Experimental Design Details
A major social and economic problem in developing countries is widespread abuse of alcohol, especially among young men. In western Kenya, a highly populated area with significant levels of rural poverty, illicit sale and consumption of locally brewed spirits appears to be causing significant negative societal impacts: harming health, decreasing agricultural productivity, and leading to intra-household conflict (Mutisya and Willis, 2009; Mkuu et al., 2019). The resulting detrimental health and economic effects on women can be especially severe. Studies show that alcohol abuse among men is correlated with intimate partner violence (IPV), which often causes severe physical and psychological damage to women and children in the household (Tumwesigye et al., 2012; Wilson et al., 2014; Greene et al., 2017). In addition, alcohol abuse, primarily among men in these areas, can potentially exacerbate the unequal distribution of household labor. Men, unable to perform agricultural tasks due to alcohol consumption, rely on women in the household for these labor-intensive activities. Moreover, as men are generally managers of household finances, male abusers of alcohol are likely to allocate financial resources sub-optimally at the expense of women and children.
Despite its severity, there has been very little research in the development economics literature analyzing methods to decrease alcohol abuse and its corresponding deleterious impact on women and economic productivity. In the Indian context, Schilbach (2019) conducted an experiment to analyze whether a commitment mechanism providing financial incentives for sobriety among male cycle-rickshaw drivers could be an effective method to decrease alcohol consumption. The results show that the incentive increased sobriety and savings, though did not have an effect on productivity. Luca et al. (2015) find that alcohol prohibition in India decreases IPV, and Angelucci (2008) finds that direct cash payments to women in Mexico decrease alcohol usage in households, although she finds mixed effects on intimate partner violence. While numerous recent studies have analyzed the effect of cash transfers on IPV in Sub-Saharan Africa (SSA) (Heath et al., 2020; Haushofer et al, 2019; Cools and Kotsadam, 2017), there have been no economic studies in SSA to our knowledge that specifically analyze the effect of programs to decrease alcohol abuse as a primary objective on intimate partner violence.
In this study, we seek to determine whether an alcohol counseling and outreach program in rural Western Kenya can increase levels of sobriety and decrease expenditures on alcohol. While this program will primarily target alcohol usage, we are interested in associated effects of the program on spousal relations (IPV), Intra-household information sharing, and economic productivity. We plan to include approximately 450 households (900 individuals) in 20 villages in Kakamega, Bungoma, and northern Busia countries in Kenya. Households will include cohabitating spouses, where at least one spouse regularly consumes alcohol. Certified health workers will medically screen prospective participants to ensure that they are healthy enough to participate in the program. All prospective participants, with their consent, will be transported to a nearby clinic for a physical exam and blood tests prior to the start of any formal project activities. During the intervention, participants will have the phone number to a nurse on staff who will be able to answer any questions or concerns. If needed, an individual who is suffering from significant withdrawal symptoms will receive assistance from the implementing partner (Giselle Foundation) and medical support (explained further below).
We will invite a randomly chosen third of these households to participate in substance abuse trainings carried out by the Giselle Foundation , which will include both group and individual counseling sessions over four months. These households will receive the opportunity to receive a financial incentive (currently planned to be 500 KSh per household per week). The 500 KSh is equal to about one-day's wage in this region. To receive this payment, the household should be actively participating in the project and engaged in meetings with counselors and social workers. Each week, 50% of actively participating households will be randomly chosen to receive the incentive. The funds will be transferred directly to households through mobile phone (in the absence of a mobile phone, cash will be provided). As long as the household members are participating, the funds will be transferred for the duration of the project.
These incentive payments are modeled after the aforementioned study by Schilbach (2019) in India. In his study, individuals who passed a daily breathalyzer received a substantial monetary payment, while those who were not sober did not. This study tries to mitigate any coercive aspect by providing the payment regardless of present sobriety of the individual --- the only condition is that the individual is participating in treatment activities. We believe these payments to be culturally acceptable given the wide use of payments for participation in programs in Kenya and Sub-Saharan Africa in general. Numerous studies in development economics analyze effects of behavioral changes in response to cash payments in Sub-Saharan Africa, and this study would not be unique in providing such monetary gifts.
A team of enumerators employed by the International Institute of Tropical Agriculture will then conduct surveys with both treatment and control households. Surveys will include questions about the household’s agricultural activities, assets, individual’s religious membership, information network, alcohol use, perceptions of gender roles, and (for female respondents) questions about incidence of IPV. These surveys will determine whether the program has affected alcohol usage, IPV, Intra-household information sharing, and productivity among participants.
In this project, we will also employ an experimental approach that uses an auction mechanism after Murphy et al., (2020). In this region of western Kenya, Murphy et al. (2020) conducted experimental auctions for various agricultural inputs in 2016. In these auctions, households received a cash endowment and bid against a random “price” for the inputs both before and after receiving information about their soils. In this experimental auction, all program participants will receive cash at the start of the auction (i.e. a cash endowment). Participants will then “bid” for a variety of goods, including some agriculturally useful goods such as garden seeds.
• If they bid at least the amount of a randomly chosen “price”, they pay the random price and receive the good. They also keep the remainder of their cash endowment.
• If they bid less than the randomly chosen “price”, they keep the entire cash endowment.
In this study, we plan to incorporate an additional intra-household bargaining component. Each spouse will have the opportunity to either keep winnings from the auction secret, or to share information on winnings with their spouse for an additional payment. This will enable us to measure Intra-household information sharing among spouses in each household. By randomizing the invitation to the trainings and workshops, we will be able to ascertain the effect of the program on Intra-household information sharing between spouses.
Cultural sensitivity is embedded into this study, specifically through its design in partnership with local stakeholders. Reduction of alcohol abuse is a major initiative of the Kenyan government, and local NGOs, including the Giselle foundation (the implementing partner) who/which has been involved in this area already. Giselle Foundation also has a working relationship with NACADA (The National Authority for the Campaign Against Alcohol and Drug Abuse), the semi-autonomous government authority in this area.