MDGs That Nudge: The Millennium Development Goals, Popular Mobilization, and the Post-2015 Development Framework
November 2012 - The Millennium Development Goals, which expire in 2015, were a global agreement to promote human development and reduce poverty. But they did not create a legalized institutional regime, in which precise obligations would be delegated to specific actors, nor were they, in many respects, compatible with the incentives of the countries whose heads of state endorsed them. They most resembled international human rights treaties, which are also not legally coercive, and which achieve their effects largely through their role in social and political mobilization. But unlike human rights treaties, the Millennium Development Goals' targets and goals were not psychologically, morally, and politically salient.
Working Paper 6282
Perils of simulation: parallel streams and the case of stata's rnormal command
November 2012 - Large-scale simulation-based studies rely on at least three properties of pseudorandom number sequences: they behave in many ways like truly random numbers; they can be replicated; and they can be generated in parallel. There has been some divergence, however, between empirical techniques employing random numbers, and the standard battery of tests used to validate them. A random number generator that passes tests for any single stream of random numbers may fail the same tests when it is used to generate multiple streams in parallel. The lack of systematic testing of parallel streams leaves statistical software with important potential vulnerabilities. This paper shows one such vulnerability in Stata's rnormal function that went unnoticed for almost four years, and how to detect it. It then shows practical implications for the use of parallel streams in existing software.
Working Papaer 6278
Evaluating Workfare When the Work Is Unpleasant:Evidence for India’s National Rural Employment Guarantee Scheme
November 2012 - Prevailing practices in evaluating workfare programs have ignored the disutility of the type of work done, with theoretically ambiguous implications for the impacts on poverty. In the case of India's National Rural Employment Guarantee Scheme, past assessments have relied solely on household consumption per person as the measure of economic welfare.
Working Paper 6272
Handwashing Behavior Change at Scale: Evidence from a Randomized Evaluation in Vietnam
September 2012 - Handwashing with soap campaigns are de rigueur in developing countries, but little is known about their effectiveness. This paper evaluates a large-scale handwashing campaign in three provinces of Vietnam in 2010. Exposure to the campaign resulted in a slight increase in the availability of handwashing materials in the household, and caregivers in the treatment group were more likely to report washing hands at some of the times emphasized by the campaign. However, no differences were found between the treatment and control groups in actual handwashing with soap, the average level of which remains very low.
Working Paper 6207
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Adam Wagstaff. Where in the world is a hospitalization least affordable?
December 2012 - In the developing world, a hospitalization is one of the things that families – especially poor ones – fear most. This came through in country after country in the World Bank’s Voices of the Poor exercise. Here are just some examples: A man from Ghana is quoted as saying: “Take the death of this small boy this morning, for example. The boy died of measles. We all know he could have been cured at the hospital. But the parents had no money and so the boy died a slow and painful death, not of measles, but out of poverty.”
Adam Wagstaff. Shocking facts about primary health care in India, and their implications
December 2012 - There’s nothing quite like a cold shower of shocking statistics to get you thinking. A paper that came out in Health Affairs today, written by my colleague Jishnu Das and his collaborators, is just such a cold shower.
Owen Ozier. Microfranchising in Nairobi hits the BBC
November 2012 - This week, the BBC and the International Rescue Committee blog both featured a project that I am evaluating together with coauthors Maddalena Honorati and Pamela Jakiela. IRC approached us because they were interested in conducting a rigorous impact evaluation of their project.
Adam Wagstaff. When the snow fell on health systems research: a symposium sketch
November 2012 - It was the perfect finale. In the vast high-tech auditorium of Beijing's International Convention Center, the audience jostled in the queue to pose questions to the final plenary panel of the Second Global Symposium on Health Systems Research.
Adam Wagstaff. How can health systems “systematic reviews” actually become systematic?
October 2012 - In my post “Should you trust a medical journal?” I think I might have been a bit unfair. Not on The Lancet, which I have since discovered, via comments on David Roodman’s blog, has something of a track record of publishing sensational but not exactly evidence-based social science articles, but rather on Ernst Spaan et al. for challenging the systematicness of their systematic review of health insurance impacts in developing countries.
Shanta Devarajan and Jishnu Das. Improving access to drugs: Fitting the solution to the problem
October 2012 - Patricio Marquez’s post correctly identifies lack of access to quality medicines as one of the constraints to poor people’s health in Africa. But the solutions he recommends—more public money for “essential drugs benefits”, building resilient institutions, and providing physicians with better scientific information and guidelines about drug prescriptions—are unlikely by themselves to improve poor people’s health outcomes.
