Learning, Misallocation, and Technology Adoption: Evidence from New Malaria Therapy in Tanzania.

I study how the misallocation of new technology to individuals who have low ex post returns to its use affects learning and adoption behavior. I focus on antimalarial treatment, which is frequently over-prescribed in many low-income country contexts where diagnostic tests are inaccessible. I show that misdiagnosis reduces average therapeutic effectiveness, because only a fraction of adopters actually have malaria, and slows the rate of social learning due to increased noise. I use data on adoption choices, the timing and duration of fever episodes, and individual blood slide confirmations of malarial status from a pilot study for a new malaria therapy in Tanzania to show that individuals whose reference groups experienced fewer misdiagnoses exhibited stronger learning effects and were more likely to adopt.

[1]  M. Kremer,et al.  The Illusion of Sustainability , 2004 .

[2]  S. P. Kachur,et al.  Drug dispensing practices during implementation of artemisinin‐based combination therapy at health facilities in rural Tanzania, 2002–2005 , 2011, Tropical medicine & international health : TM & IH.

[3]  P. Kondor,et al.  Social learning with subjective communication and self-selection ∗ , 2005 .

[4]  C. Manski Identification of Endogenous Social Effects: The Reflection Problem , 1993 .

[5]  C. Raine,et al.  Letters to the Editors , 2004, Journal of Neuroimmunology.

[6]  Kaivan Munshi Social learning in a heterogeneous population: technology diffusion in the Indian Green Revolution , 2004 .

[7]  P. Dupas,et al.  Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment , 2007 .

[8]  S. P. Kachur,et al.  Adherence to antimalarial combination therapy with sulfadoxine-pyrimethamine and artesunate in rural Tanzania. , 2004, The American journal of tropical medicine and hygiene.

[9]  Md. Nazmul Hassan,et al.  Sharing the Burden of Disease: Gender, the Household Division of Labor and the Health Effects of Indoor Air Pollution , 2005 .

[10]  S. P. Kachur,et al.  The silent threat: asymptomatic parasitemia and malaria transmission , 2013, Expert review of anti-infective therapy.

[11]  D. Ansong,et al.  Effect of the Affordable Medicines Facility—malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data , 2012, The Lancet.

[12]  Aprajit Mahajan,et al.  Micro-Loans, Insecticide-Treated Bednets and Malaria: Evidence from a Randomized Controlled Trial in Orissa (India) , 2011, The American economic review.

[13]  Adrienne M. Lucas Malaria Eradication and Educational Attainment: Evidence from Paraguay and Sri Lanka. , 2010, American economic journal. Applied economics.

[14]  P. Dupas Short-Run Subsidies and Long-Run Adoption of New Health Products: Evidence from a Field Experiment , 2010, Econometrica : journal of the Econometric Society.

[15]  K. Leonard,et al.  Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania , 2008 .

[16]  P. Dupas,et al.  PRICE SUBSIDIES, DIAGNOSTIC TESTS, AND TARGETING OF MALARIA TREATMENT: EVIDENCE FROM A RANDOMIZED CONTROLLED TRIAL , 2011 .

[17]  Michael Kremer,et al.  Spring Cleaning : Rural Water Impacts , Valuation , and Institutions * , 2009 .

[18]  R. Atun,et al.  Universal access to malaria medicines: innovation in financing and delivery , 2010, The Lancet.

[19]  C. Chamley Rational Herds: Economic Models of Social Learning , 2003 .

[20]  J. Svensson,et al.  The Market for (Fake) Antimalarial Medicine: Evidence from Uganda , 2014 .

[21]  H. Mshinda,et al.  The evolution of pyrimethamine resistant dhfr in Plasmodium falciparum of south-eastern Tanzania: comparing selection under SP alone vs SP+artesunate combination , 2011, Malaria Journal.

[22]  Petra Schneider,et al.  Moderate effect of artemisinin-based combination therapy on transmission of Plasmodium falciparum. , 2006, The Journal of infectious diseases.

[23]  M. Kremer,et al.  Early-Life Malaria Exposure and Adult Outcomes: Evidence from Malaria Eradication in India , 2010 .

[24]  S. Traore,et al.  The contribution of aestivating mosquitoes to the persistence of Anopheles gambiae in the Sahel , 2011, Malaria Journal.

[25]  Timothy G. Conley,et al.  Learning About a New Technology: Pineapple in Ghana , 2010 .

[26]  J. Banks,et al.  Switching Costs and the Gittins Index , 1994 .

[27]  B. Hamainza,et al.  Relative costs and effectiveness of treating uncomplicated malaria in two rural districts in Zambia: implications for nationwide scale-up of home-based management , 2011, Malaria Journal.

[28]  Imelda Bates,et al.  Malaria misdiagnosis: effects on the poor and vulnerable , 2004, The Lancet.

[29]  J. Baird,et al.  Effectiveness of antimalarial drugs. , 2005, The New England journal of medicine.

[30]  S. P. Kachur,et al.  The costs of introducing artemisinin-based combination therapy: evidence from district-wide implementation in rural Tanzania , 2008, Malaria Journal.

[31]  Imran Rasul,et al.  Social Networks and Technology Adoption in Northern Mozambique , 2002 .

[32]  Hoyt Bleakley,et al.  Malaria Eradication in the Americas: A Retrospective Analysis of Childhood Exposure. , 2010, American economic journal. Applied economics.

[33]  Achyuta R. Adhvaryu,et al.  Returns to Treatment in the Formal Health Care Sector: Evidence from Tanzania. , 2015, American economic journal. Economic policy.

[34]  Jesse M. Shapiro,et al.  Can Higher Prices Stimulate Product Use? Evidence from a Field Experiment in Zambia , 2010 .

[35]  E. Duflo,et al.  Cooking Stoves , Indoor Air Pollution and Respiratory Health in Rural Orissa , 2008 .

[36]  M. Rosenzweig,et al.  Learning by Doing and Learning from Others: Human Capital and Technical Change in Agriculture , 1995, Journal of Political Economy.

[37]  J. Sachs,et al.  The economic and social burden of malaria , 2002, Nature.

[38]  Kenneth J. Arrow,et al.  Saving lives, buying time : economics of malaria drugs in an age of resistance , 2004 .

[39]  Chris Drakeley,et al.  Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial , 2007, BMJ : British Medical Journal.

[40]  Chris Drakeley,et al.  Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study , 2004, BMJ : British Medical Journal.

[41]  W. Sanderson,et al.  Are User Fees Regressive? the Welfare Implications of Health Care Financing Proposals in Peru , 1987 .

[42]  S. P. Kachur,et al.  Is there evidence for dual causation between malaria and socioeconomic status? Findings from rural Tanzania. , 2007, The American journal of tropical medicine and hygiene.

[43]  Sok Chul Hong The Burden of Early Exposure to Malaria in the United States, 1850–1860: Malnutrition and Immune Disorders , 2007, The Journal of Economic History.