The Impact of Mass Bed Net Distribution Programs on Politics: Evidence from Tanzania

Abstract

Many African countries have implemented large donor funded public health programs in the past decade targeting major diseases such as HIV/AIDS and malaria. There is a large literature which examines the effect of these programs on health outcomes, but little is known about their effect on politics. Do politicians gain popularity as a result of these programs? If so, it could suggest the potential for a positive, mutually reinforcing equilibrium, whereby politicians would see delivery of health services as a key way to maintain public support. I exploit the fact that two national bed net distribution campaigns in Tanzania (in 2008-09 and 2010-11) took place at approximately the same time as the 2008-09 and 2010-11 National Panel Surveys. This enables a regression discontinuity design based on survey interview date to estimate the effect of these programs on the approval ratings of local politicians. I find that bed net distribution results in large and statistically significant improvements in the approval levels of a broad range of political leaders. However, this is only true for the 2010 campaign, when all household members (rather than children under 5) were the primary beneficiaries. Moreover, the effect is driven by respondents living in opposition-dominated villages, and by nets delivered in the rainy season, when malaria is a particularly salient problem. Taken together, these findings suggest that citizens are prepared to update their evaluation of their political leaders, especially when they deliver services that are salient and visible, and when this service delivery provides information about the capability of actors, such as opposition party officials, about whom there is limited prior knowledge. * email: kevinjcroke@gmail.com. 677 Huntington Ave, Boston MA 02115. This article benefited from helpful conversations with, and suggestions from,

The Role of Trust in the Pattern of Enrollment to a Social Health Insurance Scheme and Distribution of Healthcare Facilities in Ibadan, Southwest Nigeria

“…The system needs to gain and sustain the trust of the public through a more responsive healthcare service delivery. This is likely to strengthen the trust of the public in the system [52][53][54][55] and a likely increase in enrollment in the scheme. This is a qualitative study; therefore, generalizing the findings to other parts of the country should be done with commensurate caution.…”

“…50 Examples of interventions that have increased the trust of the people in government abound in many countries in Africa. For example, a maternal and child health program in Nigeria, 51 distribution of insecticide-treated bed net in Tanzania, 52 and provision of potable water that reduced diarrheal diseases in Latin America Mexico 53 have all been acknowledged to increase the trust of the public in political leaders and social policies implemented by governments. In Rwanda, a series of policies in different sectors including the health system has facilitated a reduction in inequity of access to beneficial social interventions and, these have been adjudged to have contributed in no small measure to the healing process after the 1994 nation-wide crisis in that country.…”

Electoral Impacts of Improving Primary Health Care

“…Using instrumental variables models, they find that a standard devi-ation shift in the lives saved by PAL was associated with a 2.4% increase in support for Mexico's long-ruling party (Partido Revolucionario Institucional, PRI) in subsequent local elections. Croke (2017) investigates this question in Tanzania, which has recently implemented health programs targeting malaria. Results show that bed net distribution results in large, statistically significant improvements in the approval levels of political leaders, especially in malaria endemic areas.…”

“…Recent works focus mainly on the effects of local health interventions. Croke (2017) examines this question in Tanzania, which has recently implemented health programs targeting malaria. Results show that bed net distribution leads to large, statistically significant improvements in the approval levels of political leaders, especially in malaria-endemic areas.…”