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

Abstract Subsidized primary care and community health worker (CHW) visits are important demand-side policies in the effort to achieve universal health care for children aged under 5. Causal evidence on the interaction between these policies is still sparse. This paper reports the effects on diarrhea prevention, curative care, and incidence as well as anthropometrics for 1,649 children from a randomized controlled 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 percent in the group that receives both subsidies and CHWs. Positive effects are concentrated among children under age 2.