Despite poverty and limited access to health care, evidence is growing that patients in low-income countries are taking a more active role in their selection of health care providers. Urban areas such as Nairobi, Kenya offer a rich context for studying these “active” patients because of the large number of heterogeneous providers available. We use a unique panel dataset from 2015 in which 402 pregnant women from peri-urban (the “slums” of) Nai- robi, Kenya were interviewed three times over the course of their pregnancy and delivery, allowing us to follow women's care decisions and their perceptions of the quality of care they received. We define active antenatal care (ANC) patients as those women who switch ANC providers and explore the prevalence, characteristics and care- seeking behavior of these patients. We analyze whether active ANC patients appear to be seeking out higher qual- ity facilities and whether they are more satisfied with their care. Women in our sample visit over 150...
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Published Paper
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September 19, 2016
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Background: The recent global climate agreement in Paris aims to mitigate greenhouse gas emissions while fostering sustainable development, and establishes an international trading mechanism to meet this goal. Currently, carbon offset program implementers are allowed to collect their own monitoring data to determine the number of carbon credits to be awarded. Objectives: We summarize reasons for mandating independent monitoring of greenhouse gas emission reduction projects. In support of our policy recommendations, we describe a case study of a program designed to earn carbon credits by distributing almost one million drinking water filters in rural Kenya to avert the use of fuel for boiling water. We compare results from an assessment conducted by our research team in the program area among households with pregnant women or caregivers in rural villages with low piped water access with the reported program monitoring data and discuss the implications. Discussion: Our assessment in Keny...
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Published Paper
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September 16, 2016
English
IPA is synonymous with impact. We’re known for both measuring impact and using those results to impact people’s lives. In 2015, we further improved our research quality and grew in research quantity, and we began new efforts to share results to improve programs and policies for the poor. Since our founding in 2002, IPA has worked with over 400 leading academics to conduct over 600 evaluations in 51 countries. This research has informed hundreds of successful programs that now impact millions of individuals worldwide. Browse an online version of the report here: annualreport.poverty-action.org
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Annual Report
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September 12, 2016
English
Asymmetric information can be costly in insurance markets and can even hinder market development, as is the case for most agricultural insurance markets. I study information asymmetries in crop insurance in the Philippines using a randomized field experiment. Using a combination of preference elicitation, a two-level randomized allocation of insurance and detailed data collection, I test for and find evidence of adverse selection, moral hazard and their interaction – that is, selection on anticipated moral hazard behavior. I conclude that information asymmetry problems are substantial in this context and that variations on this experimental design may be useful in future work for identifying interactions between choice and treatment effects.
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Working Paper
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September 07, 2016
English
We examine the potential of asset-collateralized loans in low-income country credit markets. When a Kenyan dairy cooperative exogenously replaced high down payments and joint liability requirements with loans collateralized by the asset itself—a large water tank—loan take-up increased from 2.4%to 41.9%. In contrast, substituting joint liability requirements for deposit requirements had no impact on loan take up. There were no repossessions among farmers allowed to collateralize 75% of their loans, and a 0.7% repossession rate among those offered 96% asset collateralization. A Karlan-Zinman test based on waiving borrowing requirements ex post finds evidence of adverse selection with very low deposit requirements, but not of moral hazard. A simple model and rough calibration suggests that adverse selection and regulatory caps on interest rates may deter lenders from making welfare-improving loans with low deposit requirements. We estimate that 2/3 of marginal loans led to increased water...
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Working Paper
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September 01, 2016
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Paving streets in marginalized neighborhoods in Mexico increased property values, allowing households to purchase more home appliances and vehicles and to invest more in home improvements.
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Brief
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September 01, 2016
English
Systematic reviews of existing evidence show promising effects of community health worker (CHW) programs as a strategy to improve child survival, but also highlight challenges faced by CHW programs, including insufficient incentives to deliver timely and appropriate services. We assessed the effect of an incentivized community health delivery program in Uganda on all-cause under-five mortality. A cluster-randomized controlled trial, embedded within the scale-up of a new community health delivery program, was undertaken in 214 clusters in 10 districts in Uganda. In the intervention clusters micro entrepreneur-based community health promoters (CHPs) were deployed over a three-year period (2011-2013). On average 38 households were surveyed in each cluster at the end of 2013, for a total sample size of 8,119 households. The primary study outcome was all-cause under-five mortality (U5MR). U5MR was reduced by 27% (adjusted RR 0.73, 95% CI 0.58-0.93).
