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Human Development and Public Services

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This research program spans the full gamut of human development — education, health, labor markets, and social protection. It examines the performance of the sectors in terms of levels and inequalities in utilization, quality and outcomes, as well as methods for improving performance, whether aimed at households, service providers, politicians and policymakers, or donors.    More »


Value Judgments in Health Inequality Measurement
Adam Wagstaff

Value judgments lurk beneath the surface in any study of health inequalities; analysts ought to understand them, make them explicit, and present results transparently to policymakers so that they, rather than analysts, decide which set of value judgments should be invoked. That is the key message of the paper “Lies, Damned Lies, and Health Inequality Measurements” by Gustav Kjellsson, Ulf-G Gerdtham, and Dennis Petrie.

Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study
Das, J., A. Kwan, B. Daniels, S. Satyanarayana, R. Subbaraman, S. Bergkvist, R. K. Das, V. Das and M. Pai

Existing studies of the quality of tuberculosis care have relied on recall-based patient surveys, questionnaire surveys of knowledge, and prescription or medical record analysis, and the results mostly show the health-care provider's knowledge rather than actual practice. No study has used standardised patients to assess clinical practice. Therefore we aimed to assess quality of care for tuberculosis using such patients.

Inequality of Opportunity: Reply to Pedro Rosa Dias and Erik Schokkaert
Ravi Kanbur and Adam Wagstaff

We welcome the comments of Pedro Rosa Dias and Erik Schokkaert on our Editorial as a means of stimulating further debate on the usefulness of estimates of inequality of opportunity, especially for policy purposes. Our responses to their comments are in three categories. First, they broadly agree with many of our criticisms of the Paes de Barros et al. approach to measuring inequality of opportunity, but they say that these criticisms are already well appreciated in the literature. We beg to differ. Given our knowledge of work in policy settings, we believe that strong health warnings are in order. Second, we feel they do not sufficiently engage with a number of our points, including on talent and on luck. Third, while we agree with them that a strong focus on the income–health gradient leaves out many other considerations, we would nevertheless continue to argue for this focus on pragmatic grounds in the realm of policy.

Inequality of Opportunity: The New Motherhood and Apple Pie?
Adam Wagstaff and Ravi Kanbur

The recent paper by García-Gómez et al. (2014) in this journal is part of a rapidly growing industry aiming to quantify – and hence give some policy teeth to – the concept of inequality of opportunity. The idea behind the concept is simple yet powerful. Not all inequality is bad. The bad bit of inequality (‘inequality of opportunity’) is the part that emerges because of factors over which we have no control (our ‘circumstances’). By contrast, inequality that emerges because of our different choices and efforts (holding constant our circumstances) is fine and to be encouraged.


How Effective Are Efforts to Raise Voluntary Enrollment in Health Insurance?
Winter 2015
An experiment in the Philippines suggests that achieving universal health coverage through voluntary enrollment will not be easy.

How Insecure Property Rights Affect Migration in China
Winter 2015
Land tenure insecurity reduced the rate of migration from rural to urban areas in China during the 1990s and early 2000s.

Can incentives lead to sustained impacts? The case of rewarding safe sex.
Damien de Walque, January 2015
Economists believe that incentives matter and that they can be used for changing people’s behaviors. Incentives are used for encouraging school attendance and performance or for increasing the coverage and quality of health care delivery. But a recurrent question is what happens once the incentives are discontinued? Are the incentives’ effects going to be sustained even after their payment is stopped because individuals would have been nudged towards a different behavior? Or are those effects going to die down and disappear once incentives are removed? The answer to that question has obvious consequences in terms on long run sustainability and cost effectiveness of incentive schemes.

Deworming improves child cognition. Eventually
Owen Ozier, October 16, 2014
You could be forgiven if you found deworming to be something of an enigma. Some have hailed it as one of the most cost effective interventions for improving school participation in developing countries. Yet two recent review papers, drawing together the lessons from many studies, find insignificant effects of deworming on learning specifically and only uncertain evidence on cognition more generally. How could this be?

