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We study how healthcare subsidies and improved information affect over- and under-use of primary healthcare in a randomized control trial of 1544 children in Mali. In a dynamic model of healthcare demand, misuse relative to policymaker preferences (here given by WHO care-seeking standards) arises from seeking care too early or too late during an illness spell. Using nine weeks of daily data, we show that the barrier to optimal care seeking is cost, not information: subsidies increase demand by over 250%, but overuse is rare with or without the subsidy. Information, contrary to intent, appears to increase underuse, as our model predicts.
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Working Paper
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June 01, 2016
A4
Lack of income, inadequate health services, and poor infrastructure contribute to poor global health. With more than 100 health-related studies, IPA generates evidence on effective ways to improve access to quality health services and products, and ensure people use them. In recent years, great progress has been made in global health. Rates of chronic hunger and child mortality are half what they were two decades ago. However, at the same time, progress has been slow in other areas, such as maternal mortality, access to improved sanitation, and the incidence of malaria. To determine how best to address these challenges and many others, IPA partners with health ministries, civil society organizations, and NGOs working in the sector to discover and encourage the use of effective approaches for improving health systems and programs. Among its findings, this research has identified cost-effective methods to reduce the incidence of diarrhea in children under five years of age, examined the...
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Brief
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May 27, 2016
A4 English
In 2010, IPA opened an office in Bangladesh to apply our tradition of rigorous, applicable research and gain insights into effective solutions for the country’s poor. IPA Bangladesh has since collaborated with governments, NGOs, and world-renowned researchers on over 20 evaluations across sectors. Our 35 full-time employees—who boast diverse expertise in research and questionnaire design, field and data management, and research quality control—work on-the-ground in districts as far reaching as Rangpur, Barishal, and Kurigram to ensure the quality of every evaluation.
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May 27, 2016
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We elicit sitting politicians' preferences over two attributes of local public goods, opportunities for targeting and control of discretionary funding, by conducting an incentive-compatible choice experiment with 179 elected county councilors in rural Kenya. In our experiment, local politicians choose between different public goods packages that vary across two dimensions: whether or not the politician is able to target the good to the location of his choice, and whether he controls the discretionary funding associated with the project. Local officials put a high premium on opportunities for geographic targeting, but not on the ability to control the associated discretionary funding; local officials are particularly uninterested in controlling the funding mechanism (and taking on the associated maintenance responsibilities) when they are able to choose the public good's location. Decisions about where to install the public good suggest a combination of motives: councilors choose locati...
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Working Paper
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May 17, 2016
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Individuals across the world use high-transaction-cost savings devices, even when lower-cost technologies are available. High costs may help savers protect resources from the demands of others. I investigate this hypothesis by randomly assigning ATM cards to 1,100 newly-opened bank accounts in rural Kenya. These cards reduced withdrawal fees by 50 percent. While the cards increased overall account use, the positive treatment effect is entirely driven by joint and male-owned accounts. I find evidence that these differences are driven by intrahousehold issues: household bargaining power is a key mediator of the ATM treatment effect.
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Working Paper
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May 13, 2016
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The new handwashing system, designed with end user input, features an economical foaming soap dispenser and a hygienic, water-efficient tap for use in household and institutional settings that lack reliable access to piped water. Cost of the soap and water needed for use is less than US$0.10 per 100 handwash uses, compared with US$0.20–$0.44 for conventional handwashing stations used in Kenya. Using an interactive and iterative design approach involving representative end users, we created a new handwashing system in Kisumu, Kenya, to make handwashing convenient and economical in areas without reliable piped water. The innovative and adaptable system, branded as Povu Poa (“Cool Foam” in Kiswahili), integrates a cost-effective foaming soap dispenser with a hygienic, water-frugal water tap in a secure and affordable design.
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Published Paper
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May 13, 2016
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Most wars today are civil wars, which divide countries along economic, ethnic or political lines. In many cases, these cleavages happen within communities, pitting one neighbor against another. The prevalence of civil wars has therefore spurred efforts to re-build social cohesion and promote social capital as a part of post-conflict recovery. Truth and reconciliation processes are a common approach used across the world to promote this type of societal healing. These processes bring war victims face-to-face with perpetrators in forums where victims describe war atrocities, and perpetrators confess to war crimes without facing punishment. Proponents of reconciliation processes claim that they are highly effective – not only in rebuilding social ties among individuals and promoting societal healing, but also in providing psychological relief and aiding individual healing. Yet, there is little rigorous evidence of whether, and how, reconciliation processes help communities heal from confl...
