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Research Roundup on Human Development in Sub-Saharan Africa (July 2012)

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Social pressure to share income with kin may discourage entrepreneurship in rural Africa
Individuals living in poor, rural communities often feel obligated to share income with relatives and neighbors.This obligation can discourage entrepreneurs from undertaking profitable business ventures that are easily observable.Unfortunately, it has been difficult or impossible to observe the magnitude of this effect because surveys cannot capture the returns to activities that were not actually undertaken. A newly designed lab experiment makes it possible to measure the economic impact of social pressure to share income with kin and neighbors. The goal was to test whether subjects in rural Kenyan villages reduce their income in order to keep it hidden. Results indicate that women adopt an investment strategy that conceals the size of their initial endowment in the experiment, although that strategy reduces their expected earnings.The effect is largest among women with relatives present.This suggests that women behave as though they expect to be pressured to share 4 percent of their observable income with others, and substantially more when close kin can observe income directly. Simulations suggest that a “kin tax” of this magnitude may significantly reduce the probability that women open new microenterprises.

Jakiela, Pamela, and Owen Ozier. 2012. “Does Africa Need a Rotten Kin Theorem? Experimental Evidence from Village Economies.” World Bank Policy Research Working Paper 6085, June.

Poor people benefit from constitutional litigation
Optimism about the use of laws, constitutions, and rights to achieve social change has never been higher among practitioners. But the academic literature is skeptical that any courts can direct resources toward the poor. In reality, not all courts are the same. Countries and policy areas characterized by judicial decisions with broader applicability tend to avoid the potential anti-poor bias of courts, whereas areas dominated by individual litigation and individualized effects are less likely to have pro-poor outcomes. A useful assessment of the potential distributive impact of litigation is whether the poor are over or under-represented among the beneficiaries of litigation, relative to their share of the population. Findings, based on data on social and economic rights cases in five countries, suggest that the impact of courts varies considerably, but is positive and pro-poor in two of the five countries (India and South Africa), distribution-neutral in two others (Indonesia and Brazil), and sharply anti-poor in Nigeria. Overall, the results of litigation are much more positive for the poor than conventional wisdom would suggest.

Brinks, Daniel M., and Varun Gauri. 2012. “The Law's Majestic Equality? The Distributive Impact of Litigating Social and Economic Rights.” World Bank Policy Research Working Paper 5999, March. See also World Bank Let's Talk Development blog, "The law's majestic equality," April 2, 2012; and “The Law and the Poor,” The Economist, May 31, 2012, available at

A program of incentives to reduce risky sexual behavior shows promise
HIV-prevention strategies have yielded limited success in slowing the AIDS epidemic. Contingency management approaches have successfully used outcome-based rewards to encourage behaviors that are not easily monitored, such as stopping drug abuse. Would such incentive strategies reduce risky sexual behavior? The use of sexual-behavior incentives were piloted in the Tanzanian RESPECT (Rewarding Sexually Transmitted Infection Prevention and Control in Tanzania) trial. Participants who tested negative for sexually transmitted infections are eligible for outcome-based cash rewards (20$/4 months or 10$/4 months depending on the reward arm). The trial was well-received in the communities, with high enrollment rates and more than 90 percent of participants viewed the incentives favorably. After one year, 57 percent of enrollees in the “low-value” reward arm stated that the cash rewards “very much” motivated sexual behavioral change, rising to 79 percent in the “high-value” reward arm. The findings, using sexually transmitted infections (STIs) as outcomes, suggest that financial incentives could be an effective prevention tool for STIs, and possibly HIV. Among study participants who were randomly selected for a $20 payment every 4 months if they tested negative for a set of curable STIs, researchers saw a 27 percent reduction in the incidence of those STIs after one year.

de Walque, Damien, William H. Dow, Carol Medlin, and Rose Nathan. 2012. “Stimulating Demand for AIDS Prevention: Lessons from the RESPECT Trial.” World Bank Policy Research Working Paper 5973, February.

Do more informed citizens receive more benefits from the government?
We like to think that delivering useful information to citizens leads to more government accountability and better health and education choices by households. However, when it comes to the distribution of free bed nets in Benin, a cornerstone of the fight against malaria, more informed households did not receive greater benefits from government. Instead, households with more access to community radio were more willing to pay for bed nets they should have received for free. Community radio programming—the main source of information for people living in the poor northern part of the country—emphasizes the importance of bed nets to prevent malaria, increasing households’ valuation of bed nets. Local officials, with significant discretion over bed net pricing, responded to increased household demand by charging for bed nets they could have distributed for free. In situations of feeble administrative controls and weak citizen organization, informed citizens are often unable to extract better delivery of benefits from government. In this case better media access changed citizen behavior, not government accountability.

