Education and health care in developing countries

Abstract

This thesis is a collection of three essays on education and health in developing countries. Chapter 1 shows that increasing perceived returns to education strengthens incentives for schooling when agents underestimate the actual returns. I conducted a field experiment in Madagascar to study alternative ways to provide additional information about the returns to education. I randomly assigned schools to the role model intervention, the statistics intervention, or a combination of both. I find that providing statistics reduced the large gap between perceived returns and the statistics provided. As a result, it improved average test scores and student attendance. For those whose initial perceived returns were below the statistics, test scores improved by 0.37 standard deviations. Seeing a role model of poor background has a larger impact on poor children's test scores than seeing someone of rich background. The key implication of my results is that households lack information, but are able to process new information and change their decisions in a sophisticated manner. Chapter 2, joint work with Gerard Lassibille, evaluates several interventions in Madagascar that sought to promote top-down and local monitoring of the school to improve education quality. Randomly selected school districts and sub districts received operational tools to facilitate their supervision tasks. Randomly selected schools in these treated districts were reinforced with teacher tools and parent-teacher meetings centered around a school report card. We find little impact of targeting district and sub-district administrators.

(cont.) Meanwhile, the intervention implemented at the school level improved some of the teachers' behaviors and student attendance. Student test scores also improved by 0.1 standard deviations after two years. These results suggest that beneficiary monitoring is more effective than mediated control in the hands of government bureaucrats in this context. Chapter 3 studies informal payments to doctors and nurses for inpatient health care in Vietnam. Exploiting within-hospital variation, I find that acute patients, despite having a presumably higher benefit of treatment, are 8 percentage points less likely to pay bribes, and pay less, than non-acute patients. One plausible interpretation is that doctors might face existing incentives against neglecting acute cases. I find that the differential payment by acute status is larger in central locations (expected to be well-monitored) and at facilities that receive more audit visits. Overall, these findings may be a sign of bureaucrats responding to incentives, even in a highly corruptible environment.