Figure 1: Map of Kagera Region

Tables Table 1: Percent of individual reporting illness and injury in the four weeks prior to survey, by age and gender Age Total Male Female 0-2 63.63 64.02 63.17 3-5 48.48 47.96 48.99 6-15 40.59 40.52 40.67 16-30 45.87 42.87 48.61 31-45 55.73 51.27 58.92 >45 68.88 66.12 71.14 Total 50.57 48.49 52.48 Source: author's calculation on KHDS

Table 2: Percent of individual reporting illness and injury in the four weeks prior to survey, by age and gender Age Total Male Female 0-2 63.63 64.02 63.17 3-5 48.48 47.96 48.99 6-15 40.59 40.52 40.67 16-30 45.87 42.87 48.61 31-45 55.73 51.27 58.92 >45 68.88 66.12 71.14 Total 50.57 48.49 52.48 Source: author's calculation on KHDS

Table 3: Types of symptoms of those reporting illness or injury in month prior to survey By Gender By Age Type of Symptom Total Male Female 0-2 3-5 6-15 16-30 31-45 >45 Acute Diarrhea 3.5 3.8 3.1 14.3 3.1 1.7 1.4 2.0 3.5 Chronic Diarrhea 0.1 0.09 0.2 0.3 0.2 0.4 0.05 Weight Loss 0.05 0.05 0.06 0.1 0.04 0.2 0.05 Acute Fever 21.9 22.2 21.3 22.6 26.5 26.4 19.3 19 18.5 Recurring Fever 2.2 1.9 2.4 4.1 2.9 1.5 1.7 2.0 2.3 Skin Rash 1.2 1.5 0.8 1.8 2.05 1.3 0.9 0.7 0.8 Weakness 2.09 1.9 2.2 0.7 0.4 0.9 2.1 3.2 4.5 Severe Headache 10.6 9.4 11.6 0.7 2.7 11.6 16.6 13.9 8.6 Fainting 0.2 0.07 0.3 0.2 0.5 0.3 Chills 7.6 7.4 7.8 11 10.9 8.2 6.8 5.7 5.7 Vomiting 0.8 0.8 0.8 1.4 1.09 1.3 0.3 0.4 0.5 Cough 12.1 12.5 11.8 14.8 17.6 13.3 9.4 8.7 11.9 Productive Cough 1.7 1.5 1.9 1.5 2.29 1.5 1.4 1.4 2.5 Coughing blood 0.1 0.1 0.08 0.2 0.1 0.1 0.2 Urine Pain 0.04 0.09 0.04 0.1 Genitals sores 0.05 0.07 0.04 0.08 0.05 0.09 0.05 Mental 0.2 0.2 0.2 0.04 0.5 0.4 Abdominal pain 6.9 6.1 7.5 2.6 4.8 7.2 8.5 8.8 6.6 Sore Throat 0.1 0.1 0.2 0.1 0.04 0.2 0.4 0.1 Breathing 0.9 1.0 0.8 0.3 0.4 0.5 1.2 2.2 0.9 Burn 0.2 0.3 0.08 0.5 0.1 0.2 0.05 0.3 0.2 Fracture 0.2 0.3 0.2 0.2 0.2 0.4 0.4 Wound 3.8 4.8 2.8 1.8 2.8 5.7 4.05 3.6 2.5 Child Birth 0.2 0.2 0.2 0.2 0.04 0.3 0.09 0.3 Other 23.3 23.3 23.2 20.89 22.1 17.9 24.3 25.5 29.3 No obs. 9,463 4,415 5,047 991 828 2,456 2,198 1,137 1,852 Source: author's calculation on KHDS