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Brief
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May 05, 2016
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While improving government performance is a key challenge for state development, we still know little about what factors affect citizens' toleration of poor performance by government officials. This paper argues that taxation is a significant predictor of citizens' demands, detailing and formalizing a micro-level theory of how taxation affects citizens' preferences over accountability. By taking away earned income, taxation pushes loss-averse citizens below their reference point, increasing the utility citizens lose from non-accountable government behavior and making them more likely to enact costly sanctions against officials. Laboratory experiments, conducted in Uganda, find that in a single-shot game taxation increases citizens' willingness to punish leaders by 12% overall, and by 30% among the group who has the most experience paying taxes in Uganda. Additional experiments confirm that this effect is driven by the loss aversion mechanism, and a survey experiment demonstrates that t...
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Working Paper
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May 01, 2016
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Theoretically, weather-index insurance is an effective risk reduction option for small-scale farmers in low-income countries. Renewed policy and donor emphasis on bridging gender gaps in development also emphasizes the potential social safety net benefits that weather-index insurance could bring to women farmers who are disproportionately vulnerable to climate change risk and have low adaptive capacity. To date, no quantitative studies have experimentally explored weather-index insurance preferences through a gender lens, and little information exists regarding gender-specific preferences for (and constraints to) smallholder investment in agricultural weather-index insurance. This study responds to this gap, and advances the understanding of preference heterogeneity for weather-index insurance by analysing data collected from 433 male and female farmers living on a climate change vulnerable coastal island in Bangladesh, where an increasing number of farmers are adopting maize as a pote...
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Published Paper
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May 01, 2016
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In developing countries, poor households often do not have access to formal financial products or use bank accounts to save for the future. Without a safe and secure way to save, many people rely on riskier and more expensive methods of managing their assets. Increasingly, government-to-person cash transfer programs are addressing this issue by providing beneficiaries with formal savings accounts through which they disburse cash transfers. In Peru, evidence from one such program suggests that very few beneficiaries of a conditional cash transfer (CCT) use their accounts to save, preferring instead to withdraw the entire cash transfer immediately after it is made. Beneficiaries may prefer to withdraw their funds all at once due to the time and cost required to travel to a bank branch or automated teller machine (ATM) to access their account, especially in rural areas where there is limited banking infrastructure. Furthermore, although access is improved and travel time reduced, benefici...
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Working Paper
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April 30, 2016
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As data-sharing becomes more prevalent throughout the natural and social sciences, the research community is working to meet the demands of managing and publishing data in ways that facilitate sharing. Despite the availability of repositories and research data management plans, fundamental concerns remain about how to best manage and curate data for long-term usability. The value of shared data is very much linked to its usability, and a big question remains: What tools support the preparation and review of research materials for replication, reproducibility, repurposing, and reuse? This paper describes key curation tasks and new data curation software designed specifically for reviewing and enhancing research data. It is being developed by two research groups, the Institution for Social and Policy Studies at Yale University and Innovations for Poverty Action, in collaboration with Colectica. The software includes curation steps designed to improve the research materials and thus to en...
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Research Resource
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April 18, 2016
Spanish A4
In Colombia, 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 research below offer promising insights into everyday issues for Colombians. 
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Brief
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April 10, 2016
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Through a field experiment in Afghanistan, we show that default enrollment in payroll deductions increases rates of savings by 40 percentage points, and that this increase is driven by present-biased preferences. Working with Afghanistan’s primary mobile phone operator, we designed and deployed a new mobile phone-based automatic payroll deduction system. Each of 967 employees at the country’s largest firm was randomly assigned a default contribution rate (either 0% or 5%) as well as a matching incentive rate (0%, 25%, or 50%). We find that employees initially assigned a default contribution rate of 5% are 40 percentage points more likely to contribute to the account 6 months later than individuals assigned to a default contribution rate of zero; to achieve this effect through financial incentives alone would require a 50% match from the employer. We also find evidence of habit formation: default enrollment increases the likelihood that employees continue to save after the trial ended,...
