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The single largest item in the United States foreign aid health budget is antiretroviral therapy (ART) for the treatment of HIV/AIDS. Many supply- and demand-side factors in sub-Saharan Africa could cause smaller than expected epidemiological effects of this at scale drug provision. We provide what appears to be the first quasi-experimental evidence on the effect of at scale drug provision in a poor country, using the phased roll-out of ART in Zambia, a setting where approximately 1 in 6 adults are HIV positive. Combining anthropometric data from national household surveys and a spatially-based triple difference specification, we find that local ART introduction increased the weight of high HIV likelihood adult women. This finding from a clinically difficult setting suggest that the generalized challenges of scalability of ART for adult health in sub-Saharan Africa are surmountable.

Zonder onderwerpscode: economie

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In 2007, approximately one in five children in Zambia lived with an HIV positive adult. We identify the effect of adult antiretroviral therapy (ART) availability at scale on children's educational outcomes by combining data on the expansion of ART availability with two national household surveys that include HIV testing. Through a triple difference specification, we find that the availability of ART increased the likelihood that children in households with HIV positive household heads started school on time and were the appropriate grade-for-age. The mechanisms were likely decreased opportunistic infections in the household and related care giving duties.

Zonder onderwerpscode: economie

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In low-income countries, educators often encourage weak primary students to drop out before reaching the end of primary school in order to avoid the negative attention they receive when their students perform poorly on primary leaving exams. We conducted an experiment in rural Uganda that sought to reduce dropout rates in grade six and seven by rewarding teachers for the performance of each of their students. Teachers responded to this Pay for Percentile (PFP) incentive system in ways that raised attendance rates two school years later from .56 to .60. These attendance gains were driven primarily by outcomes in treatment schools that provide textbooks for grade six math students, where two-year attendance rates rose from .57 to .64. In these same schools, students whose initial skills levels prepared them to use grade six math texts enjoyed significant gains in math achievement. We find little evidence that PFP improved attendance or achievement in schools without books even though PFP had the same impact on reported teacher effort in schools with and without books. We document several results that are consistent with the hypothesis that teacher effort and books are complements in education production.

Zonder onderwerpscode: economie

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Using two RCTs in middle schools in Pakistan, we show brief, expert-led, curriculum based videos integrated into the classroom experience improved teaching effectiveness-student test scores in math and science increased by 0.3 standard deviations, 60% more than the control group, after 4 months of exposure. Students and teachers increased their attendance, and students were more likely to pass the government high-stakes exams. In contrast, similar content when provided to students on personal tablets decreased student scores by 0.4SD. The contrast between the two effects shows the importance of engaging existing teachers and the potential for technology to do so.