Publication: Health Information, Treatment, and Worker Productivity : Experimental Evidence from Malaria Testing and Treatment among Nigerian Sugarcane Cutters
Loading...
Published
2014-11
ISSN
Date
2014-12-03
Author(s)
Editor(s)
Abstract
Agricultural and other physically demanding sectors are important sources of growth in developing countries but prevalent diseases such as malaria adversely impact the productivity, labor supply, and choice of job tasks among workers by reducing physical capacity. This study identifies the impact of malaria on worker earnings, labor supply, and daily productivity by randomizing the temporal order at which piece-rate workers at a large sugarcane plantation in Nigeria are offered malaria testing and treatment. The results indicate a significant and substantial intent to treat effect of the intervention -- the offer of a workplace-based malaria testing and treatment program increases worker earnings by approximately 10 percent over the weeks following the offer. The study further investigates the effect of health information by contrasting program effects by workers' revealed health status. For workers who test positive for malaria, the treatment of illness increases labor supply, leading to higher earnings. For workers who test negative, and especially for those workers most likely to be surprised by the healthy diagnosis, the health information also leads to increased earnings via increased productivity. Possible mechanisms for this response include selection into higher return tasks within the plantation as a result of changes in the perceived cost of effort. A model of the worker labor decision that allows health expectations partly to determine the supply of effort suggests that, in endemic settings with poor quality health services, inaccurate health perceptions may lead workers to suboptimal labor allocation decisions. The results underline the importance of medical treatment, but also of access to improved information about one's health status, as the absence of either may lead workers to deliver lower effort in lower return jobs.
Link to Data Set
Citation
“Dillon, Andrew; Friedman, Jed; Serneels, Pieter. 2014. Health Information, Treatment, and Worker Productivity : Experimental Evidence from Malaria Testing and Treatment among Nigerian Sugarcane Cutters. Policy Research Working Paper;No. 7120. © http://hdl.handle.net/10986/20645 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Publication The Macroeconomic Implications of Climate Change Impacts and Adaptation Options(Washington, DC: World Bank, 2025-05-29)Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.Publication South Africa’s Fragmented Cities: The Unequal Burden of Labor Market Frictions(Washington, DC: World Bank, 2026-01-08)Using high-resolution administrative, census, and satellite data, this paper shows that South African cities are characterized by spatial mismatches between where people live and where jobs are located, relative to 20 global peers. Areas within 5 kilometers of commercial centers have 9,300 fewer residents per square kilometer than expected, which is 60 percent below the global median. Poor, dense neighborhoods are most affected. In Johannesburg, a 10-percentile increase in distance from the nearest business hub corresponds to a 3.7-percentile drop in asset wealth (a proxy of household wellbeing) and 4.9-percentile drop in employment. In Cape Town, the declines are 4.0 and 3.7 percentiles, respectively. Employment is 87 percent lower in the poorest decile than the richest in Johannesburg and 61 percent lower in Cape Town. These findings suggest that South Africa’s spatial organization of people and economic activity constrains agglomeration and reinforces inequality. This methodology provides a scalable and standardized data-driven framework to analyze spatial accessibility and agglomeration frictions in complex, data-constrained urban systems.Publication The Evolution of Local Participatory Democracy in Nepal(Washington, DC: World Bank, 2025-11-05)Nepal is, according to its constitution, among the world’s most decentralized countries, with a long and complex tradition of local-level public participation. This paper traces the evolution of Nepal’s modern participatory institutions, examining the extent to which they are “induced” by external interventions versus being “organically” rooted in indigenous practices. The paper identifies three broad phases: an initial focus on participation in project implementation; a subsequent phase that expanded citizen engagement; and a third phase of citizen empowerment, culminating in the 2015 federal constitution, which granted unprecedented local autonomy. The analysis yields five key findings. First, over the past 50 years, successive reforms have progressively expanded opportunities for citizens to influence local decision-making. Second, these reforms have integrated traditional participatory mechanisms into formal institutions of local government. Third, although central-level initiatives exist, most participatory platforms continue to operate at the local level. Fourth, the federal constitution has created a new landscape of local democracy, embedding autonomy and accountability. Fifth, although they are still valued in many ethnic and territorial communities, traditional participatory