus parental-awareness meetings (TTPA), and controls. The programs incorporated workshops and in-classroom coaching for teachers and video-based discussion groups for parents. Moderate impacts were found on some dimensions of professional well-being (reduced burnout in the TT and TTPA conditions, reduced turnover in the TT condition), classroom quality (increased emotional support/behavior management in the TT and TTPA conditions, support for student expression in the TT condition), and small impacts on multiple domains of children’s sc...
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October 18, 2018
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In Rwanda, we have continued our global tradition of rigorous, applicable research by building foundational research capacity and conducting evaluations in areas of pressing national concern. Examples of our work below offer promising insights into everyday issues that affect the lives of the Rwandan poor. 
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October 17, 2018
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Children and parents sometimes make ill-informed educational choices, resulting in unrealized educational goals, children dropping out of school, and children joining the labor force. In partnership with Innovations for Poverty Action and the Ministry of Education in Peru, researchers designed and rigorously evaluated two interventions intended to improve decision-making about education and time-use by providing schoolchildren and their families with information about the returns to education. Preliminary Findings*: Students’ and parents’ perceptions of the financial benefits to education increased. Accessing information about the social and financial returns to education via videos and an interactive tablet application corrected misconceptions about the benefits of education. Dropout rates fell. Information had a significant negative effect on dropout rates in both rural and urban areas. Child labor effects were mixed. Videos decreased child labor for girls in urban areas, but did not...
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Brief
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September 28, 2018
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In Mexico, we have continued our global tradition of rigorous, applicable research by building foundational research capacity and conducting evaluations in areas of pressing national concern. Examples of our work detailed in this brief promising insights into everyday issues that affect the lives of people in Mexico.
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September 26, 2018
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How do standard development programs compare to just giving people cash? In Rwanda, researchers conducted a randomized evaluation to shed light on this question. Villages were randomly assigned to one of four groups: they received either a USAID-funded, integrated WASH and nutrition program (with savings and asset transfer components), unconditional cash grants of equal cost to the donor, a larger cash transfer, or no program at the time of study. The transfers were funded by USAID and Google.org. The evaluation measured impacts on five main health and economic outcomes: household dietary diversity, maternal and child anemia, child growth (height-for-age, weight-for-age, and mid-upper arm circumference), household wealth, and household consumption, as well as other secondary outcomes, such as savings. Key Findings: After approximately one year: »  The integrated nutrition and WASH program had a positive impact on savings, a secondary outcome, among the eligible population, but did not...
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September 18, 2018
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African agricultural markets are characterized by low revenues for farmers and high food prices for consumers. Many have worried that this wedge is partially driven by imperfect competition among intermediaries. This paper provides experimental evidence from Kenya on intermediary market structure. Experimentally elicited parameters governing cost pass-through and demand curvature are used to calibrate a structural model of market competition. Estimates reveal a high degree of intermediary market power, with large implied losses to consumer welfare and market e ciency. Exogenously induced firm entry has negligible effects on prices and competitiveness parameters, implying that marginal entry does not meaningfully enhance competition.
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Working Paper
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September 08, 2018
Changing pedagogy is a promising avenue for improving education in developing countries, especially when done without changing current inputs, such as teachers and instruction time. Previous research suggests that tailoring instruction to each student needs can produce significant learning gains. In this paper, we present the results of a randomized evaluation of a program that uses an individualized approach to tailor instruction to each student to teach Mathematics to preschoolers in Peru. Our results show an improvement of overall Mathematics outcomes, which persist even one year after the program ended for some areas. We find no evidence of differential effects by gender, language-spoken at home, and proxies for socioeconomic status, in contrast with results from previous research that suggest Mathematics programs are biased along gender and socioeconomic lines but we do find persistent stronger impacts on students whose teachers have university degrees.
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Working Paper
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August 29, 2018
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Designers and funders of payments for ecosystem services (PES) programs have long worried that payments flow to landholders who would have conserved forests even without the program, undermining the environmental benefits (“additionality”) and cost-effectiveness of PES. If landholders self-select into PES programs based on how much conservation they were going to undertake anyway, then those who were planning to conserve should always enroll. This paper discusses the less-appreciated fact that enrollment is often based on other factors too. The hassle of signing up or financial costs of enrollment (e.g., purchasing seedlings) can affect who participates in a PES program. These enrollment costs reduce overall take-up, and, importantly, they can also influence the composition of landholders who select into the program—and thereby the program’s environmental benefits per enrollee. Enrollment costs can increase a program’s benefits per enrollee if they are systematically higher for (and th...
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August 02, 2018
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In 2008, Uganda granted hundreds of small groups $400/person to help members start individual skilled trades. Four years on, an experimental evaluation found grants raised earnings by 38% (Blattman, Fiala, Martinez 2014). We return after 9 years to find these start-up grants acted more as a kick-start than a lift out of poverty. Grantees' investment leveled off; controls eventually increased their incomes through business and casual labor; and so both groups converged in employment, earnings, and consumption. Grants had lasting impacts on assets, skilled work, and possibly child health, but had little effect on mortality, fertility, health or education.
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July 30, 2018
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Maternal mortality remains very high in many parts of the developing world, especially in sub-Saharan Africa. Limited awareness of risk factors for maternal mortality such as maternal age and birth spacing may contribute to persistently high death rates, and public health campaigns to increase awareness of risk factors could help curb maternal mortality. Research shows that men, in particular, tend to underestimate maternal mortality risk, which may lead to their lower demand for contraception. Researchers worked in close collaboration with Zambia’s Ministry of Health and local NGOs to evaluate the impact of providing information to men and women about maternal mortality risk on knowledge of risk, demand for family planning, and maternal and child health outcomes. Preliminary results indicate that providing husbands with the information led to a reduction in fertility in the year that followed, while providing information to women had no comparable impact.
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July 30, 2018
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Although abortion is now legal in Kenya under expanded circumstances, access is limited and many providers and individuals still believe it is illegal. This study aimed to characterise Kenyan women’s perceptions and experiences with abortion and post-abortion care (PAC) services in Nairobi regarding barriers to care, beliefs about abortion, and perceived stigma. We conducted 15 semi-structured in-depth interviews with Kenyan women aged 18–24 years who recently received abortion and PAC services at four Marie Stopes Kenya clinic sites in Nairobi. The most significant psychosocial barrier respondents faced in promptly seeking abortion and PAC was perceived stigma. In response to stigma, participants developed a sense of agency and self-reliance, which allowed them to prioritise their own healthcare needs over the concerns of others. To adequately address perceived stigma as a barrier to abortion- and PAC-seeking, significant cultural norm shifting is required.
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July 30, 2018
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Limited financial knowledge, skills, and confidence are associated with suboptimal financial behavior such as low rates of saving, limited usage of deposit and transactional accounts, and overindebtedness. The Government of Rwanda, the World Bank Group, and Innovations for Poverty Action (IPA) partnered to conduct a large-scale randomized evaluation that measured the impact of Phase One of the Financial Education through SACCOs program. The evaluation measured and compared the impacts of two program delivery models—autonomous vs. fixed trainer selection—on SACCO members’ financial knowledge, skills, attitudes, and behaviors. Key Findings SACCO members attended more sessions of the Financial Education through SACCOs when SACCOs had autonomy to choose trainers from the local community (“autonomous selection”). SACCO members in this autonomous selection group showed improvements in financial knowledge, attitudes, and behaviors, including with respect to knowledge of key rules of thumb, at...
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July 13, 2018

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