Study Overview
We examine whether a diagnosis contingent incentive contract structure improves the treatment of malaria, and whether it’s best to target those incentives to patients or providers. The contract provides incentives to use rapid tests (RDTs) to diagnose patient malaria status combined with incentives to treat with antimalarial drugs (ACTs) if the patient tests positive but not if negative.
Study Results
Using data from a cluster randomized field experiment with 140 pharmacies in malaria endemic regions of Kenya, we find that both patient subsidies and provider incentives significantly increased RDT testing uptake. Absent incentives, 87% of suspected malaria patients purchase ACTs, of which as many as 66% are doing so unnecessarily because they do not have malaria. The incentives lead to an increase RDT test use by 25 pp, a 7 pp increase in the purchase of ACTs by malaria positive patients, and a 27 pp decline in the purchase of ACTs by malaria negative patients. The contract increases (decreases) ACTs for those who are malaria positive (negative) through both improved diagnostic information and incentives. Diagnosiscontingent contracts are highly cost effective, actually lowering the cost per malaria positive person being treated by reducing the unnecessary treatment of malaria negative patients.
Intervention: Diagnostic-contingent incentive contract
Intervention Partner: Maisha Meds
Working Paper: Maria Dieci & Paul Gertler & Jon Kolstad & Carlos Paramo, 2024. "Using Diagnosis Contingent Incentives to Improve Malaria Treatment"