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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 »


Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru
Sven Neelsen and Owen O'Donnell
Health Economics, February 2017.
Like other countries seeking a progressive path to universalism, Peru has attempted to reduce inequalities in access to health care by granting the poor entitlement to tax-financed basic care without charge. We identify the impact of this policy by comparing the target population's change in health care utilization with that of poor adults already covered through employment-based insurance. There are positive effects on receipt of ambulatory care and medication that are largest among the elderly and the poorest. The probability of getting formal health care when sick is increased by almost two fifths, but the likelihood of being unable to afford treatment is reduced by more than a quarter. Consistent with the shallow coverage offered, there is no impact on use of inpatient care. Neither is there any effect on average out-of-pocket health care expenditure, but medical spending is reduced by up to 25% in the top quarter of the distribution.

Mutual HIV status disclosure is associated with consistent condom use in public sector ART clients in Free State province, South Africa: A short report
Frederik le Roux Booysen,, Edwin Wouters, Damien de Walque, and Mead Over
AIDS Care 1-5, February 2017.
Risky sexual behaviour in PLWHA on antiretroviral therapy threatens both prevention and treatment efforts, but disclosure promises to support safer sexual practices. This paper investigates the association between HIV self-disclosure and consistent condom use in a cohort of public sector patients on antiretroviral (ARV) treatment. Using data from the FEATS cohort study, logistic regression analysis shows that knowledge of your partner’s HIV status is positively associated with consistent condom use (OR 2.73, 95% CI 1.37–5.43, p = 0.004) and so too mutual HIV disclosure (OR 3.38, 95% CI 1.60–7.18, p = 0.001). Prevention and treatment programmes, through couple HIV counselling and testing (CHCT) and other assistance programmes, should focus on supporting the mutual disclosure of HIV status among PLWHA on ARV treatment.

Commentary: Fixed effects and risks of miscommunication: A comment on Jullien, Sinclair and Garner
Owen Ozier
Int J Epidemiol., January 2017.
Jullien et al. (henceforth, JSG) frame their manuscript as an appraisal of all long-term follow-up studies of mass deworming. This is a welcome and important undertaking. It becomes another exercise, however, when the search criteria reveal that the only such studies are those written by social scientists rather than public health or medical researchers. The result is an examination of the work of social scientists by public health researchers. This examination includes my own work (Ozier 2016), which JSG discuss in some detail.2 Because it is under revision with a peer-reviewed journal, my draft manuscript has benefited from our correspondence. Nonetheless, some details of Ozier 2016 are misrepresented in the JSG discussion, exemplifying the pitfalls that may complicate such interdisciplinary exchange. The main critiques JSG present of Ozier 2016 are inaccurate, as I discuss below. Thus, JSG's conclusion that Ozier 2016 is ‘at risk of substantial methodological bias’ is incorrect.

China’s Rural Poor Bear the Brunt of the Nation’s Aging Crisis: If we can stand the pain, we don’t go to the hospital
Dexter Roberts, January 2017.
Chinese farmers typically toil in the fields past 70, says John Giles, lead economist in the Development Research Group at the World Bank and an expert on aging in China. “This isn’t just puttering around in the garden,” he says. “This is arduous work. And if the elderly have children who have migrated, then they are more likely to be working longer and for more hours.” China’s restrictive residency permit system makes it difficult for the rural elderly to join their children in cities, and their insurance usually doesn’t cover treatment at urban hospitals. Some children are returning home to care for their parents, a move that could hurt economic growth as younger Chinese take less productive work or even leave the workforce, says the World Bank’s Giles. “Later I will have to return to my hometown because my parents are getting older,” says 25-year-old Zhang Chi, who works at a toy factory in Dongguan more than 825 miles from his hometown of Xi’an, in central China. “Working far away, you can only see them infrequently, which isn’t good.


Changes in Poverty and Female-Headed Households in Africa
Annamaria Milazzo and Dominique van de Walle
Research Digest, Summer 2016

Non-monetary indicators of poverty routinely tell us that substantive gaps persist among household members in terms of access to other resources such as schooling services and protection against shocks. Gender and age are arguably key fault lines along which these differences emerge. Yet there are some practical explanations as to why monetary poverty estimates typically don’t distinguish among individuals within households.

Should cash transfers be systematically paid to mothers?
Damien de Walque, July 6, 2016

In policy circles, both in low- and high-income countries, it is often assumed that giving transfers to mothers rather than fathers will lead to better outcomes. This research on the transfer recipient’s gender suggests that the assumption that it is always better to give transfers to the mother should be questioned or at least nuanced.

India’s informal doctors are assets not crooks
Jishnu Das, April 28, 2016

Most of us would agree that when it comes to healthcare providers, some training is better than none. Yet even this seemingly innocuous statement is highly contentious in India, where training primary care providers who lack formal medical qualifications is anathema to the professional medical classes.

Health and the SDGs: Out of the doldrums, heading for the rapids
Adam Wagstaff and Joseph Kutzin, March 23, 2016

Until quite recently, things were looking good for health in the SDG process. It wasn’t always so. Two and a half years ago, at the time of the high-level panel report on the SDGs, the health SDG discussion was actually stuck in the doldrums. Health was the only area to get less column inches than in the MDGs. The proposed goals and targets were pretty much business as usual. The only real hint of any new thinking was the addition of a target to reduce non-communicable diseases, but it was subsumed within an old target and looked very much like an afterthought.