Keefer, Philip, and Stuti Khemani. 2012. “Do Informed Citizens Receive More? or Pay More? The Impact of Radio on the Government Distribution of Public Health Benefits.” World Bank Policy Research Working Paper 5952, January.
See also World Bank, Let’s Talk Development Blog, “Do informed citizens receive more, or pay more,” Feb. 15, 2012.

Incentivizing safe sex in rural Tanzania
Existing prevention strategies have had a limited impact on the trajectory of the HIV/AIDS epidemic. A randomized control trail in Tanzania tested whether conditional cash transfers could prevent HIV and other sexually transmitted infections. Transfers were conditional on testing negative for a set of curable STIs. The study had three separate arms—a control arm and two treatment arms (low-value treatment and high-value treatment). Among study participants who were randomly selected for a $20 payment (high value) every 4 months if they tested negative, the results showed a 27 percent reduction in the incidence of curable STIs after one year. These findings suggest that financial incentives could be an effective prevention tool for STIs, and possibly HIV.

de Walque, Damien, William H. Dow, Rose Nathan, and others. 2012. “Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania.” BMJ Open 2(1): 1-10.

HIV infection increasing among remarried couples in Sub-Saharan Africa
Separated, divorced, and widowed individuals in Africa are at increased risk for HIV infection. Using nationally representative data from 13 sub-Saharan African countries, this research examines the HIV status of couples that have dissolved a marriage and are now remarried. Remarried individuals from a large portion of the population have a higher-than-average HIV prevalence. These HIV-positive individuals are at risk of transmitting the infection to their spouse because many of the couples enter the marriage with different HIV status. Such a high number of high-risk remarried individuals is a source of vulnerability and further infection. This population has to be included in prevention strategies.

de Walque, Damien, and Rachel Kline. 2012. “The Association Between Remarriage and HIV Infection in 13 Sub-Saharan African Countries.” Studies in Family Planning 43(1): 1-10.

Cash transfer program reduced HIV and HSV-2 infections in young women in Malawi
A randomized control trial in Malawi tested the efficacy of conditional (on school attendance) and unconditional cash transfer programs to reduce the risk of sexually transmitted infections in young women. Eighteen months after the start of the program, women receiving cash transfers who were in school at the baseline had prevalence levels of HIV and genital herpes (HSV-2) that were half and one quarter, respectively, those of women in the control group. No differences were found between the conditional and unconditional transfer groups. No effects were detected on either HIV or HSV-2 among women who had already dropped out of school by the baseline. These effects are supported by changes in self-reported sexual behavior; no effects on age of sexual debut or unprotected sex were detected, but individuals in the intervention group chose younger partners than those in the control group and their sexual activity with those partners was less frequent. The findings suggest that financially empowering school-age girls and their families can have substantial effects on their sexual and reproductive health.

Baird, Sarah J., Richard S. Garfein, Craig T. McIntosh, Berk Özler. 2012. “Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: A cluster randomised trial.” The Lancet 379(Issue 9823): 1320-29.

Widows in poor countries are often neglected and disadvantaged
In many poor West African countries there are significant legal and economic inequalities between the sexes, and wives are largely dependent on husbands. Widows face unusual disadvantage, though this has been mostly overlooked by economists and policy makers. A new study for Mali suggests that those who have experienced the shock of widowhood, some of whom are very young, have lower living standards than other women of the same age. Households headed by widowed women (comprising the vast majority of female-headed households) are significantly poorer than all other households, even when controlling for an extensive set of household and individual characteristics. Widows absorbed into male-headed households—through remarriage or some other arrangement—also fair poorly. The detrimental effects are also passed on to their children through reduced schooling, and even more so for daughters. Thus there is an intergenerational transmission of poverty stemming from widowhood. Existing social safety nets make little systematic attempt to reach widows or their dependent children. The study demonstrates the importance for social policy of examining the allocation of resources and the treatment of individual members within the household.

van de Walle, Dominique. 2011. “Lasting Welfare Effects of Widowhood in a Poor Country.” World Bank Policy Research Working Paper 5734, July.

