The Effects of Community Health Worker Visits and Primary Care Subsidies on Health Behavior and Health Outcomes for Children in Urban Mali

Subsidized primary care and community health worker (CHW) visits are important demand side policies in the effort to achieve universal health care for children under five. Causal evidence on the effects of these policies, alone and in interaction, is still sparse. This paper reports the effects on diarrhea prevention, curative care, and incidence as well as anthropometrics for 1649 children from a randomized control trial in Bamako that cross-randomized CHW visits and access to free health care. CHW visits improve prevention and subsidies increase the use of curative care for acute illness, with some indication of positive interaction effects. There is no evidence of moral hazard, such as reduced preventive care among families receiving the subsidy. Although there are no significant improvements in malnutrition, diarrhea incidence is reduced by over 70% in the group that receives both subsidies and CHW. Positive effects are concentrated among children ages 0 to 2.