Table 4 : Choice of health care provider on sample of ill individuals By Gender By age Place Total Male Female 0-2 3-5 6-15 16-30 31-45 >45 No care 66.7 65.8 67.5 59.5 72.8 70.7 64.4 64.7 66.9 Informal care 5.3 5.7 4.9 4.8 3.7 3.6 6.5 7.0 5.5 Pharmacy 1.7 1.8 1.5 0.4 0.1 0.8 2.9 2.9 1.3 Practitioner s 1.9 2.3 1.7 2.7 2.2 1.3 1.8 2.6 2.4 Own home 1.2 1.3 1.1 1.4 1.2 1.02 1.2 0.9 1.5 Other 0.5 0.3 0.5 0.3 0.2 0.5 0.6 0.6 0.3 Formal Care 27.9 28.5 27.6 35.6 23.4 25.7 29.2 28.2 27.7 Hospital 8.7 8.1 9.2 9.4 5.3 6.2 10.2 10.3 9.5 Health Centre 3.1 3.4 2.7 5.1 2.05 2.9 2.8 3.2 3.0 Dispensary 15.9 16.6 15.2 19.98 15.7 16.1 15.9 14.4 14.9 Clinic 0.4 0.3 0.4 1.21 0.4 0.4 0.2 0.4 0.3 No. Obs. 10,703 4,963 5,743 991 828 2,645 2,74 1,324 2,011 Source: author's calculation on KHDS 5 Table 5: Benefits and Costs of formal health care Formal Infor P-value No. No P-value No. Sample μ F μ I μ F -μ I =0 μ NC μ F -μ NC =0 Fraction of individuals ill at time t-1 who are still ill at time t Pooled Sample 0.40 0.47 0.01 2781 0.42 0.13 8398 Routine 0.39 0.45 0.02 2349 0.42 0.01 7429 Symptoms Not Routine Symptoms 0.47 0.54 0.26 432 0.40 0.04 969 Fraction of ill individuals, treated by a doctor Pooled Sample 0.19 0.04 0.00 2663 - - - Distance (Km) between the facility and the household Pooled Sample 6.23 5.82 0.893 2663 - - - Notes: The table includes only 4 waves, because of lack of data about distance and individuals Source: author's calculation on KHDS

Table 6: Probability of illness Dependent variable=1 if an individual reported an illness Probit HH FE Baseline By age Baseline By age Age >12 Age<=12 Age >12 Age<=12 (1) (2) (3) (4) (5) (6) Age -0.010 0.020-0.195-0.002 0.007-0.072 (0.003)*** (0.004)*** (0.018)*** (0.001)** (0.001)*** (0.005)*** Age sq. (a) 0.000-0.000 0.011 0.000-0.000 0.004 (0.000)*** (0.000) (0.001)*** (0.000)*** (0.000) (0.000)*** Female 0.084 0.106 0.007 0.029 0.048-0.006 (0.027)*** (0.040)*** (0.035) (0.008)*** (0.012)*** (0.011) Education -0.014-0.012-0.005-0.004 (0.006)** (0.006)** (0.002)*** (0.002)* Education of HH -0.010 0.000 (0.006)* (0.000) Female Head 0.185 0.155 0.046 0.032 (0.074)** (0.080)* (0.023)** (0.027) HH head 0.138 0.033 0.040 0.016 (0.050)*** (0.057) (0.015)*** (0.017) HH size -0.011-0.012-0.012 0.001 0.001-0.001 (0.003)*** (0.004)*** (0.005)** (0.003) (0.004) (0.006) Log Phys. Stock -0.023-0.026-0.011 0.004-0.000 0.013 (0.008)*** (0.011)** (0.013) (0.005) (0.006) (0.007)* Bad House 0.074 0.115-0.014-0.002 0.015-0.023 (0.029)** (0.038)*** (0.043) (0.019) (0.022) (0.029) Bad Water 0.014-0.012 0.042-0.013-0.034 0.015 (0.030) (0.038) (0.044) (0.017) (0.020)* (0.030) Dep. Ratio (b) -0.077-0.024 0.000 0.000 (0.048) (0.015) (0.000) (0.000) Child<=12 0.052 0.097 0.042 0.027 (0.066) (0.080) (0.045) (0.053) Wave Dummies yes yes yes - - - District Dummies yes yes yes - - - Constant -0.061-0.390 0.259 0.292 0.225 0.371 (0.132) (0.167)** (0.182) (0.069)*** (0.085)*** (0.106)*** Observations 19012 11481 7531 19081 11517 7564 Number of pid 6308 3968 2671 R-squared 0.18 0.21 0.26 Notes: Sample includes waves 1-4 Robust standard errors in parentheses. * significant at 10%; ** significant at 5%; *** significant at 1% (b) Dependency Ratio=N. of elderly and kids in the HH over HH size (a) Marginal probit coefficients are calculated at the mean. Fordummies, marginal effect is calculated for disrete change from 0 to 1.

