Working with Community Health Workers to Increase Use of ORS and Zinc to Treat Child Diarrhea in Uganda: The Role of Price and Convenience

Diarrhea remains the second leading cause of death among children, although nearly all deaths could be prevented with the use of oral rehydration salts (ORS). There is little evidence demonstrating why ORS use remains low and what can be done to increase use. In this study, we conducted a field experiment designed to 1) measure the impact of several novel community health worker (CHW) interventions aimed at increasing ORS use and 2) isolate the role of two potentially important barriers to ORS use: price and inconvenience. We randomized 118 villages in Uganda to one of four methods of ORS distribution by BRAC’s CHWs: 1) free and preemptive delivery of ORS (free and convenient); 2) preemptive home sales (convenient only); 3) free upon retrieval using voucher (free only); 4) status quo CHW distribution (not free and not delivered). We found that having CHWs switch to free and convenient ORS distribution increased ORS coverage by 36%. Moreover, free and convenient distribution increased ORS coverage by 18% relative to convenient only distribution, suggesting that price is an important barrier to ORS use. Convenience was not an important barrier. We also find that CHWs exhibited more effort under free distribution than when instructed to charge. There is growing support for entrepreneurial CHW models where CHWs sell products to community members. Our findings suggest that such a model not only creates a barrier to ORS use, but also could reduce CHW motivation compared to free distribution. Switching to free ORS distribution is low-cost, easily scalable, and could substantially reduce child mortality.