Working papers

Designing Incentive Contracts to Improve the Diagnosis and Treatment of Malaria

We examine whether a diagnosis contingent incentive contract structure improves the diagnosis and appropriate treatment of malaria, and whether demand or supply incentives for rapid tests (RDTs) and high quality antimalarials (ACTs) only to malaria positive cases better promote socially-optimal antimalarial use. Using a cluster randomized trial design we randomize pa- tient subsidies and pharmacist performance incentives. We find that both patient subsidies and provider incentives increase RDT testing uptake by 25 percentage points, on average, and lead to significant improvements in appropriate antimalarial use, largely due to malaria negative patients opting out of taking unnecessary malaria medication. The increase in ACT purchase appears to be concentrated among those that find out that they are malaria positive. However, the reduction in ACT purchase is concentrated in the group that finds out that they were malaria negative and in the incentivized treatment groups. This suggests that the reduction in ACT purchase is driven by a combination of patient specific diagnosis information and incen- tives. We find evidence that patient subsidies and provider incentives operate through different channels: patient subsidies result in significantly lower RDT prices paid by patients, while provider incentives induce pharmacists to provide more comprehensive counseling. Finally, we find that all three incentive interventions are cost-effective approaches to improve appropri- ate antimalarial use in pharmacies. Taken together, these results suggest that appropriately calibrated and targeted financial incentives are promising for changing patient and provider behavior, with implications for quality of care.

Trial pre-registration:
  • AEARegistry
  • Current draft:
  • Click here


  • Ongoing projects

    Provider Agency and Health Technology Adoption: How Financial Incentives Impact the Uptake of a New Contraceptive

    We investigate how targeted subsidies for long-acting injectable contraception and provider incentives impact initial uptake, pricing and stocking decisions for contraceptive products in local markets, sales, and user health outcomes. Following prior work on the effectiveness of subsidies to promote the adoption of new technologies and experience goods, we aim to test if subsidies lead to sustained adoption of injectable contraception as well as to study possible mechanisms for continued usage (or lack of) such as learning, price anchoring, and information effects. We condcuted a market-level cluster randomized controlled trial in 140 pharmacies in Kenya to answer these questions. Patient subsidies and pharmacist incentives will be cross-randomized and compared against the status quo to evaluate their effectiveness in promoting sustained adoption. Data collection complete. Collaborators are Paul Gertler and Carlos Paramo.

    Trial pre-registration:
  • AEARegistry


  • Caregiver Decision-making and Quality of Care for Childhood Fevers in Pharmacy Settings

    Febrile illness is a leading cause of death and serious illness for millions of children across sub-Saharan Africa, despite the availability of diagnostics and appropriate medications. Unfortunately, many fevers are not treated appropriately due to incorrect or no diagnosis, and use of inappropriate medications. Inappropriate treatment has uncertain health and economic costs to individuals as well as at a population level. This study will provide visibility on this issue through an analysis of care-seeking behavior, diagnosis/treatment decisions, and illness episode outcomes in children with fevers who seek care in Kenyan pharmacies. This pilot will contribute towards a better understanding of the causes and consequences of childhood fevers and associated care-seeking trajectories, which is crucial for effective management of childhood illness in sub-Saharan Africa. Funding obtained, and pilot study underway.

    Extreme weather, parental investments, and child health in Madagascar

    Using panel microdata on household inputs and child health outcomes and high-resolution gridded climate data from Madagascar, we investigate how weather-induced income shocks affect parental investments and child nutrition and cognition outcomes.

    Publications

    For list of publications, see here. Please reach out if you are unable to access an article - I am happy to send you an ungated version.