Governance and Effectiveness of Public Health Subsidies

Heavily subsidizing essential health products through existing health infrastructure could substantially improve health in sub-Saharan Africa. There is, however, widespread concern that poor governance – in particular, limited health worker accountability – seriously undermines the effectiveness of subsidy programs. Using innovative audits of targeted bed net distribution programs in Ghana, Kenya and Uganda, we measure the extent of local agency problems. Overall, agency concerns are modest and do not undermine the cost-effectiveness of free distribution. Around 80% of the eligible receive the subsidy as intended, and leakage to the ineligible appears limited, even when the ineligible have a high willingness to pay. The data currently included in this entry are from the Ghana study sites.