Preventive Health Care in Malawi

Mil­lions of chil­dren in low-in­come coun­tries die every year as a re­sult of health con­di­tions that could be eas­i­ly avert­ed, such as di­ar­rhea. This is the case even though house­holds spend a high share of their bud­get on re­me­di­al care. In­vest­ing in pre­ven­tive health care (such as adding chlo­rine to drink­ing wa­ter) would be a cheap way of mit­i­gat­ing those fi­nan­cial and liv­ing costs. Strik­ing­ly, how­ev­er, take-up of pre­ven­tive health care in de­vel­op­ing coun­tries is per­va­sive­ly low, even when it is avail­able at low cost.

CCWD supports the Sustainable Development Goals

The Sus­tain­able De­vel­op­ment Goals of this Pro­ject

This project stud­ies whether the fact that such goods are typ­i­cal­ly sold at high sub­si­dies - fram­ing the prices deemed ac­cept­able by cus­tomers and ul­ti­mate­ly low­er­ing will­ing­ness to pay - could be put for­ward as a lead­ing rea­son for the low take-up of pre­ven­tive health care in de­vel­op­ing coun­tries.

While pre­vi­ous re­search has shown that learn­ing about the ben­e­fits of pre­ven­tion thanks to such sub­si­dies tends to gen­er­ate high­er de­mand for pre­ven­tion, this con­clu­sion con­flates al­ter­na­tive ex­pla­na­tions. Dis­counts can lead to ex­per­i­menter de­mand ef­fects as well as leav­ing house­holds with more cash on hand, an im­por­tant con­straint on fu­ture pur­chas­es. How­ev­er, be­yond the im­me­di­ate fu­ture - once all fam­i­lies are again equal­ly con­strained - fram­ing ef­fects may still be present, ul­ti­mate­ly low­er­ing fu­ture de­mand for pre­ven­tion. Fi­nal­ly, ex­ist­ing ev­i­dence is con­cen­trat­ed on bed­nets, which are clos­er to an ex­pe­ri­ence good: it is easy for a house­hold to learn about their ben­e­fits upon first use. Most pre­ven­tive health care, how­ev­er, is clos­er to creed goods: with chlo­rine, for in­stance, the ben­e­fits are not im­me­di­ate­ly ob­vi­ous.

Our study de­sign at­tempts to rule out these al­ter­na­tive ex­pla­na­tions. We vis­it poor house­holds in Malawi, of­fer­ing dif­fer­ent pre­ven­tive goods at ran­dom­ly as­signed dis­counts. Con­di­tion­al on take-up, we fur­ther vary the fram­ing of price com­po­si­tion: by ran­dom­iz­ing the de­liv­ery fee as part of that full price, house­holds ef­fec­tive­ly face dif­fer­ent prices for the same good – al­though with the same cash on hands by the end of that round. We then re­vis­it house­holds a month lat­er to elic­it their will­ing­ness to pay for a range of pre­ven­tive health care goods.

Vari­a­tion in dis­counts for bed­nets at­tempts to repli­cate pre­vi­ous em­pir­i­cal ev­i­dence. Vari­a­tion in de­liv­ery fees al­lows us to study fram­ing ef­fects with­out af­fect­ing liq­uid­i­ty con­straints and thus min­i­mizes con­cerns re­gard­ing ex­per­i­menters de­mand ef­fects for fu­ture de­mand. Last­ly, a se­lec­tion of goods com­pris­ing cre­dence goods, such as vi­t­a­mins, al­lows us to study the po­ten­tial fram­ing ef­fects of dis­counts more broad­ly.

We hope to shed light on po­ten­tial be­hav­ioral chal­lenges be­hind of­fer­ing sub­si­dized pre­ven­tive health care in de­vel­op­ing coun­tries to in­form gov­ern­ments and in­ter­na­tion­al or­ga­ni­za­tions about the full range of con­se­quences of their pro­gram­mat­ic choic­es.

The loop: un­der-in­vest­ment in pre­ven­tive health care of chil­dren and ado­les­cents, lead­ing to child mor­tal­i­ty and mor­bid­i­ty

Break­ing the loop: Un­der­stand­ing the full range of con­se­quences of sub­si­dized pre­ven­tive health care to in­form pro­grams with the po­ten­tial of in­creas­ing those in­vest­ments in chil­dren and ado­les­cents

Re­search Team

Guilherme Lichand

UZH

More Infos

Maite Deambrosi

UZH

Jiajing Feng

UZH