practices are gradually disappearing. The paper concludes by offering policy recommendations to help donor agencies and governments strengthen Nepal’s democratic trajectory. It argues that effective interventions should build on Nepal’s deep participatory traditions while recognizing the constitutional reality of far-reaching local autonomy.Publication Institutional Capacity for Policy Implementation: An Analytical Framework(Washington, DC: World Bank, 2026-01-07)State capacity is an important prerequisite for policy implementation, yet at the country level it is difficult to measure, assess, and reform. This paper proposes a focus on institutional capacity: the ability of public institutions to implement the specific policy mandates for which they are responsible. Based on a review of existing literature, the paper defines the different dimensions that compose institutional capacity and groups them into two cross-cutting categories: organizational dimensions (personnel, financial resources, information systems, and management practices) and governance dimensions (transparency, independence, and accountability). The paper proposes measures for organizational and governance dimensions using existing data, shows intra-institutional variation of these measures within countries, and discusses how new data could be collected for better measurement of these concepts. Finally, the paper illustrates how the framework can be used to diagnose the sources of common problems related to weak policy implementation.Publication Closing the Gender Gap in Entrepreneurship: Overcoming Challenges in Law and Practice for Female Entrepreneurs(Washington, DC: World Bank, 2026-01-07)Despite significant strides toward gender equality, women around the world continue to encounter systemic obstacles that hinder their entrepreneurial success. This paper systematically reviews the literature on the barriers female entrepreneurs face and the solutions proposed to overcome these challenges. It discusses institutional factors, financial factors, human capital factors, and social and cultural factors. The literature overview is complemented by a series of stylized facts that illustrate how overcoming some of these existing barriers is correlated with improved women’s entrepreneurship and female labor force participation, drawing on the World Bank’s Women, Business and the Law database as well as the World Bank’s Enterprise Surveys. The findings underscore the need for creating an enabling environment where women can thrive as entrepreneurs.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication The Challenge of Non-Communicable Diseases and Road Traffic Injuries in Sub-Saharan Africa : An Overview(World Bank, Washington, DC, 2013-06)This report draws on a comprehensive review of the literature and on input from policy makers, researchers, and practitioners to address four questions: (1) how is the growing burden of non-communicable diseases (NCDs) and road traffic injuries (RTIs) changing the epidemiology of Sub-Saharan Africa? (2) What determines and drives this burden, and what are the commonalities with communicable diseases? (3) What is the rationale for public intervention? (4) How could resource-constrained governments approach NCD prevention and treatment and road safety in a comprehensive, effective and efficient way? The data show that action against NCDs and RTIs in Sub-Saharan Africa is needed, together with continued efforts to address communicable diseases and maternal and child health as well as to reach the Millennium Development Goals (MDGs). The report suggests that NCDs and RTIs should not be tackled separately as a vertical program, nor should they displace communicable diseases as priorities. Instead, given resource constraints, and some shared determinants, characteristics, and interventions, there is scope for an integrated approach focusing on functions (prevention, treatment, and care) rather than on disease categories. Examples are cited of potential opportunities to integrate and add NCD prevention and treatment into existing services and programs. Proven, cost-effective, prevention interventions are clearly needed, many of which (such as tobacco and alcohol taxes, road safety measures, and fuel-efficient ventilated cook-stoves) require action beyond the health sector. These can deliver broader development benefits in addition to their benefits for health. Selective, evidence-based actions to reduce NCDs and RTIs will address the changing disease burden in Africa and achieve a more sustainable improvement in health outcomes, more efficient use of resources, and better equity across patients and populations.Publication Quality and Accountability in Healthcare Delivery(World Bank, Washington, DC, 2015-06)This paper presents direct evidence on the quality of health care in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly representative sample of rural public and private primary care providers in the Indian state of Madhya Pradesh. Three main findings are reported. First, private providers are mostly unqualified, but they spent more time with patients and completed more items on a checklist of essential history and examination items than public providers, while being no different in their diagnostic and treatment accuracy. Second, the private practices of