Research

We study how removing a universal, untargeted subsidy affects healthcare utilization across the full sequence of early-life contact with the health system. Using Nigeria's May 2023 petrol subsidy removal — a sharp, nationally unanticipated shock — we examine three outcome domains: antenatal care, birth outcomes, and childhood vaccination. Each domain uses a distinct identification design matched to data structure. For ANC and birth outcomes, we exploit variation in conception-cohort exposure: children born at different dates have different shares of their nine-month gestation window falling in the post-reform period, generating continuous within-cluster treatment variation conditional on birth-month seasonality. Post-reform exposure reduced ANC quantity and content quality, with proportionally larger effects in rural areas. Greater in-utero exposure widened urban–rural disparities in categorical birth size: rural births shifted toward smaller reported categories, while urban births shifted toward larger ones, consistent with an offsetting reduction in combustion-related PM2.5 that disproportionately benefited urban areas. For childhood vaccination, we exploit a within-child design: children born at different times face the same national immunization schedule, so comparing vaccine windows exposed before and after the reform — within the same child — controls for all child-level time-invariant unobservables. Post-reform coverage fell for vaccines requiring return clinic visits, with shortfalls expanding monotonically across the dosing schedule. Three pieces of evidence converge on disrupted physical access — not demand withdrawal — as the dominant mechanism. Rotavirus, newly added to the free national immunization schedule in 2022, and IPV, sustained by externally funded polio-eradication outreach, both maintain coverage despite the access shock. Rural households with older siblings show smaller vaccination shortfalls, consistent with transportation costs being shared across children. These results illustrate a broader pattern: the households capturing the largest implicit transfer under an untargeted subsidy need not be those bearing the largest adjustment cost when it is removed.

Labor markets in developing countries are marked by high informality, self-employment, and strong ties to agriculture, yet evidence on short-term job dynamics remains scarce. This paper provides the first nationally representative estimates of within-year labor market transitions in Sub-Saharan Africa and examines how they interact with agricultural cycles and household welfare. Using ten rounds of panel data from the Nigeria General Household Survey (2010–2024), I construct quarterly transition rates across employment types and household non-farm enterprise (HNFE) job flows. The Nigerian labor market is highly fluid: only 77 percent of workers remain in the same job each quarter, with farm–non-farm switches dominating job-to-job transitions. HNFEs display quarterly job creation and destruction rates around 15–16 percent, mostly reflecting household entry and exit. Smaller HNFEs grow faster, rejecting Gibrat's Law and suggesting binding early-stage frictions. Employment and enterprise outcomes move in sync with the agricultural cycle — post-harvest periods expand non-farm activity despite lower productivity, while shocks shift labor back to farming. Together, the findings reveal a mobile but weakly productive labor market and argue against one-size-fits-all entrepreneurship policies, underscoring the value of targeted, timely interventions aligned with seasonal agricultural rhythms.

JEL Codes: J21, J63, O12, Q12

Excess manganese (Mn) exposure may harm brain development and is widespread in drinking water in low- and middle-income countries. Despite this, evidence linking Mn and child development remains limited, especially in sub-Saharan Africa. We collect 170 drinking-water samples from households, preschools, and community sources in rural Ghana and link Mn concentrations to developmental assessments of 180 children aged 2–4 years. Mn contamination is common across source types; notably, elevated concentrations in sachet water, widely consumed as a safer alternative to surface and tap water, occur exclusively in products from unregistered manufacturers outside regulatory oversight. Despite measured contamination, perceived water safety remains high across exposed families. Higher Mn concentrations in household water are associated with lower developmental scores for children, with an additive effect on children attending preschools with high-Mn drinking water. These associations are not explained by co-occurring metals, highlighting the need to strengthen Mn monitoring and drinking-water regulation.

Background: Limited access to high-quality care for rural populations contributes to significant rural–urban health disparities and slow progress towards universal health coverage in many countries. Programs aimed at increasing access to healthcare in remote areas have produced mixed results, and evidence on the downstream social and economic impacts of these programs remains scarce, particularly in low-income settings.

Objectives: By means of a cluster-randomized controlled trial, this project evaluates an integrated community health outreach model providing routine access to basic healthcare services by linking government healthcare providers with hard-to-reach communities in rural Uganda. The primary aim of the trial is to evaluate the impact and implementation of this integrated outreach program on family planning service delivery, women's contraceptive choices, and subsequent labor market outcomes.

Methods: A total of 64 health facilities in six rural districts will be randomized into two arms: (1) a treatment group, in which health facility staff will roll out monthly healthcare service delivery outreach visits to two remote villages within their catchment area; and (2) a control group, in which there are no health outreach activities. Twenty households from each of the two outreach villages, and one key personnel from each of the 64 health facilities, will be invited to participate in a baseline survey and a 12-month follow-up. Household survey data will be complemented with health facility surveys and administrative data on service provision.

Discussion: Results will provide novel evidence on the potential of an integrated community-health outreach model for expanding access to care in Uganda, with relevance for other low- and middle-income countries.

Trial registration: AEA Social Science Registry (AEARCTR-0015003), registered January 27, 2025; also on ClinicalTrials.gov.