Previous Blogs & Research Briefs
Krishnan, S., D. Vohra, et al. (2012). "Tanzanian Couples’ Perspectives on Gender Equity, Relationship Power, and Intimate Partner Violence: Findings from the RESPECT Study." AIDS Research and Treatment, 2012.
Intimate partner violence (IPV) is widely prevalent in Tanzania. Inequitable gender norms manifest in men’s and women’s attitudes about power and decision making in intimate relationships and are likely to play an important role in determining the prevalence of IPV. We used data from the RESPECT study, a randomized controlled trial that evaluated an intervention to prevent sexually transmitted infections in a cohort of young Tanzanian men and women, to examine the relationship between couples’ attitudes about IPV, relationship power, and sexual decision making, concordance on these issues, and women’s reports of IPV over 12 months. Women expressed less equitable attitudes than men at baseline...
Das, J., A. Holla, et al. (2012). "In Urban And Rural India, A Standardized Patient Study Showed Low Levels Of Provider Training And Huge Quality Gaps." Health Affairs 31(12): 2774-2784.
This article reports on the quality of care delivered by private and public providers of primary health care services in rural and urban India. To measure quality, the study used standardized patients recruited from the local community and trained to present consistent cases of illness to providers. We found low overall levels of medical training among health care providers; in rural Madhya Pradesh, for example, 67 percent of health care providers who were sampled reported no medical qualifications at all. What’s more, we found only small differences between trained and untrained doctors in such areas as adherence to clinical checklists. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics...
Chiburis, R. C., J. Das, et al. (2012). "A practical comparison of the bivariate probit and linear IV estimators." Economics Letters 117(3): 762-766.
This paper compares asymptotic and finite sample properties of linear IV and bivariate probit in models with an endogenous binary treatment and binary outcome. The results provide guidance on the choice of model specification and help to explain large differences in the estimates depending on the specification chosen...
Filmer, D. and K. Scott (2012). "Assessing asset indices." Demography 49(1): 359-392.
The use of asset indices in welfare analysis and poverty targeting is increasing, especially in cases in which data on expenditures are unavailable or hard to collect. We compare alternative approaches to welfare measurement. Our analysis shows that inferences about inequalities in education, health care use, fertility, and child mortality, as well as labor market outcomes, are quite robust to the economic status measure used. Different measures—most significantly per capita expenditures versus the class of asset indices—do not, however, yield identical household rankings. Two factors stand out in predicting the degree of congruence in rankings. First is the extent to which expenditures can be explained by observed household and community characteristics...
Previous Journal Articles
Localizing Development: Does Participation Work?
November 2012 - The Policy Research Report Localizing Development: Does Participation Work? brings analytical rigor to a field that has been the subject of intense debate and advocacy, and billions of dollars in development aid. It briefly reviews the history of participatory development and argues that its two modalities, community-based development and local decentralization, should be treated under the broader unifying umbrella of local development. It suggests that a distinction between organic participation (endogenous efforts by civic activists to bring about change) and induced participation (large-scale efforts to engineer participation at the local level via projects) is key, and focuses on the challenges of inducing participation.
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The Elderly and Old Age Support in Rural China. Directions in Development Series
March 2012 - The Elderly and Old Age Support in Rural China 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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Health Equity and Financial Protection: Streamlined Analysis with ADePT Software
May 2011 - ADePT Health is a free-standing computer program that allows users to produce quickly - and with the minimal risk of errors - most tables that have become standard in applied health and equity analysis. ADePT produces summary statistics and charts that allow inequalities to be compared across countries and over time. This manual explains the methods ADePT uses, how to prepare data for it, how to navigate the ADePT interface to generate the desired tables and charts, and how to interpret them.
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Making Schools Work: New Evidence on Accountability Reforms
February 2011 - This book is about the threats to education quality in the developing world that cannot be explained by lack of resources. It reviews the observed phenomenon of service delivery failures in public education: cases where programs and policies increase the inputs to education but do not produce effective services where it counts – in schools and classrooms. It documents what we know about the extent and costs of such failures across low and middle-income countries. And it further develops the conceptual model posited in the World Development Report 2004: that a root cause of low-quality and inequitable public services – not only in education—is the weak accountability of providers to both their supervisors and clients.
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