Designing Health Policies

As developing countries begin to meet the first round of public health goals, they should put in place policies that anticipate the next.

Improving the health of the poor is at the top of the world’s development agenda; in fact, three of the UN’s nine Millennium Development Goals are health-related. According to recent reports, progress on frontline issues has been good: in the first decade of the new millennium the number of people newly infected with HIV dropped by 33%, and global malaria deaths by around 26%. Both the maternal mortality rate and the mortality rate for children under five have nearly halved since 1990. There is much progress yet to be made, especially in sub-Saharan Africa and South Asia; still, policymakers in developing countries are beginning to turn toward the next round of health-related questions – ones developed countries already ask. To what extent can states pay to keep their citizens healthy? The US grapples with whether heart stents are affordable in cases where they make only a marginal health difference in life expectancy; in developing countries, meager resources and underdeveloped healthcare systems can make cost-benefit questions much harder. Add to that the fact that some obvious free and low-cost options – such as child vaccination and using cooking stoves that are cleaner and safer – don’t work when they come up against human behavior. As nations make progress toward eradicating malnutrition and treating treatable diseases, they must put in place policies that anticipate the next round of health goals. How should those policies be designed? To what extent can health-related policy and data from developed countries apply to developing ones?

Policy Engagements

Driving bad medications out with good

We examined the market for antimalarial drugs in Uganda, which is rife with fake and low-quality medications, and found that the introduction of real medication sold at low price by an NGO improved quality across the market. Biomedical misconceptions were common in this population, however, and the worse informed the customers, the weaker the effect of introducing quality products to the market.

Policy Partners: Living Goods and BRAC – Uganda

Researchers: David Yanagizawa-Drott, Jakob Svensson (Stockholm University) and Martina Björkman-Nyqvist (Stockholm School of Economics)

Funding: Children's Investment Fund Foundation, William F. Milton Fund (Harvard), and Harvard Center for Population

Measuring the effects of air and water pollution on child mortality

EPoD affiliates assembled some of the most comprehensive data files ever on pollution, regulation, and infant mortality in developing countries, and showed that that importing developed-country data to these contexts can create harmful inaccuracies, that regulations can work even countries with weak governance, and that bottom-up, market-based methods might work best – results that spurred our environmental engagements.

Researchers: Rema Hanna, Michael Greenstone (MIT), Eva Arceo (CIDE), and Paulina Oliva (UCSB)
Research Partner:
Funding: Harvard Center for Population and Development Studies, UCMexus

Assessing the long-run impact of improved cooking stoves

Indoor cooking fires contribute to nearly two million deaths annually worldwide – more than malaria causes. When safe and cheap alternatives exist, why don’t people don’t use them? Our investigation into the issue raised important points about the difference between laboratory and real-world results and the necessity of taking human behavior into account when designing health-related products and policies.

Policy Partner: Gram Vikas, Orissa, India
Researchers: Rema Hanna and Ester Duflo (MIT)
Research Partner: J-PAL South Asia at IFMR – Chennai, India
Funding: MIT Energy Initiative, Centre for Microfinance at IFMR, the Institut Veolia Environement, and the Children's Investment Fund Foundation

Reducing hospital staff absenteeism with multi-function devices

A survey in Karnataka, India showed that doctors, nurses and other staff at government hospitals were absent about 50% of the time. We are developing and testing systems to improve attendance, such as fingerprint check-in that sends data to a central control room, and a system of rewards and penalties linked to this continuous data stream. If successful, the program could be scaled up all primary health centers in the state.

Policy Partner: National Rural Health Mission, Karnataka, India
Researchers: Rema Hanna and Iqbal Dhaliwal (MIT)
Research Partner: J-PAL South Asia at IFMR
Funding: USAID