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Youth Employment in SSAYouth Employment in Sub-Saharan Africa
January 2014 - The report examines obstacles faced by households and firms in meeting the youth employment challenge. It focuses primarily on productivity, in agriculture, in nonfarm household enterprises (HEs), and in the modern wage sector, because productivity is the key to higher earnings as well as to more stable, less vulnerable, livelihoods. To respond to the policy makers' dilemma, the report identifies specific areas where government intervention can reduce those obstacles to productivity for households and firms, leading to brighter employment prospects for youth, their parents, and their own children.

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Risking Your Health: Causes, Consequences, and Interventions to Prevent Risky Behaviors
November 2013 – Individuals all over the worlds engage in behaviors that are risky for their health: smoking, drugs, alcohol, unhealthy food, and risky sexual encounters. They increasingly affect the health of individual and their populations. This report examines the causes, consequences and interventions to prevent these growing threats.

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The Elderly and Old Age in Rural ChinaThe Elderly and Old Age Support in Rural China
March 2012 - This book examines projected demographic changes that will affect the economic well-being of China’s rural elderly over the next 20 years, taking into account both China’s sharp demographic transition and the continued migration of young adults to cities. The projected old age dependency ratio of 34 percent in China’s rural areas by 2030 suggests that support of the elderly is likely to be an increasing burden on China’s families.

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Quality and accountability in healthcare delivery: audit evidence from primary care providers in India
Jishn Das, Alaka Holla, Aakash Mohpal, Karthik Muralidharan
This paper presents direct evidence on the quality of health care in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly representative sample of rural public and private primary care providers in the Indian state of Madhya Pradesh. Three main findings are reported. First, private providers are mostly unqualified, but they spent more time with patients and completed more items on a checklist of essential history and examination items than public providers, while being no different in their diagnostic and treatment accuracy.
Working Paper 7334, June 2015

Women left behind? poverty and headship in Africa
Annamaria Milazzo and Dominique van de Walle
This paper is motivated by two stylized facts about poverty in Africa: female-headed households tend to be poorer, and poverty has been falling in the aggregate since the 1990s. These facts raise two questions: How have female-headed households fared? And what role have they played in Africa's impressive recent aggregate growth and poverty reduction? Using data covering the entire region, the paper reexamines the current prevalence and characteristics of female-headed households, and asks whether their prevalence has been rising over time, what factors have been associated with such changes since the mid-1990s, and whether poverty has fallen equi-proportionately for male- and female-headed households. Rising gross domestic product has dampened rising female headship.
Working Paper 7331, June 2015

Unbundling institutions for external finance: worldwide firm-level evidence
Stephen Knack Xu and L. Colin Xu
The empirical literature on institutions and development has been challenged on grounds of reverse causality, measurement error in institutional indicators, and heterogeneity. This paper uses firm-level data across countries to confront these challenges. Instead of analyzing ultimate outcomes, such as income levels where institutional quality is likely endogenous, the focus is on firm-level external finance. Moreover, institutions are “unbundled” to explore how various types of institutions affect external finance differently. The paper documents that micro firms have significantly less access to external finance than small and medium firms.
Working Paper 7287, June 2015

Delivering education: a pragmatic framework for improving education in low-income countries
Tahir Andrabi, Jishnu Das, Asim Ijaz Khwaja
Even as primary-school enrollments have increased in most low-income countries, levels of learning remain low and highly unequal. Responding to greater parental demand for quality, low-cost private schools have emerged as one of the fastest growing schooling options, challenging the monopoly of state-provided education and broadening the set of educational providers. Historically, the rise of private schooling is always deeply intertwined with debates around who chooses what schooling is about and who represents the interests of children. This time is no different. But rather than first resolve the question of how child welfare is to be adjudicated, this paper argues instead for a `pragmatic framework’. In this pragmatic framework, policy takes into account the full schooling environment—which includes public, private and other types of providers—and is actively concerned with first alleviating constraints that prohibit parents and schools from fulfilling their own stated objectives.
Working Paper 7277, May 2015


Publications (2008-2015)

Boogle map of the countries covered by selected research
The map shows research on human development by research department staff, 2008-2015.


Research Manager

Adam Wagstaff
Adam Wagstaff

Last updated: 2015-09-24

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