Table 7: Probability of care by formal providers Dependent variable=1 if an individual consulted a formal provider, conditional on illness Baseline By age Type of symptom Age >12 Age <=12 Routine Non Routine (1) (2) (3) (4) (5) Age -0.006 0.015-0.177-0.010 0.014 (0.005) (0.007)** (0.027)*** (0.006)* (0.013) Age sq. 0.000-0.000 0.013 0.000-0.000 (0.000) (0.000)** (0.002)*** (0.000) (0.000) Female -0.012-0.112 0.028-0.008-0.040 (0.047) (0.074) (0.056) (0.049) (0.115) Education 0.032 0.032 0.029 0.046 (0.009)*** (0.011)*** (0.010)*** (0.022)** Education of HH 0.020 (0.009)** Female Head -0.060 0.022-0.133 0.202 (0.113) (0.134) (0.120) (0.263) HH head 0.105-0.042 0.121 0.071 (0.083) (0.103) (0.087) (0.196) Log Phys. Stock -0.007-0.011-0.007-0.006-0.059 (0.014) (0.019) (0.021) (0.015) (0.037) Bad House -0.092-0.147-0.024-0.058-0.315 (0.049)* (0.068)** (0.070) (0.052) (0.117)*** Bad Water -0.251-0.226-0.300-0.256-0.285 (0.048)*** (0.065)*** (0.070)*** (0.051)*** (0.120)** HH size 0.006-0.003 0.011 0.004 0.026 (0.005) (0.008) (0.007) (0.006) (0.014)* Child<=12 0.062 0.007 0.346 (0.085) (0.090) (0.216) Dep. Ratio 0.079 0.230 0.072 0.283 (0.107) (0.137)* (0.113) (0.256) Wave Dummies yes yes yes yes yes District Dummies yes yes yes yes yes Constant -0.034-0.166 0.209 0.090-0.053 (0.222) (0.299) (0.293) (0.236) (0.548) Observations 8704 5313 3391 7678 1026 Number of pid 4720 2906 1915 4441 934 Notes: Sample includes waves 1-4.Robust standard errors in parentheses. * significant at 10%; ** significant at 5%; *** significant at 1% (b) Dependency Ratio=N. of elderly and kids in the HH over HH size (a) Marginal probit coefficients are calculated at the mean. Fordummies, marginal effect is calculated for disrete change from 0 to 1.

Table 8: Probability of care by formal providers, same individual over time Dependent variable=1 if an individual seek formal care Baseline By Age Non Ciclic Diseases Age >12 Age<=12 (1) (3) (4) (5) (6) (7) Switch to Formal -0.599-0.464-0.717-0.319-0.372-0.533 (0.082)*** (0.088)*** (0.105)*** (0.147)** (0.104)*** (0.095)*** Routine Symptoms -0.241-0.124 (0.146)* (0.206) Age 0.003-0.001 0.003-0.195-0.015-0.009 (0.010) (0.011) (0.012) (0.074)*** (0.013) (0.012) Age sq. (b) -0.000 0.000-0.000 0.017 0.000 0.000 (0.000) (0.000) (0.000) (0.006)*** (0.000) (0.000) Female -0.062-0.052-0.101-0.044-0.181-0.175 (0.083) (0.088) (0.118) (0.133) (0.103)* (0.096)* Education 0.017 0.021 0.010 0.022 0.020 (0.019) (0.020) (0.021) (0.024) (0.022) Head Education 0.017 (0.023) HH Head 0.270 0.379 0.284 0.462 0.289 (0.128)** (0.137)*** (0.143)** (0.165)*** (0.153)* Log Phys. Stock -0.016-0.012-0.008-0.053-0.031-0.026 (0.031) (0.034) (0.039) (0.058) (0.042) (0.037) Bad house -0.163 0.099-0.129-0.288-0.057-0.263 (0.096)* (0.136) (0.121) (0.181) (0.158) (0.110)** Bad water -0.078-0.136-0.131-0.060-0.059 0.013 (0.095) (0.105) (0.125) (0.171) (0.124) (0.111) HH size 0.002 0.000 0.017-0.014 0.011 0.009 (0.012) (0.013) (0.016) (0.021) (0.016) (0.014) Dependency Ratio 0.192 0.037 0.254-0.084-0.173 0.071 (0.197) (0.214) (0.239) (0.421) (0.254) (0.229) Child <12 0.245 0.248 0.082 0.077 (0.191) (0.201) (0.240) (0.227) Constant -0.397-1.045-0.242 0.971-0.227-0.006 (0.472) (0.616)* (0.610) (0.859) (0.731) (0.586) Wave Dummies yes yes yes yes yes yes District Dummies yes no yes yes no yes Cluster Dummies no yes no no yes no Observations 1390 1395 857 533 1039 1034 Number of pid 1146 1151 704 448 897 892 Notes: Robust standard errors in parentheses. * significant at 10%; ** significant at 5%; *** significant at 1%. Probit Estimates. (a) Marginal probit coefficients are calculated at the mean. Fordummies, marginal effect is calculated for discrete change from 0 to 1.

