Household and Provider Behaviour in the Health Sector in Africa: What has been Learned from Program Evaluations?

"This paper reports on what has been learned about these issues in the African context through (primarily) evaluations of health interventions. The focus, as in many surveys of research, is broadly speaking on ‘what works’ (or does not work). However, the concern is not primarily about whether certain treatments improve health in a clinical sense, that is, efficacy. Rather, almost all of the program evaluations and other research considered here involve strategies to improve the delivery, uptake, and effective use of services or products, that is, program effectiveness. Central to the success of these strategies, as indicated, are behavioral responses of households or providers. To clarify the distinction with an example, Cohen and Dupas (2008) use a randomized controlled design to examine the effects of variation in the price of insecticide-treated bednets on the demand for the nets and their actual utilization by women attending antenatal clinics in Kenya. The focus of this study is not on whether such bednets, if used appropriately, can prevent malaria in children; efficacy had already been established in a number of clinical trials."