More on Free Goods and Aid Dependency

In a previous News Blog we reported results showing that maintenance of communal lavatories was worse among people who had had a subsidy for lavatory maintenance withdrawn than among those who had never had the subsidy in the first place.[1] The ‘free good’ idea was at work here, whereby people can develop a sense of entitlement. A recent study involved providing free shoes for poor people.[2] Those who received the free shoes were more likely to feel that other people should provide family needs in general than those who had not been given free shoes – classic aid dependency. Handing out free shoes did not increase overall ownership of shoes, foot health or self-esteem; presumably because of ‘fungability’ – people used their shoe money for other purposes. Yet not all ‘free goods’ are bad – a recent paper co-authored by CLAHRC WM researchers showed that even very small user fees reduce access to services in Malawi and this hits the most vulnerable – children – the hardest.[3] Taken in the round this leads to the CLAHRC WM Director’s axiom – “ration health care, but not access to health care.”

— Richard Lilford, CLAHRC WM Director


  1. Garn JV, Sclar GD, Freeman MC, et al. The impact of sanitation interventions on latrine coverage and latrine use: A systematic review and meta-analysis. Int J Hyg Environ Health. 2016. [ePub].
  2. Wydick B, Katz E, Calvo F, Gutierrez F, Janet B. Shoeing the Children: The Impact of the TOMS Shoe Donation Program in Rural El Salvador. World Bank Econ Rev. 2016.
  3. Watson SI, Wroe EB, Dunbar EL, et al. The impact of user fees on health services utilization and infectious disease diagnoses in Neno District, Malawi: a longitudinal, quasi-experimental study. BMC Health Serv Res. 2016; 16(1):595.

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