Death toll of adults from HIV/AIDS in Sub-Saharan Africa is larger than casualties from conflict
Under-5 mortality is often used—perhaps implicitly—as a measure of “population health.” But in Sub-Saharan Africa, contrary to under-5 mortality everywhere and to adult mortality outside of Africa, adult mortality increased between 1975-79 and 2000-04 and the relationship between adult mortality and per-capita income became positive. In the highest HIV-prevalent countries of southern Africa mortality rates exceed those in countries experiencing episodes of civil war. Even in Sub-Saharan African countries where HIV-prevalence is not as high, mortality rates appear to be stagnating at best, and even increasing in several cases. Finally, the main socioeconomic dimension along which mortality appears to differ in the aggregate is gender. Adult mortality rates for men in Sub-Saharan Africa have risen substantially above those for women especially in high HIV-prevalent countries. On the whole, the data do not show large gaps in mortality by urban/rural residence or school attainment.

de Walque, Damien, and Deon Filmer. 2011. “Trends and Socioeconomic Gradients in Adult Mortality around the Developing World.” World Bank Policy Research Working Paper 5716, June.

Education matters more than inheritance to economic activity, welfare and inequality in Senegal
Institutional features of the African setting—large extended families and imperfect credit and land markets—affect the equity and efficiency roles played by intergenerational linkages. Original survey data from Senegal that include an individualized measure of consumption are used to explore the role of land inheritance, other bequests, and parental background as influences on an adult’s economic welfare and economic activities. Although intergenerational linkages are evident, so is a seemingly high degree of mobility across generations, associated with the shift from farm to non-farm sectors and greater economic activity of women. Male-dominated bequests of land and housing bring little gain to mean consumption and don’t explain inequality, although bequests have effects on the sector of activity. Inheritance of non-land assets and the education and occupation of parents (especially the mother) and their choices about children’s schooling are more important to adult welfare than property inheritance. Significant gender inequality in consumption is evident, although it is almost entirely explicable in terms of education and (non-land) inheritance. There are a number of other pronounced gender differences, with intergenerational linkages coming through the mother rather than the father.

Lambert, Sylvie, Martin Ravallion, and Dominique van de Walle. 2011. “Is It What You Inherited or What You Learnt? Intergenerational Linkage and Interpersonal Inequality in Senegal.” World Bank Policy Research Working Paper 5658, May.

School grants crowd-out private educational spending almost one-for-one
School children in low-income countries learn very little, according to many international assessments. For example, in India, only 27 percent of 10-11 year olds can read a simple passage, complete a simple division problem, tell time, or handle money. Cash grants to schools have emerged as an increasingly popular policy lever to increase learning in low-income countries, but do they work? New evaluations, using observational data from Zambia and experimental data from India, show that every additional dollar in school grants crowds-out household spending on children’s education by 80 cents in India and one dollar in Zambia. Only when households are unable to cut back spending—in schools that receive unanticipated grants—do test-scores increase. Once households internalize the increase in public spending, the impact of school grants on test-scores in both settings is zero because households realign their own spending patterns optimally. The key policy implication is not that school grants should be given in an unanticipated fashion, but that schooling inputs that are not substitutes for household inputs (teacher inputs, school infrastructure, or similar public goods) are better candidates for government provision.

Das, Jishnu, Stefan Dercon, James Habyarimana, Pramila Krishnan, Karthik Muralidharan, and Venkatesh Sundararaman. 2011. “School Inputs, Household Substitution, and Test Scores.” World Bank Policy Research Working Paper 5629, April.

Media effects on education operate through private household behavior, not government accountability
Donors have long supported greater citizen access to mass media to improve government accountability. Community radio in Africa, in particular, is seen as a vehicle to mobilize communities to improve public services. A natural experiment in Benin documents for the first time the positive effects of community radio, but that these effects do not operate through community mobilization. The data come from a March 2009 survey of more than 4,000 households and 210 villages, and from a literacy test given to 2,100 children in second grade, across 32 of the 77 communes in Benin. Community radio programs do broadcast more information about health and education, and literacy rates are higher in villages exposed to signals from a larger number of community radio stations. If community radio increased accountability, government inputs into village schools and household knowledge of government education policies would be greater in villages with greater radio access; they are not. Instead, community radio exposure encourages households to make financial investments in their children’s education. The fact that media does not influence education outcomes through greater government accountability indicates the need for a deeper understanding of interventions that can improve accountability for effective public spending.

Keefer, Philip, and Stuti Khemani. 2011. “Mass Media and Public Services: The Effects of Radio Access on Public Education in Benin.” World Bank Policy Research Working Paper 5559, February.

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