Table 9: Instrumenting illness First Stage Selection Bias Control Dependent variable Illness Formal Care (1) (2) (3) (4) (5) Disaster 0.149 (0.019)*** Switch to Formal Care -0.198-0.142 (0.030)*** (0.031)*** Age 0.182 0.009 0.004-0.068-0.069 (0.020)*** (0.022) (0.020) (0.094) (0.083) Age sq. (b) -0.001-0.000-0.000 0.000 0.000 (0.000)*** (0.000) (0.000) (0.001) (0.001) Female 0.073-0.020 0.002 0.052 0.050 (0.022)*** (0.030) (0.028) (0.110) (0.100) Education 0.004 0.046 0.048-0.008-0.002 (0.017) (0.011)*** (0.011)*** (0.027) (0.026) Female Head 0.176 0.019-0.032 0.089-0.081 (0.337) (0.104) (0.109) (0.258) (0.251) HH Head 0.025 0.177 0.243 0.458 0.416 (0.257) (0.130) (0.125)* (0.390) (0.367) HH Sice 0.050-0.016-0.024-0.046-0.032 (0.010)*** (0.013) (0.013)* (0.047) (0.044) Log Phys. Stock 0.035-0.011-0.014-0.019-0.021 (0.014)** (0.007) (0.008)* (0.022) (0.023) Bad house -0.011 0.200 0.244 0.143 0.164 (0.052) (0.081)** (0.087)*** (0.217) (0.218) Bad water 0.010-0.213-0.240-0.331-0.282 (0.054) (0.073)*** (0.069)*** (0.201)* (0.195) Dependency Ratio -0.406 0.222 0.340 0.138 0.268 (0.139)*** (0.131)* (0.139)** (0.336) (0.344) Child <12-0.013-0.383-0.457-0.767-0.662 (0.085) (0.242) (0.245)* (0.699) (0.658) routine -0.058-0.059-0.074-0.060 (0.023)** (0.024)** (0.050) (0.054) Wave Dummies yes yes yes yes District Dummies yes no yes no Cluster Dummies no yes no yes Constant 0.377-0.332-1.187-2.360-2.320 (0.125)*** (1.182) (1.148) (3.537) (3.233) Observations 18403 8385 8418 1348 1353 Note: standard errors in parentheses. * significant at 10%; ** significant at 5%; *** significant at 1%. The first stage estimate includes all five waves. (a) Disaster includes drought, epidemic, insect and crop diseases. (b) Controls: Age, Age Sq., Female, Female HH Head, HH Head, HH Size, Child<=12, Dependency Ratio, and all the mean of these covariates.

Appendix Tables Table A1: Definition of variables and descriptive statistics Variable Definition Obs Mean S.D. Min Max Ill Equal to 1 if individual reported ill or injury and 0 23632.505.499 0 1 Formal Equal 1 if formal provider (hospital, health centre 10706.279.448 0 1 Switch To Formal Equal 1 if an individual ill in time t-2, consulted an informal provider in t-2 and he is still ill in time t-1 1397.725.446 0 1 Female Equal 1 if female, 0 otherwise 24234 0.5202.499 0 1 Age Age in years 24203 24.02 19.8 0 115 Age sq. Age squared in years 24203 971.39 1487. 2 0 13225 Education Years of education 24234 4.51 5.46 0 22 HH head Equal 1 if head of household, 0 otherwise 24221.2048.4036 0 1 Female head Interaction between head and female 24221.0556.2293 0 1 HH size Number of member in each hh 24222 7.78 3.79 1 36 Phys. stock Value of physical asset held by the HH 24201 4.17e+1 6.4e+ 14 0 1e+17 Log Phys. Stock Log value of physical asset 24087 13.30 1.95 0 39.14 Bad water Equal 1 if the source of drinking water for 24113 0.783 0.411 0 1 household river/lake, well without pump, rain 0 Bad floor Equal 1 if main floor material is earth, 0 otherwise 23548.807.394 0 1 Bad wall Equal 1 if main wall material is mud brick or 23548.719.449 0 1 Bad roof Equal 1 if main roof material is grass or mud 23548.275.446 0 1 Bad house Equal 1 if inadequate house (bad wall bad floor bad 24222.210.407 0 1 roof), 0 otherwise Symtom Symptoms suffered:1= Acute diarrhea, 2=Chronic 9462 13.6 11.8 1 25 Diarrhea, 3=weight loss, 4=Acute Fever, 5=Recurring Fever, 6=skin rash, 7=weakness, 8=severe headache, 9=fainting, 10=chills (feeling hot and cold), 11=vomiting, 12=cough, 13=productive cough, 15=pain on passing urine, 16=genitals pain, 17=mental problems, 18=abdominal pain, 19=sore throat, 20=difficult breathing, 21=burn, 22=fracture, 23=wound, Routine Equal 1 if it is a routine symptom, 0 otherwise 9368.83.37 0 1 Distance Distance from the nearest health establishment 2664 6.19 46.66 0 1600 (Km) Facility distance Distance between the community and the nearest 23135 3.22 3.89 0 30 health establishment (Km) Disasters Equal 1 if there was a disaster in the past 6 months in the community, such as: drought, epidemic, 23278.564.495 0 1