National-level differences in the adoption of environmental health technologies: a cross-border comparison from Benin and Togo. Health Policy Plan. (2015) 30 (2): 145-154.doi: 10.1093/heapol/czt106.
Authors: Kelly J Wendland, Subhrendu K Pattanayak and Erin O Sills. Corresponding author. Department of Conservation Social Sciences, University of Idaho, Moscow, ID 83844, USA. E-mail: kwendland@uidaho.edu
Environmental health problems such as malaria, respiratory infections, diarrhoea and malnutrition pose very high burdens on the poor rural people in much of the tropics. Recent research on key interventions—the adoption and use of relatively cheap and effective environmental health technologies—has focused primarily on the influence of demand-side household-level drivers. Relatively few studies of the promotion and use of these technologies have considered the role of contextual factors such as governance, the enabling environment and national policies because of the challenges of cross-country comparisons.
We exploit a natural experimental setting by comparing household adoption across the Benin–Togo national border that splits the Tamberma Valley in West Africa. Households across the border share the same culture, ethnicity, weather, physiographic features, livelihoods and infrastructure; however, they are located in countries at virtually opposite ends of the institutional spectrum of democratic elections, voice and accountability, effective governance and corruption.
Binary choice models and rigorous non-parametric matching estimators confirm that households in Benin are more likely than households in Togo to plant soybeans, build improved cookstoves and purchase mosquito nets, ceteris paribus. Although we cannot identify the exact mechanism for the large and significant national-level differences in technology adoption, our findings suggest that contextual institutional factors can be more important than household characteristics for technology adoption.
