Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jan 1:118:112-132.
doi: 10.1016/j.jdeveco.2015.09.001.

Does a ban on informal health providers save lives? Evidence from Malawi

Susan Godlonton  1 , Edward N Okeke  2
Affiliations

Does a ban on informal health providers save lives? Evidence from Malawi

Susan Godlonton et al. J Dev Econ. .

Abstract

Informal health providers ranging from drug vendors to traditional healers account for a large fraction of health care provision in developing countries. They are, however, largely unlicensed and unregulated leading to concern that they provide ineffective and, in some cases, even harmful care. A new and controversial policy tool that has been proposed to alter household health seeking behavior is an outright ban on these informal providers. The theoretical effects of such a ban are ambiguous. In this paper, we study the effect of a ban on informal (traditional) birth attendants imposed by the Malawi government in 2007. To measure the effect of the ban, we use a difference-in-difference strategy exploiting variation across time and space in the intensity of exposure to the ban. Our most conservative estimates suggest that the ban decreased use of traditional attendants by about 15 percentage points. Approximately three quarters of this decline can be attributed to an increase in use of the formal sector and the remainder is accounted for by an increase in relative/friend-attended births. Despite the rather large shift from the informal to the formal sector, we do not find any evidence of a statistically significant reduction in newborn mortality on average. The results are robust to a triple difference specification using young children as a control group. We examine several explanations for this result and find evidence consistent with quality of formal care acting as a constraint on improvements in newborn health.

Keywords: child mortality; government bans; informal health providers.

PubMed Disclaimer

Figures

Figure A.1
Figure A.1
Figure 1
Figure 1
Figure 2
Figure 2
Figure 3
Figure 3
Figure 4
Figure 4
Figure 5
Figure 5
Figure 6
Figure 6
Figure 7
Figure 7
Figure 8
Figure 8
See this image and copyright information in PMC

References

    1. Abadie A. Semiparametric instrumental variable estimation of treatment response models. Journal of Econometrics. 2003;113(2):231–263.
    1. Adda J, Cornaglia F. The effect of bans and taxes on passive smoking. American Economic Journal: Applied Economics. 2010;2(1):1–32.
    1. Adhvaryu A, Nyshadham A. Returns to treatment in the formal health care sector: Evidence from Tanzania. American Economic Journal: Economic Policy. 2014 Forthcoming. - PMC - PubMed
    1. Almond D, Doyle JJ. After midnight: A regression discontinuity design in length of postpartum hospital stays. American Economic Journal: Economic Policy. 2011;3(3):1–34.
    1. Almond D, Doyle JJ, Kowalski AE, Williams H. Estimating marginal returns to medical care: Evidence from at-risk newborns. Quarterly Journal of Economics. 2010;125(2):591–634. - PMC - PubMed

LinkOut - more resources