Attending to Traditional Birth Attendants: Incentives and Responses in Western Kenya

Abstract

Ph.D.

In this dissertation I examine topics in development economics. The first two chapters relate to Traditional Birth Attendants (TBAs) in the Western Province of Kenya, and the final chapter focuses on network-based hiring in sub-Saharan Africa. My first chapter studies the use of intermediaries in a maternal health program. The program provided payments for TBAs in treatment villages to encourage pregnant women to attend antenatal care (ANC) visits at a local health facility. In this way, TBAs serve as intermediaries to link pregnant women with health facilities, the TBAs' competition. I use a randomized controlled trial (RCT) to evaluate the efficacy of these financial incentives. My findings suggest that living in a TBA treatment village increases the likelihood of a woman attending at least the recommended number of ANC visits by 21%.

In the second chapter, I examine the competition between TBAs and health facilities. I study the market for TBA services and examine TBAs' responses to a separate maternal health RCT, designed to evaluate a program that gave pregnant women vouchers for maternity care at public health facilities. Exploiting village level variation in the distribution of vouchers, I find that in larger villages, higher proportions of women in a village with a voucher result in lower prices and higher quantities of TBA-provided pre-delivery services. These results suggest that in larger villages, TBAs shift their allocation of labor away from leisure or other activities to increase their supply of pre-delivery services.

My third chapter examines selection and moral hazard issues in sub-Saharan labor markets by providing a detailed review of existing literature and presenting descriptive statistics from recent survey data. The results suggest that in sub-Saharan Africa the poor signaling value of education and the under-developed legal and informational infrastructure increase asymmetric information challenges and are associated with the prevalent use of network-based hiring. After establishing the prevalence of this hiring practice, I explain how the use of networks of friends and family in hiring could increase inequality and fractionalization in the labor market and create distorted perceptions about the relevance of skills for employment.