The illusion of sustainability

81474 enGender Impact: The World Bank’s Gender Impact Evaluation Database The Illusion of Sustainability Author(s) Michael Kremer and Edward Miguel Contact mkremer@fas.harvard.edu Country Kenya Organizing Theme Health Status Completed Intervention Category Deworming Sector Health, Nutrition & Population We use a randomized evaluation of a Kenyan deworming program to estimate peer effects in technology adoption and to shed light on foreign aid donors’ movement towards sustainable community provision of public goods. Deworming is a public good since much of its social benefit comes through reduced disease transmission. People were less likely to take deworming if their direct first-order or indirect second-order social contacts were Abstract exposed to deworming. Efforts to replace subsidies with sustainable worm control measures were ineffective: a drug cost-recovery program reduced take-up 80 percent; health education did not affect behavior, and a mobilization intervention failed. At least in this context, it appears unrealistic for a one-time intervention to generate sustainable voluntary local public goods provision. Gender Connection Gender Informed Analysis Gender Outcomes Use of healthcare services IE Design Clustered Randomized Control Trial (Clustered at school level) Schools were randomly divided into three groups of 25 schools each. An intervention included both health education on worm prevention behaviors and provision of deworming medicine. Group 1 schools received assistance in 1998, Group 2 started receiving assistance in 1999, Group 3 began receiving assistance in 2001. At each school, Intervention there was a community meeting which included a discussion of worm infections, the nature of medical deworming treatment and worm prevention measures. Two teachers from each school were given special training on worms. 25 of the Group 1 and Group 2 schools were randomly selected to pay user fees. Intervention Period 1998-2001; the NGO field team visited the treatment school several times per year. The sample is comprised of a representative subsample of children who were in school the day the survey was administered. There was also a parent questionnaire. Approximately 40 Sample population parents were surveyed in each Group 2 and Group 3 school. 1678 parents were surveyed from either Round 1 or 2. 886 parents were surveyed just in Round 2. There are two orthogonal comparison conditions. First, the treatment had a pipeline phase Comparison conditions in. Second, some of the phase 1 and phase 2 treatments also had to pay a user fee. Last updated: 14 August 2013 1  enGender Impact: The World Bank’s Gender Impact Evaluation Database Unit of analysis Student and Community Level Evaluation Period The study uses a survey collected in 2001 The introduction of a small fee for deworming drugs led to an 80% reduction in treatment rates. Take-up was not sensitive to the exact price level, suggesting that it is particularly counter-productive to charge small positive prices for the treatment of infectious diseases. An intensive school health education had no impact on worm prevention. A verbal Results commitment, where people said in advance whether they planned to take deworming drugs, had no impact on take-up. Social links to early treatment schools reduce the probability that children take deworming drugs and increase the probability that parents say that deworming drugs are not effective. The cross-section nature of the analysis on school effects leads to very imprecise Primary study limitations estimations. Funding Source World Bank, NIH Fogarty International Center, Berkeley Center for Health Research Kremer, M., & Miguel, E. (2007). The illusion of sustainability. The Quarterly Journal of Reference(s) Economics, 122(3), 1007-1065. Link to Studies http://qje.oxfordjournals.org/content/122/3/1007.short Microdata Last updated: 14 August 2013 2