This interdisciplinary abstract explores the converging challenges that arise where psychiatric incapacity, digital wrongdoing, and professional ethics meet the law-specifically at the intersection of Islamic finance, cyber regulation, medical responsibility, and the insanity defence. The paper synthesises doctrinal analysis, comparative case law, and ethical literature to map how different legal traditions handle allocation of responsibility, evidentiary thresholds for mental incapacity, and remedies when harms are digital, diffuse, or transnational. Simultaneously, the study interrogates medical-ethical duties: confidentiality, duty to warn, fitness-to-practice assessments, and mandatory reporting obligations when clinicians encounter patients who may commit or have committed cyber harms. Through comparative analysis across common law, civil law, and selected Islamic jurisdictions, the paper identifies recurring tensions: between restorative and punitive aims; between religiously grounded reparative expectations and secular criminal sanctions; and between clinical confidentiality and public protection in cyberspace.

We study the potential for asset collateralization to expand access to credit in rural Kenya. Increasing the share of a loan for a durable agricultural asset that is collateralized by the physical asset itself (from 0 to 96%) while reducing the share backed by financial assets increases loan take-up considerably, with only a very limited impact on repayment behavior and the lender's profitability. A Karlan-Zinman test finds evidence of small and marginally significant selection effects in some specifications but no evidence of moral hazard. We find no evidence that joint versus individual liability affects take-up or repayment. Loans had real impacts on investment, milk sales, and girls' school enrollment. The lender, a savings and credit cooperative, responded to the study results by offering 80% asset-collateralized loans.

We report results of a randomized controlled trial in which parents of final-year primary school students were encouraged to open a mobile phone–based bank account. Being offered access to the account induced a 5–6 percentage point increase in the probability of transitioning to high school, or a nearly 40% increase among compliers. This impact is driven in part by changes in financial behavior—parents save and/or borrow more and accumulate resources consistent with the observed increase in enrollment. Behavioral attention constraints do not appear to bind, as reminder text messages had no discernible impacts on financial behavior or enrollment decisions.

Developing country lenders are taking advantage of fintech tools to create fully digital loans on mobile phones. Using administrative and survey data, we study the take up and impacts of one of the most popular digital loan products in the world, M-Shwari in Kenya. While 34% of those eligible for a loan take it, the loan does not substitute for other credit. The loans improve household resilience: households are 6.3 percentage points less likely to forego expenses due to negative shocks. Fintech tools can be a crucial way to improve financial access and household resilience.

We conducted a randomized controlled experiment to test whether vouchers, cash transfers, and SMS messages were effective in boosting facility delivery rates among poor, pregnant women in rural Kenya. We find a strong effect of the full vouchers and the conditional cash transfers: 48% of women with access to both interventions delivered in a health facility, while only 36% of those with neither did. Amongst women who did not receive a cash transfer, we find that a small copayment dramatically reduced voucher effectiveness, suggesting a discontinuous impact of cost-sharing on the demand for health services. Both the unconditional cash transfer and the text messages had limited effect on the use of health services. Finally, we also find no evidence that a government policy to eliminate user fees increased demand for maternal health services.

