Research
Working Papers
Social Signaling and Childhood Immunization: A Field Experiment in Sierra Leone Conditionally Accepted, Quarterly Journal of Economics.
This paper explores the use of social signaling as a policy tool to sustainably affect childhood immunization. In a 26-month field experiment with public clinics in Sierra Leone, I introduce a verifiable signal - in the form of color-coded bracelets - given to children upon timely completion of the first four, or all five required vaccinations. Signals increase parents' belief in the visibility of their actions and their knowledge of other children's vaccine status. The impact of signals varies significantly with the cost and perceived benefits of the action: there are no discernible effects on timely and complete immunization when the signal is linked to an easier-to-complete vaccine with low perceived benefits, and large, positive effects when the signal is linked to a costlier-to-achieve vaccine with high perceived benefits. Parents adjust their behavior nine months prior to realizing the social image benefit, demonstrating the motivational strength of signaling incentives. Of substantive policy importance, bracelets increase full immunization at one year of age by 9 percentage points, with impacts persisting up to two years. At a cost of US$24.7 per additional fully immunized child, social signals can prove more cost-effective than financial or in-kind incentives.
Recipient of the Distinguished CESifo Affiliate Award in Behavioral Economics.
Awarded USAID/DIV Stage 2 grant for scale-up research, in partnership with Ministry of Health Sierra Leone and Innovations for Poverty Action.
Optimal Policy in the Presence of Social Image Concerns with Edward Jee and Karim Naguib.
Economic theory suggests that social image concerns can mitigate or amplify the effects of economic incentives. We investigate these interactions through a large-scale field experiment in Kenya, varying both the cost and visibility of adults' deworming decisions. We randomly assign communities to either close or far distances from deworming treatment locations and introduce signaling incentives that enable adults to broadcast their deworming status to community members. First, we find that take-up of deworming decreases with travel distance to treatment locations; while signaling incentives, by increasing the social image returns from deworming, increase take-up and do so significantly more at farther distances. Second, we build a structural model through which we show that changes in the cost of deworming shift equilibrium beliefs about the prosociality of those who deworm compared to those who do not, meaningfully altering the social image returns from deworming. Third, we show that ignoring endogenous shifts in social image returns leads to a suboptimal allocation of treatment points, placing them 8 to 13 percent closer to communities than the welfare maximizing optimum.
Incentives and Motivation Crowd-Out: Experimental Evidence from Childhood Immunization with Juliette Finetti and Zachary Kuloszewski.
We examine the impact of incentives on intrinsic motivation after their removal. We follow up with parents three years after exposure to a bracelet incentive given to children upon timely vaccination in Sierra Leone. We leverage the design of an experiment under which clinics were randomly assigned to either offer incentives or not. Since only parents who had a newborn at the time were eligible, we also exploit individual variation in exposure within clinics. First, we find that eligibility to an incentive for an earlier child reduces parents' motivation to vaccinate their subsequent child on time, with decreases of 5 to 11 percent in the number of timely visits compared to unexposed parents. There are no impacts on vaccination rates by 15 months of age, suggesting parents delay vaccination, but do not abstain. Second, parents living in incentive communities who were ineligible at the time are unaffected, ruling out that results are driven by changes in community norms or clinic practices. Third, incentives that focus parents' attention on caring for their child's health do not lead to adverse effects. Together, our results suggest that incentives that shift parents' attention to an external reward, can crowd-out intrinsic motivation and negatively impact behaviors once removed.
Publications
Government Trust and Covid-19 Vaccination: The Role of Supply Disruptions and Political Allegiances in Sierra Leone with Anbar Aizenman, Fatu E. Conteh, Rachel Glennerster, Samantha Horn, Desmond M. Kangbai and Sarah Shaukat. American Economic Review, Papers & Proceedings, 113: 647-52, 2023.
Health Knowledge and Non-Pharmaceutical Interventions During the COVID-19 Pandemic in Africa with Anne Fitzpatrick, Sabrin Beg, Laura Derksen, Jason Kerwin, Adrienne Lucas, Natalia Ordaz Reynoso and Munir Squires. Journal of Economic Behavior & Organization, 190, 2021.
Works in Progress
Mandates versus Recommendations: Evidence from Covid-19 Vaccine Rollout in Sierra Leone with Rachel Glennerster, Samantha Horn and Sarah Shaukat (Draft coming soon)
Knowledge versus Skills: Evidence from a Field Study on Health Information in Sierra Leone with Fatu Conteh, Rachel Glennerster and Samantha Horn (Pilot in progress)
Relying on Unregulated Firms to Achieve Public Health Goals: Evidence from Pharmacies in Kenya with Michael Dinerstein, Emma Yan and Younggeun Yoo (Pilot in progress)
Informal Markets for Medicines with Fatu Emilia Conteh and Sofia Gallo (Pilot in progress)