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Working Paper
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September 01, 2016
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We conduct a randomized experiment that generates exogenous variation in the access to foreign markets for rug producers in Egypt. Combined with detailed survey data, we causally identify the impact of exporting on firm performance. Treatment firms report 16-26 percent higher profits and exhibit large improvements in quality alongside reductions in output per hour relative to control firms. These findings do not simply reflect firms being offered higher margins to manufacture high-quality products that take longer to produce. Instead, we find evidence of learning-by-exporting whereby exporting improves technical efficiency. First, treatment firms have higher productivity and quality after controlling for rug specifications. Second, when asked to produce an identical domestic rug using the same inputs and same capital equipment, treatment firms produce higher quality rugs despite no difference in production time. Third, treatment firms exhibit learning curves over time. Finally, we docu...
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Working Paper
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September 01, 2016
Spanish
Una capacitación financiera simplificada basada en reglas prácticas mejoró las prácticas de negocios y los resultados económicos de microempresarios en República Dominicana, mientras que una capacitación técnica basada en principios contables tradicionales no produjo impactos significativos.
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Brief
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August 30, 2016
English
We report the results of a randomized field experiment in the Philippines on the effects of two common anti-vote-selling strategies involving eliciting promises from voters. An invitation to promise not to vote-sell is taken up by most respondents, reduces vote-selling, and has a larger effect in races with smaller vote-buying payments. The treatment reduces vote-selling in the smallest-stakes election by 10.9 percentage points. Inviting voters to promise to “vote your conscience” despite accepting money is significantly less effective. The results are consistent with a behavioral model in which voters are only partially sophisticated about their vote-selling temptation.
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Working Paper
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August 19, 2016
Spanish
El acceso a servicios nancieros es crucial para el crecimiento de la Pequeña y Mediana Empresa (PyME). Estos servicios permiten a los emprendedores innovar, incrementar su e ciencia, expandirse a nuevos mercados y crear nuevos puestos de trabajo. Sin embargo, la mayoría de las PyMEs en países en desarrollo son incapaces de conseguir el nanciamiento necesario para alcanzar su potencial. Proporcionar nanciamiento a las PyMEs en dichos países puede ser riesgoso y costoso para los prestamistas, lo que ha llevado a una brecha de crédito de aproximadamente un billón de dólares (IFC, 2011). Para reducir la brecha de crédito, instituciones nancieras, gobiernos y donantes han invertido en una gran cantidad de programas y políticas orientadas a proporcionar a las PyMEs el nanciamiento necesario para crecer e innovar. No obstante, la e cacia de estos programas en reducir los obstáculos para el nanciamiento de las PyMEs no ha sido evaluada con rigor. El Programa PyME en Innovations for P...
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Brief
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August 12, 2016
English
We evaluated a program to improve literacy instruction on the Kenyan coast using training workshops, semiscripted lesson plans, and weekly text-message support for teachers to understand its impact on students’ literacy outcomes and on the classroom practices leading to those outcomes. The evaluation ran from the beginning of Grade 1 to the end of Grade 2 in 51 government primary schools chosen at random, with 50 schools acting as controls. The intervention had an impact on classroom practices with effect sizes from 0.57 to 1.15. There was more instruction with written text and more focus on letters and sounds. There was a positive impact on three of four primary measures of children’s literacy after two years, with effect sizes up to 0.64, and school dropout reduced from 5.3% to 2.1%. This approach to literacy instruction is sustainable, and affordable and a similar approach has subsequently been adopted nationally in Kenya.
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Published Paper
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August 11, 2016
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One Acre Fund: Measuring Yields from Space A substantial proportion of the world’s poor are smallholder farmers, and measuring their productivity is a basic first step in understanding where livelihoods are improving (and where additional help is needed).  Unfortunately, comprehensive data on farmers’ productivity do not exist.  They are collected piecemeal by researchers and governments in limited areas of the globe, and over limited periods, typically using household surveys which are both expensive and time consuming.  One Acre Fund (1AF) is a social enterprise working with such farmers in East Africa. 1AF’s mission is to address long-standing barriers to farmer productivity. 1AF provides seeds and fertilizers on credit, delivers agricultural inputs within walking distance of farmers’ homes, trains farmers on how to use inputs most effectively, helps them store their crops safely, and links them to local traders to provide access to markets. This comprehensive approach is geared tow...