Objective Community health clubs (CHCs)—multi‐session village‐level gatherings led by trained facilitators, designed to promote healthful behaviors—have been implemented in several African and Asian countries but have never been rigorously evaluated. We aimed to evaluate the impact of CHCs on child health and nutrition outcomes. Methods We conducted a cluster‐randomized controlled trial to evaluate the health impact of two versions of the CHC model in Rusizi district, western Rwanda. We enrolled 8734 households with children under five years of age in a baseline survey in 2013. A total of 150 villages were randomized to three groups: no intervention (control, n=50), eight sessions (Lite, n=50), or 20 sessions (Classic, n=50). We re‐enrolled 7934 (91%) of the households in an endline survey in 2015. The primary outcomes were caregiver‐reported diarrhea in children <5 years within the previous seven days and nutritional status of children <2 years, measured through length‐for‐age (LAZ) and weight‐for‐length (WLZ) z‐scores. We measured intermediate outcomes related to water, sanitation, hygiene, infant and young child feeding, and food security. To analyze impact on dichotomous variables at the individual level, we used log‐binomial regression with a log link function and generalized estimating equations (GEE) to account for community level clustering, then exponentiated the coefficients to obtain prevalence ratios (PRs). For dichotomous outcomes at the household level, we used binomial regression with an identity link function and GEE, to obtain risk differences (RDs). For continuous variables, we used linear regression with GEE. All analyses accounted for clustering at the village level. Analysis was by intention to treat and per‐protocol. Results We observed no impact on caregiver‐reported diarrhea in the Lite (PR=0.97, 95% CI: 0.81–1.16) or the Classic group (PR=0.99, CI: 0·85–1·15). We observed no impact on LAZ in the Lite (β=−0·04, 95% CI: −0·18–0·11) or the Classic (β=−0·08, 95% CI: −0·23–0·08) group, nor on WLZ in the Lite (β=−0·01, 95% CI: −0·12–0·10) or the Classic (β=−0·07, 95% CI: −0·18–0·05) group. The Classic intervention had a positive impact on reported household water treatment (RD=0·086, 95% CI: 0·029–0·14), use of improved sanitation facilities (RD=0·085, 95% CI: 0·015–0·16), and presence of structurally complete sanitation facility (RD=0·065, 95% CI: 0·0013–0·13). There was no impact on the remaining intermediate outcomes, including improved microbiological water quality; drinking water source; presence of a hand washing station with soap; exclusive breastfeeding for children <6 months; dietary diversity for children 6–23 months; or household food security. In the Lite intervention, there was no impact on any intermediate outcomes. Per‐protocol analysis of households in the Classic arm who reported attending all 20 sessions suggested positive impacts on reported household water treatment (RD=0·20, 95% CI: 0·12–0·28), use of improved sanitation facility (RD=0·14, 95% CI: 0·053–0·22), and presence of structurally complete sanitation facility (RD=0·075, 95% CI: 0·0014–0·15). No other differences were noted. Conclusions The CHC approach, as implemented in this setting in western Rwanda, had no impact on any main outcomes, but it had a positive impact on household water treatment and type and structure of sanitation facility. Our results raise questions about the value of implementing this intervention at scale. Support or Funding Information Bill & Melinda Gates Foundation

Background: Community health clubs are multi-session village-level gatherings led by trained facilitators and designed to promote healthy behaviours mainly related to water, sanitation, and hygiene. They have been implemented in several African and Asian countries but have never been evaluated rigorously. We aimed to evaluate the effect of two versions of the community health club model on child health and nutrition outcomes. Methods: We did a cluster-randomised trial in Rusizi district, western Rwanda. We defined villages as clusters. We assessed villages for eligibility then randomly selected 150 for the study using a simple random sampling routine in Stata. We stratified villages by wealth index and by the proportion of children younger than 2 years with caregiver-reported diarrhoea within the past 7 days. We randomly allocated these villages to three study groups: no intervention (control; n=50), eight community health club sessions (Lite intervention; n=50), or 20 community health club sessions (Classic intervention; n=50). Households in these villages were enrolled in 2013 for a baseline survey, then re-enrolled in 2015 for an endline survey. The primary outcome was caregiver-reported diarrhoea within the previous 7 days in children younger than 5 years. Analysis was by intention to treat and per protocol. This trial is registered with ClinicalTrials.gov, number NCT01836731. Findings: At the baseline survey undertaken between May, 2013, and August, 2013, 8734 households with children younger than 5 years of age were enrolled. At the endline survey undertaken between Sept 21, 2015, and Dec 22, 2015, 7934 (91%) of the households were re-enrolled. Among children younger than 5 years, the prevalence of caregiver-reported diarrhoea in the previous 7 days was 514 (14%) of 3616 assigned the control, 453 (14%) of 3196 allocated the Lite intervention (prevalence ratio compared with control 0·97, 95% CI 0·81–1·16; p=0·74), and 495 (14%) of 3464 assigned the Classic intervention (prevalence ratio compared with control 0·99, 0·85–1·15; p=0·87). Interpretation: Community health clubs, in this setting in western Rwanda, had no effect on caregiver-reported diarrhoea among children younger than 5 years. Our results question the value of implementing this intervention at scale for the aim of achieving health gains. Funding: Bill & Melinda Gates Foundation.

