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Improving Child Immunization in Sierra Leone

Health & Psychology
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Behavior-change strategies to improve child health informs health policy in Sierra Leone.

Reducing child mortality is a public health priority in many sub-Saharan African countries. Still, finding cost-effective ways to improve service delivery has been challenging. With funding from CEGA, graduate student Anne Karing (now at Princeton) explored whether social signaling could motivate mothers in Sierra Leone to seek care for themselves and their children.

Karing collaborated directly with the Ministry of Health and Sanitation in Sierra Leone to distribute bracelets of different colors to children for each vaccination administered. Unlike other types of incentives, such as food or cash transfers, the bracelets make observable the decision to seek out formal health services, and allow mothers to signal to others that they look after their child’s health.

Karing found that this subtle behavioral intervention increased immunization rates to levels necessary for population immunity at a cost of 1 USD per child. She also discovered that health effects for children were durable—persisting 12 months after the launch of the experiment. Given these significant results and low cost, the program has strong potential for scale-up through existing government institutions in Sierra Leone.

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