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showing that maintenance of communal lavatories was worse among people who had had a subsidy for lavatory maintenance withdrawn than among those who had never had the subsidy in the first place.[1] The ‘free good’ idea was at work here, whereby people can develop a sense of entitlement.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
- 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].
- 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.
- 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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