In economies with weak enforcement of traffic regulations, drivers who adopt excessively risky behavior impose externalities on other vehicles, and on their own passengers. In light of the difficulties of correcting inter-vehicle externalities associated with weak third-party enforcement, this paper evaluates an intervention that aims instead to correct the intra-vehicle externality between a driver and his passengers, who face a collective action problem when deciding whether to exert social pressure on the driver if their safety is compromised. We report the results of a field experiment aimed at solving this collective action problem, which empowers passengers to take action. Evocative messages encouraging passengers to speak up were placed inside a random sample of over 1,000 long-distance Kenyan minibuses, or matatus, serving both as a focal point for, and to reduce the cost of, passenger action. Independent insurance claims data were collected for the treatment group and a control group before and after the intervention. Our results indicate that insurance claims fell by a half to two-thirds, from an annual rate of about 10 percent without the intervention, and that claims involving injury or death fell by at least 50 percent. Results of a driver survey eight months into the intervention suggest passenger heckling was a contributing factor to the improvement in safety.

Do the stringent formal sector borrowing requirements common in many developing countries restrict credit access, technology adoption, and welfare?When a Kenyan dairy's savings and credit cooperative randomly offered some farmers the opportunity to replace loans with high down payments and stringent guarantor requirements with loans collateralized by the asset itself -a large water tank -loan take-up increased from 2.4% to 41.9%.(In contrast, substituting joint liability requirements for deposit requirements did not affect loan take up.)There were no repossessions among farmers allowed to collateralize 75%of their loans, and there was only a 0.7% repossession rate among those offered 96% asset collateralization.A Karlan-Zinman test based on waiving borrowing requirements ex post finds evidence of adverse selection with lowered deposit requirements, but not of moral hazard.A simple model and rough calibration suggests that adverse selection may deter lenders from making welfare-improving loans with lower deposit requirements, even after introducing asset collateralization.We estimate that 2/3 of marginal loans led to increased water storage investment.Real effects of loosening borrowing requirements include increased household water access, reductions in child time spent on waterrelated tasks, and greater school enrollment for girls.