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Working Paper
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April 09, 2016
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We estimate the impact of Kenya’s post-election crisis on individual risk preferences. The crisis interrupted a longitudinal survey of more than five thousand Kenyan youth, creating plausibly exogenous variation in exposure to civil conflict by the time of the survey. We measure individual risk preferences using hypothetical lottery choice questions which we validate by showing that they predict migration and entrepreneurship in the cross-section. Our results indicate that the post-election violence sharply increased individual risk aversion. Immediately after the crisis, the fraction of subjects displaying extreme risk aversion increased by more than 80 percent. Findings remain robust when we use an IV estimation strategy that exploits random assignment of respondents to waves of surveying. Our results suggest that the crisis also impacted trust, social capital, and beliefs about the economy, though it did not have any detectable negative impacts on job prospects or wages.
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Working Paper
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April 01, 2016
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We show that extremely poor, war-affected women in northern Uganda have high returns to a package of $150 cash, five days of business skills training, and ongoing supervision. Sixteen months after grants, participants doubled their microenterprise ownership and incomes, mainly from petty trading. We also show these ultrapoor have too little social capital, but that group bonds, informal insurance, and cooperative activities could be induced and had positive returns. When the control group received cash and training 20 months later, we varied supervision, which represented half of the program costs. A year later, supervision increased business survival but not consumption.
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Published Paper
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April 01, 2016
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Can innovation among micro-entrepreneurs in South Africa teach global corporations a lesson? Rajesh Chandy, Stephen Anderson-Macdonald and Bilal Zia reckon so. Mass poverty is a huge world problem, typically addressed through multibillion aid programmes. But a grassroots research project in South Africa’s impoverished townships suggests another, sustainable solution. It isn’t the first study into the impact of skills training on microentrepreneurs in developing countries. But prior initiatives have tended to show that any benefits are small or short-lived. This project is remarkable because it is the first to demonstrate the opposite. “You can solve many of the problems of poverty and growth in the world by doing better business,” says LBS’s Rajesh Chandy, one of the three academics who devised the project. “Microentrepreneurs represent the most common type of business in the world. Yet we tend to ignore them – even though they are hiding in plain sight. If we can help them transform t...
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March 30, 2016
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Background. By 2009, two decades of war and widespread displacement left the majority of the population of Northern Uganda impoverished. Methods. This study used a cluster-randomized design to test the hypothesis that a poverty alleviation program would improve economic security and reduce symptoms of depression in a sample of mostly young women. Roughly 120 villages in Northern Uganda were invited to participate. Community committees were asked to identify the most vulnerable women (and some men) to participate. The implementing agency screened all proposed participants, and a total of 1800 were enrolled. Following a baseline survey, villages were randomized to a treatment or wait-list control group. Participants in treatment villages received training, start-up capital, and follow-up support. Participants, implementers, and data collectors were not blinded to treatment status. Results. Villages were randomized to the treatment group (60 villages with 896 participants) or the wait-lis...
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Published Paper
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March 30, 2016
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Weather index insurance protects farmers against losses from extreme weather and facilitates investment in their farms, but randomized evaluations in South Asia and sub-Saharan Africa have shown low demand for these products at market prices, suggesting the need for alternative approaches.  Key Findings: Without substantial subsidies, take-up of insurance was low. Large discounts increased take-up substantially, and interventions designed to increase financial literacy or reduce basis risk also had positive effects. However, at market prices, take-up was in the range of 6–18 percent, which cannot sustain unsubsidized markets. Insured farmers were more likely to plant riskier but higher-yielding crops. In the three studies that measured changes in farmer behavior, farmers who felt protected against weather risks shifted production toward crops that were more sensitive to weather but more profitable on average. While self-sustaining markets for weather index insurance have not emerged, f...
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Brief
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March 24, 2016
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Loans and business management training helped men grow their small business profits, but women did not experience any impacts on their businesses as a result of loans, training, or grants.
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Brief
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March 21, 2016
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Labor-intensive public works programs are important social protection tools in low- income settings, intended to supplement the income of poor households and improve public infrastructure. In this evaluation of the Malawi Social Action Fund, an at- scale, government-operated program, across- and within-village randomization is used to estimate effects on food security and use of fertilizer. There is no evidence that the program improves food security, and suggestive evidence of negative spillovers to untreated households. These disappointing results hold even under modifications to the design of the program to offer work during the lean rather than harvest season or increase the frequency of payments. 
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Working Paper
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March 09, 2016

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