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Goldilocks Toolkit
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August 09, 2016
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Premise: Monitoring Food Prices in Post-Disaster Environments In most countries, government agencies collect data on the prices of consumer goods throughout the year, using periodic market and household level surveys run by National Statistics Offices (NSOs). The data are reported in aggregate (in the form of a monthly consumer price index, for example) and are used for central planning and macroeconomic policy as well as private sector decision-making.  In tandem, the World Food Programme (WFP) monitors prices for a small set of staple goods, particularly in areas of the world prone to food insecurity, where emergencies are frequent and resources to collect high quality data are scarce. WFP is a United Nations (UN) humanitarian agency that fights hunger worldwide through food aid, emergency assistance, and disaster prevention activities. A key function of the agency is to track food security globally, through a program of Vulnerability Analysis and Mapping (VAM). The VAM is a collecti...
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Goldilocks Toolkit
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August 09, 2016
Financial products and transfer schemes are often designed to help individuals improve welfare by following through on intertemporal plans. This paper implements an artefactual field experiment in Malawi to test the ability of households to manage a cash windfall. This study varies whether 474 households receive a payment in cash or through direct deposit into pre-established accounts at a local bank. Payments are made immediately, with one day delay, or with eight days delay. Defaulting the payments into savings accounts leads to higher bank account balances, an effect that persists for several weeks. However, neither savings defaults nor payment delays affect the amount or composition of spending, suggesting that households manage cash effectively without the use of formal financial products. 
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Working Paper
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August 01, 2016
English
We worked with two microlenders to test impacts of randomly assigned reminders for loan repayments in the “text messaging capital of the world”. We do not find strong evidence that loss versus gain framing or messaging timing matter. Messages only robustly improve repayment when they include the loan officer’s name. This effect holds for clients serviced by the loan officer previously but not for first-time borrowers. Taken together, the results highlight the potential and limits of communications technology for mitigating moral hazard, and suggest that personal obligation/reciprocity between borrowers and bank employees can be harnessed to help overcome market failures.
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Working Paper
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August 01, 2016
English
This paper identifies separate and unique pathways to profits among small businesses in South Africa that are exposed to marketing or finance training in a randomized control study. The marketing group achieves greater profits by adopting a growth focus on higher sales, greater investments in stock and materials, and hiring more employees. The finance group achieves similar profit gains but through an efficiency focus on lower costs. Both groups show significantly higher adoption of business practices related to their respective training program. Consistent with a growth focus, marketing/sales skills are significantly more beneficial to firm owners who ex ante have less exposure to different business contexts. In contrast and in line with an efficiency focus, entrepreneurs who have been running more established businesses prior to training benefit significantly more from finance/accounting skills.
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Working Paper
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July 30, 2016
English
I investigate whether a school-based deworming intervention in Kenya had long-term effects on young children in the region. I exploit positive externalities from the program to estimate impacts on younger children who were not directly treated. Ten years after the intervention, I find large cognitive effects—comparable to between 0.5 and 0.8 years of schooling—for children who were less than one year old when their communities received mass deworming treatment. I find no effect on child height or stunting. Because treatment was administered through schools, I also estimate effects among children whose older siblings received treatment directly; in this subpopulation, effects on cognition are nearly twice as large.
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Working Paper
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July 27, 2016
English
Women who received private access to vouchers for contraceptives were more likely to take up and use contraception, compared to women whose husbands were involved in the voucher program. In contexts in which women have less bargaining power in family planning decisions, providing private access to contraceptives may be an important and effective means of enabling women to achieve their fertility goals.
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Brief
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July 25, 2016
English
An audit study was conducted in Ghana, Mexico and Peru to understand the quality of financial information and products offered to low-income customers. Trained auditors visited multiple financial institutions, seeking credit and savings products. Consistent with Gabaix and Laibson (2006), staff only provides information about the cost when asked, disclosing less than a third of the total cost voluntarily. In fact, the cost disclosed voluntarily is uncorrelated with the expensiveness of the product. In addition, clients are rarely offered the cheapest product, most likely because staff is incentivized to offer more expensive and thus more profitable products to the institution. This suggests that clients are not provided enough information to be able to compare among products, and that disclosure and transparency policies may be ineffective because they undermine the commercial interest of financial institutions.
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Working Paper
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July 19, 2016

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