ObjectiveTo explore associations of environmental and demographic factors with diarrhoea and nutritional status among children in Rusizi district, Rwanda.MethodsWe obtained cross-sectional data from 8847 households in May-August 2013 from a baseline survey conducted for an evaluation of an integrated health intervention. We collected data on diarrhoea, water quality, and environmental and demographic factors from households with children <5, and anthropometry from children <2. We conducted log-binomial regression using diarrhoea, stunting and wasting as dependent variables.ResultsAmong children <5, 8.7% reported diarrhoea in the previous 7days. Among children <2, stunting prevalence was 34.9% and wasting prevalence was 2.1%. Drinking water treatment (any method) was inversely associated with caregiver-reported diarrhoea in the previous 7days (PR=0.79, 95% CI: 0.68-0.91). Improved source of drinking water (PR=0.80, 95% CI: 0.73-0.87), appropriate treatment of drinking water (PR=0.88, 95% CI: 0.80-0.96), improved sanitation facility (PR=0.90, 95% CI: 0.82-0.97), and complete structure (having walls, floor and roof) of the sanitation facility (PR=0.65, 95% CI: 0.50-0.84) were inversely associated with stunting. None of the exposure variables were associated with wasting. A microbiological indicator of water quality was not associated with diarrhoea or stunting.ConclusionsOur findings suggest that in Rusizi district, appropriate treatment of drinking water may be an important factor in diarrhoea in children <5, while improved source and appropriate treatment of drinking water as well as improved type and structure of sanitation facility may be important for linear growth in children <2. We did not detect an association with water quality.ObjectifExplorer les associations entre les facteurs environnementaux et demographiques avec la diarrhee et l'etat nutritionnel chez les enfants dans le district de Rusizi, au Rwanda.MethodesNous avons obtenu des donnees transversales de 8.847 menages de mai a aout 2013 d'une enquete de reference realisee pour l'evaluation d'une intervention de sante integree. Nous avons recueilli les donnees sur la diarrhee, la qualite de l'eau et les facteurs environnementaux et demographiques des menages avec des enfants <5ans, et l'anthropometrie des enfants <2 ans. Nous avons effectue une regression log-binomiale en utilisant la diarrhee, le retard de croissance et l'emaciation comme variables dependantes.ResultatsChez les enfants <5 ans, 8,7% ont rapporte la diarrhee au cours des 7 jours precedents. Chez les enfants <2 ans, la prevalence du retard de croissance etait de 34,9% et celle de l'emaciation de 2,1%. Le traitement de l'eau de boisson (toute methode) etait inversement associe a la diarrhee rapportee par les soignants au cours des sept jours precedents (PR = 0,79; IC95%: 0,68 a 0,91). L'amelioration de la source d'eau de boisson (PR = 0,80; IC95%: 0,73 a 0,87), un traitement approprie de l'eau de boisson (PR = 0,88; IC95%: 0,80 a 0,96), l'amelioration des installations sanitaires (PR = 0,90; IC95%: 0,82-0,97) et une structure complete (presence de murs, de plancher et de toit) de l'installation sanitaire (PR = 0,65; IC95%: 0,50 a 0,84) etaient inversement associes a un retard de croissance. Aucune des variables d'exposition n'a ete associee a l'emaciation. Un indicateur microbiologique de la qualite de l'eau n'a pas ete associe a la diarrhee ou au retard de croissance.ConclusionsNos resultats suggerent que dans le district de Rusizi, un traitement approprie de l'eau de boisson peut etre un facteur important dans la diarrhee chez les enfants <5 ans, tandis que l'amelioration de la source et un traitement approprie de l'eau de boisson ainsi que l'amelioration du type et de la structure des installations sanitaires peuvent etre importants pour une croissance lineaire chez les enfants <2 ans. Nous n'avons pas detecte une association avec la qualite de l'eau.ObjetivoExplorar las asociaciones entre factores ambientales y demograficos con la diarrea y el estatus nutricional de ninos del distrito de Rusizi, Ruanda.MetodosHemos obtenido datos croseccionales de 8,847 hogares entre Mayo y Agosto del 2013 de una encuesta basal realizada por la evaluacion de una intervencion integral en salud. Hemos recogido datos sobre diarrea, calidad del agua, factores ambientales y demograficos de hogares con ninos <5 anos, y antropometria de ninos <2 anos. Hemos realizado una regresion logistica binaria utilizando diarrea, la atrofia y el marasmo como variables dependientes.ResultadosDe los ninos <5 anos, un 8.7% reporto diarrea en los ultimos 7 dias. Entre los ninos <2 anos, la prevalencia de atrofia era del 34.9% y la prevalencia de marasmo del 2.1%. El tratamiento del agua para consumo (cualquier metodo) estaba inversamente asociada con la diarrea reportada por el cuidador en los siete dias previos (PR=0.79, IC 95%: 0.68-0.91). Una fuente mejorada del agua para consumo (PR=0.80, IC 95%:0.73-0.87), el tratamiento apropiado del agua para consumo (PR=0.88, IC 95%:0.80-0.96), mejoras en las instalaciones sanitarias (PR=0.90, IC 95%:0.82-0.97) y una estructura completa (tener paredes, suelo, y techo) de las instalaciones sanitarias (PR=0.65, IC 95%:0.50-0.84) estaban inversamente asociados con atrofia. Ninguna de las variables de exposicion estaba asociada con el marasmo. Un indicador de la calidad del agua no estaba asociado con la diarrea o la atrofia.ConclusionesNuestros hallazgos sugieren que en el distrito de Rusizi, el tratamiento apropiado del agua para consumo podria ser un factor importante en la diarrea de ninos <5 anos, mientras que las mejoras en las fuentes y un tratamiento adecuado del agua para consumo, al mismo tiempo que el tipo y estructura de las instalaciones sanitarias podrian ser importantes para el crecimiento linear en ninos <2 anos. No detectamos una asociacion con la calidad del agua.

Mobile money, a service that allows monetary value to be stored on a mobile phone and sent to other users via text messages, has been adopted by the vast majority of Kenyan households. We estimate that access to the Kenyan mobile money system M-PESA increased per capita consumption levels and lifted 194,000 households, or 2% of Kenyan households, out of poverty. The impacts, which are more pronounced for female-headed households, appear to be driven by changes in financial behavior-in particular, increased financial resilience and saving-and labor market outcomes, such as occupational choice, especially for women, who moved out of agriculture and into business. Mobile money has therefore increased the efficiency of the allocation of consumption over time while allowing a more efficient allocation of labor, resulting in a meaningful reduction of poverty in Kenya.

Road accidents kill 1.3 million people each year, most in the developing world. We test the efficacy of evocative messages, delivered on stickers placed inside Kenyan matatus, or minibuses, in reducing road accidents. We randomize the intervention, which nudges passengers to complain to their drivers directly, across 12,000 vehicles and find that on average it reduces insurance claims rates of matatus by between one-quarter and one-third and is associated with 140 fewer road accidents per year than predicted. Messages promoting collective action are especially effective, and evocative images are an important motivator. Average maximum speeds and average moving speeds are 1-2 km/h lower in vehicles assigned to treatment. We cannot reject the null hypothesis of no placebo effect. We were unable to discern any impact of a complementary radio campaign on insurance claims. Finally, the sticker intervention is inexpensive: we estimate the cost-effectiveness of the most impactful stickers to be between $10 and $45 per disability-adjusted life-year saved.