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Conducting Ethical Economic Research: Complications from the Field
April 2016: This chapter in The Oxford Handbook of Professional Economic Ethics discusses practical issues confronted when conducting surveys as well as designing appropriate field trials. First, we look at the challenge of ensuring transparency while maintaining confidentiality. Second, we explore the role of trust in light of asymmetric information held by the surveyor and by the respondents as well as the latter’s expectations as to what their participation will set in motion. We present case studies relevant to both of these issues. Finally, we discuss the role of ethical review from the perspective of research conducted through the World Bank.

Right to Work?Poverty in a Rising Africa: Africa Poverty Report
October 2015: According to latest World Bank estimates, the share of Africans who are poor fell from 56% in 1990 to 43% in 2012. The report argues that the poverty rate may have declined even more if the quality and comparability of the underlying data are taken into consideration. However, because of population growth many more people are poor, the report says. The most optimistic scenario shows about 330 million poor in 2012, up from about 280 million in 1990. Poverty reduction has been slowest in fragile countries, the report notes, and rural areas remain much poorer, although the urban-rural gap has narrowed.

Right to Work?Right to Work? Assessing India's Employment Guarantee Scheme in Bihar
February 2014: India's 2005 National Rural Employment Guarantee Act creates a justiciable "right to work" by promising up to 100 days of wage employment per year to all rural households whose adult members volunteer to do unskilled manual work. Work is provided in public works projects at the stipulated minimum wage. The study finds that the scheme is falling well short of its potential impact on poverty in Bihar. Analysis of the study’s survey data points to a number of reasons. Workers are not getting all the work they want, and they are not getting the full wages due. And participation in the scheme is far from costless to them. Many report that they had to give up some other income-earning activity when they took up work. The unmet demand for work is the single most important policy-relevant factor in accounting for the gap between actual performance and the scheme’s potential impact on poverty.
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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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A poor means test? Econometric targeting in Africa
Caitlin Susan Brown, Martin Ravallion and Dominique van de Walle
Working Paper 7915, December 2016
Proxy-means testing is a popular method of poverty targeting with imperfect information. In a now widely-used version, a regression for log consumption calibrates a proxy-means test score based on chosen covariates, which is then implemented for targeting out-of-sample. In this paper, the performance of various proxy-means testing methods is assessed using data for nine African countries. Standard proxy-means testing helps filter out the nonpoor, but excludes many poor people, thus diminishing the impact on poverty. Some methodological changes perform better, with a poverty-quantile method dominating in most cases. Even so, either a basic-income scheme or transfers using a simple demographic scorecard are found to do as well, or almost as well, in reducing poverty. However, even with a budget sufficient to eliminate poverty with full information, none of these targeting methods brings the poverty rate below about three-quarters of its initial value. The prevailing methods are particularly deficient in reaching the poorest.

If Politics Is the Problem, How Can External Actors Be Part of the Solution?
Shantayanan Devarajan and Stuti Khemani
Working Paper 7761, July 2016
Despite a large body of research and evidence on the policies and institutions needed to generate growth and reduce poverty, many governments fail to adopt these policies or establish the institutions. Research advances since the 1990s have explained this syndrome, which this paper generically calls "government failure," in terms of the incentives facing politicians, and the underlying political institutions that lead to those incentives. Meanwhile, development assistance, which is intended to generate growth and reduce poverty, has hardly changed since the 1950s, when it was thought that the problem was one of market failure.

A Randomized Control Trial of a Peer Adherence and Nutritional Support Program for Public Sector Antiretroviral Patients
Frederik Booysen, Damien de Walque, Mead Over, Satoko Hashimoto, and Chantell de Reuck
Working Paper 7760, July 2016
Access to antiretroviral treatment has expanded rapidly in South Africa, making it the country in the world with the largest treatment program. As antiretroviral treatment coverage continues to rise in resource-constrained settings, effective community-based adherence support interventions are of central importance in ensuring the long-term sustainability of treatment. This paper reports the findings from a randomized control trial of a peer adherence and nutritional support program implemented in a public health care setting in South Africa's antiretroviral treatment program. The analysis assesses the impact of these peer adherence and nutritional support interventions on self-reported adherence, timeliness of clinic and hospital visits, and immunologic response to antiretroviral treatment. Peer adherence and nutritional support improved the timeliness of adults´ clinic and hospital visits for routine follow-up while on antiretroviral treatment.

Impacts of Conditional and Unconditional Cash Transfers Given to Mothers or Fathers
Richard Akresh, Damien de Walque, and Harounan Kazianga
Working Paper 7730, June 2016
This study conducted a randomized control trial in rural Burkina Faso to estimate the impact of alternative cash transfer delivery mechanisms on education, health, and household welfare outcomes. The two-year pilot program randomly distributed cash transfers that were either conditional or unconditional and were given to either mothers or fathers. Conditionality was linked to older children enrolling in school and attending regularly and younger children receiving preventive health check-ups. Compared with the control group, cash transfers improve children's education and health and household socioeconomic conditions. For school enrollment and most child health outcomes, conditional cash transfers outperform unconditional cash transfers. Giving cash to mothers does not lead to significantly better child health or education outcomes, and there is evidence that money given to fathers improves young children's health, particularly during years of poor rainfall. Cash transfers to fathers also yield relatively more household investment in livestock, cash crops, and improved housing.

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Publications (2008-2016)

Google map of the countries covered by selected research
The map shows research on human development by research department staff, 2008-2016.


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