qualified public sector doctors were identified and the same doctors exerted higher effort and were more likely to provide correct treatment in their private practices. Third, there is a strong positive correlation between provider effort and prices charged in the private sector, whereas there is no correlation between effort and wages in the public sector. The results suggest that market-based accountability in the unregulated private sector may be providing better incentives for provider effort than administrative accountability in the public sector in this setting. While the overall quality of care is low both sectors, the differences in provider effort may partly explain the dominant market share of fee-charging private providers even in the presence of a system of free public healthcare.Publication Impact of Intermittent Screening and Treatment for Malaria among School Children in Kenya : A Cluster Randomized Trial(World Bank, Washington, DC, 2014-02)This paper investigates the effects of intermittent screening and treatment of malaria on the health and education of school children in an area of low-to-moderate malaria transmission. A cluster randomized trial was implemented with 5,233 children in 101 government primary schools on the south coast of Kenya in 2010-12. The intervention was delivered to children randomly selected from classes 1 and 5 who were followed up twice across 24 months. Once during each school term, public health workers used malaria rapid diagnostic tests to screen the children. Children who tested positive were treated with a six-dose regimen of artemether-lumefantrine. Given the nature of the intervention, the trial was not blinded. The primary outcomes were anemia and sustained attention and the secondary outcomes were malaria parasitaemia and educational achievement. The data were analyzed on an intention-to-treat basis. Anemia in this setting in Kenya, intermittent screening and treatment, as implemented in this study, is not effective in improving the health or education of school children. Possible reasons for the absence of an impact are the marked geographical heterogeneity in transmission, the rapid rate of reinfection following artemether-lumefantrine treatment, the variable reliability of malaria rapid diagnostic tests, and the relative contribution of malaria to the etiology of anemia in this setting.Publication Health Service Delivery in Tanzania(World Bank, Washington, DC, 2015-01)The Service Delivery Indicators (SDIs) provides a set of key indicators serving as a benchmark for service delivery performance in the health and education sectors in Sub-Saharan Africa. The overarching objective of the SDIs is to ascertain the quality of service delivery in primary education and basic health services. This would in turn enable governments and service providers alike to identify gaps and bottlenecks, as well as track progress over time, and across countries. The SDI survey interviewed 403 heath providers across Tanzania between May 2014 and July 2014. This technical report presents the findings from the implementation of the SDI in the health sector in Tanzania in 2014. Survey implementation activities took place following extensive consultations with the government and key stakeholders on survey design, sampling, and adaptation of survey instruments. A major challenge for Tanzania’s health sector is the shortage of skilled human resources for health (HRH). This survey found that provider knowledge and abilities were not adequate to deliver quality services. Caseload per provider and absenteeism are relatively low, so the issue is not over burdened providers. There seems to be ample room for a significant increase in the caseload of Tanzanian providers, i.e. the level of productivity in health service delivery, without jeopardizing quality. In addition to increasing the volume of skilled HRH to address the shortage of providers, improvements in management, supervision and training is important to improving service delivery. Health for all in Tanzania will mean the simultaneous availability of widely accessible inputs and skilled providers.Publication Multisectoral Preventive Health Services in Sri Lanka : Lessons for Developing Countries in Providing Public Goods in Health(World Bank, Washington, DC, 2013-08)What can other developing countries learn from Sri Lanka on achieving good health at low cost? While its well-organized medical and maternal-child health services have been documented elsewhere, this paper fills a gap in documenting how it organizes services to reduce the population's exposure to disease -- a pure public good. The key factors underlying the effectiveness of these services are (1) strong focal points in the central Health Ministry for supporting preventive services; (2) pro-active outreach by the health line agency to collaborate with other sectors / agents whose work influences public health outcomes; and (3) community-level delivery institutions with well-trained multivalent Public Health Inspectors -- all underpinned by (4) assured tax-based financing. This paper describes this system in some detail such that other countries can learn from Sri Lanka's successful approach to improving population health. It also makes some recommendations for strengthening the system in response to changing conditions.