Do stringent formal sector borrowing requirements in developing countries restrict credit access? Randomization of borrowing requirements for Kenyan dairy farmers purchasing rainwater harvesting tanks yields no evidence that substituting joint liability requirements for deposit requirements increased credit access. In contrast, allowing borrowers to collateralize loans primarily with the asset purchased under the loan increased borrowing dramatically, from 2.4% to 44.3%. All 460 loans were fully recovered, in one case out of the proceeds from a repossession. Results were similar in a second, out-of-sample, set of loans . A KarlanZinman test based on waiving borrowing requirements ex post yields no evidence that borrowing requirements have a negative treatment effect on tank repossession, but suggests they select safer borrowers (significant at the 5.25% level). A simple model suggests that such selection effects will cause profit-maximizing lenders to set borrowing requirements above the socially optimal level, because lenders will not internalize costs to infra-marginal borrowers. and cCalibrations suggest that tight borrowing requirements may be privately, but not socially optimal. Allowing borrowers to collateralize loans with purchased assets had real effects on water access, time use, and girls' school enrollment. Although nearly 95% of borrowers were subject to credit constraints, many repaid loans early. While a decisive test awaits further work, the model suggests prospect theory could potentially account for both the sensitivity of loan take up to the ability to allowing collateralize collateralization of loans with purchased assets, high repayment rates, and for widespread early repayment. *The authors would like to thank Egor Abramov, William Glennerster, Benjamin Marx, Adam Ray, Itzchak Raz, Indrani Saran, and Kevin Xie, for exceptional research assistance. Our gratitude also goes out to Suleiman Asman, Antony Wainaina and Nadir Shams for excellent management, field supervision and data collection. We are grateful to Joshua Angrist, Michael Boozer, Esther Duflo and Rachel Glennerster and seminar audiences at the Northwestern, Georgetown, the IPA Microfinance Conference, UCSD, Tinbergen Institute, Amsterdam, the World Bank and MIT Development Lunch for comments. We thank the Gates Foundation, Google and the Agricultural Technology Adoption Initiative for funding. Jack is at the Department of Economics at Georgetown University, Kremer is at the Department of Economics at Harvard University, de Laat is at the World Bank and Suri is at the MIT Sloan School of Management. Suri is the corresponding author. Electronic correspondence: tavneet@mit.edu.

We explore the impact of reduced transaction costs on risk sharing by estimating the effects of a mobile money innovation on consumption. In our panel sample, adoption of the innovation increased from 43 to 70 percent. We find that, while shocks reduce consumption by 7 percent for nonusers, the consumption of user households is unaffected. The mechanisms underlying these consumption effects are increases in remittances received and the diversity of senders. We report robustness checks supporting these results and use the four-fold expansion of the mobile money agent network as a source of exogenous variation in access to the innovation.

Mobile money allows households in Kenya to spread risk more efficiently. In this paper we show that these efficiencies are achieved through deeper financial integration and expanded informal networks. Active networks are more geographically dispersed and support more reciprocal financial arrangements. Consistent with the reported reciprocity, mobile money users report a higher share of transactions as being for credit and insurance purposes.

This paper compares the relative impact of two road safety interventions in the Kenyan minibus or matatu sector: a top down set of regulatory requirements known as the Michuki Rules and a consumer empowerment intervention. We use very detailed insurance claims data on three classes of vehicles to implement a difference-in-differences estimation strategy to measure the impact of the Michuki Rules. Despite strong political leadership and dedicated resources, we find no statistically significant effect of the Michuki Rules on accident rates. In contrast, the consumer empowerment intervention that didn't rely on third party enforcement has very large and significant effects on accident rates. Our intent-to-treat estimates suggest reductions in accident rates of at least 50%. Our analysis suggests that in institutionally weak environments, innovative consumer-driven solutions might provide an alternative solution to low quality service provision.

This article examines rationales for public intervention in health insurance markets from the perspective of public economics. It draws on the literature of organizational design to examine alternative public intervention strategies, including issues of contracting, purchaser provider splits, and regulation of competition. Health insurance reforms in four Latin American countries are then considered in light of the insights provided by the theoretical literature.