Users also downloaded
Showing related downloaded files
Publication Services Unbound(Washington, DC: World Bank, 2024-12-09)Services are a new force for innovation, trade, and growth in East Asia and Pacific. The dramatic diffusion of digital technologies and partial policy reforms in services--from finance, communication, and transport to retail, health, and education--is transforming these economies. The result is higher productivity and changing jobs in the services sector, as well as in the manufacturing sectors that use these services. A region that has thrived through openness to trade and investment in manufacturing still maintains innovation-inhibiting barriers to entry and competition in key services sectors. 'Services Unbound: Digital Technologies and Policy Reform in East Asia and Pacific' makes the case for deeper domestic reforms and greater international cooperation to unleash a virtuous cycle of increased economic opportunity and enhanced human capacity that would power development in the region.Publication Gender and Health(World Bank, Washington, DC, 2015-05)Despite their strong contribution to the overall world economic growth, gender gaps are wide in many countries in sub Saharan Africa and low representation of women in the private health sector is wider than in other sectors. While women and youth use the majority of health services both private and public, women are underrepresented as private health care providers and have limited access to financing to open their own private practices. This landscape has prompted the HNP Global Practice to take a critical look at the factors which hamper the growth of female and young private health practitioners vis a vis their male counterparts (usually older and more experienced in their profession). This assessment provides information on ways to close the gap which exists between male private service providers and female providers as well as recommends ways in which the existing gaps can be addressed. The assessment also provides the basis for further developing a strong public- private dialogue in health while providing avenues for building capacities for women to fully contribute to the development of the private health sector through the development of training module to be administered in private training schools as a pilot in Burkina Faso and Mali.Publication Strengthening Peru's Tax Agency(World Bank, Washington, DC, 2001-11)The reforms were remarkably successful: by 1997 internal tax revenue had recovered to 13 percent of GDP-despite an extremely difficult political and economic environment-and 90 percent of large corporate taxpayers surveyed believed that taxpayer services had improved. The reforms had several key elements: granting the National Tax Administration Superintendency (SUNAT) meaningful administrative and financial autonomy, implementing radical personnel reform, investing in infrastructure and information technology, and generating public support. The reforms also forged a new relationship between taxpayers and the tax agency and committed to improving services. At the same time, the agency made clear its intention to enforce compliance with the tax code. SUNAT's experience offers several lessons for tax administration reform in other countries. First, the immediate efficacy of SUNAT as a semiautonomous revenue authority was due to a combination of several factors, perhaps the most important of which was a coupling of political leadership with managerial expertise. But Peru's experience also highlights pitfalls to avoid for other countries engaging in tax administration reform.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Global Economic Prospects, January 2023(Washington, DC: World Bank, 2023-01-10)Global growth is projected to decelerate sharply, reflecting synchronous policy tightening aimed at containing very high inflation, worsening financial conditions, and continued disruptions from Russia’s invasion of Ukraine. Investment growth in emerging market and developing economies (EMDEs) is expected to remain below its average rate of the past two decades. Further adverse shocks could push the global economy into recession. Small states are especially vulnerable to such shocks because of the reliance on external trade and financing, limited economic diversification, elevated debt, and susceptibility to natural disasters. Against this backdrop, it is critical that EMDE policy makers ensure that any fiscal support is focused on vulnerable groups, that inflation expectations remain well anchored, and that financial systems continue to be resilient. Urgent global and national efforts are also needed to mitigate the risks of global recession and debt distress in EMDEs, and to support a major increase in EMDE investment.