Click here for search results

Health and Nutrition

The research program on health examines measures of health and nutrition outcomes and how these relate broadly to poverty reduction and development.

It also examines issues related to health and nutrition services in developing countries and the complex motivations, multiple tasks, and various stakeholders that drive different delivery systems. Analyses combine new types of data collected through clinic surveys, with data from household surveys, in order to explore key relationships of accountability in delivery systems, explain performance and outcomes, and evaluate interventions for impact.

Research Programs | Related Resources | Publications

Health and Poverty

Health Financing and Delivery

Articles & Briefs

Exploring New Policy Questions in HIV/AIDS Treatment
Featured Article 2008

Missing in Action: Teacher and Medical Provider Absence in Developing Countries 
Featured Article 

Cushioning the Effects of Health Shocks on Households 
Research Brief 

Investing in Early Childhood Development 
Research Brief 2006

A New Look at Quality of Medical Care in Low-Income Countries 
Research Brief 2006 

More articles/briefs

Are You Being Served? New Tools for Measuring Service Delivery (2008)
Order book  Download book 


Analyzing Health Equity Using Household Survey Data (2007)
Order book 
Download book 

Health and Poverty
Contact: Adam Wagstaff (

Improving the health of the poor and protecting people from the impoverishing effects of illness are the two overarching goals of the World Bank’s health sector strategy. This research program has focused on the development of methods to monitor progress toward these objectives, understand the causes of gaps in health outcomes in the health sector, and evaluate the impacts of programs geared towards reducing gaps or reducing the impoverishing effects of illness.  

The program has also involved studies examining the targeting and impacts of health programs, and of the design of policies to reduce inequalities in the health sector.  

Researchers: Adam Wagstaff, Davidson Gwatkin, Magnus Lindelow, and Abdo Yazbeck (World Bank), Eddy van Doorslaer (Erasmus University, Rotterdam), and Owen O’Donnell (University of Thessaloniki, Greece), and Damien de Walque. 

Analyzing Health Equity Using Household Survey Data
Contact:Adam Wagstaff ( 

This work has focused on disseminating techniques used to analyze the health sector from an equity standpoint. The book, Analyzing Health EquityUsing Household Survey Data (2007) provides researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity.   It is hoped the book will stimulate analysis in the field of health equity, especially in developing countries, where more comprehensive monitoring of trends in health equity are needed to better understand the causes of these inequities, to evaluate the impacts of development programs on health equity, and to design more effective policies and programs to reduce inequities in the health sector.

Each chapterincludes examples and computer code to guide easy-to-implement computer routines; presents the relevant concepts and methods, with the help of charts and equations, as well as a worked example using real data, and the necessary computer code for the computer program STATA; and contains a bibliography listing the key articles in the field, further reading and Internet links to useful Web sites.

The target audience comprises researchers and analysts. The volume will be especially useful to those working on health equity issues. But because many chapters cover more general issues in the analysis of health data from household surveys, the volume may prove valuable to others too. Most chapters—originally written as technical notes downloadable from the World Bank's Poverty & Health ( have proved popular with government officials, academic researchers, graduate students, NGOs, and international organization staff, including Bank staff in operations. They have also been used in training exercises run by the Bank and universities.  The technical notes were all extensively revised for the book in the light of this 'market testing'. By collecting these revised notes in the form of a book, we hope to increase their use and usefulness, and encourage further empirical work on health equity.


Country Data on Inequalities in Health
Contact:Adam Wagstaff ( 

Comparing inequalities in health, nutrition and population across countries and tracking inequalities over time are key to better understanding health equity and to monitoring trends in equity over time. For these exercises, comparable data are required for different countries at different points in time. Data from the Demographic and Health Survey have been disaggregated by wealth quintile and are downloadable from the internet free of charge.

In 2000, reports were issued on health, nutrition, and population (HNP) conditions among the poor and better off in 45 low- and middle-income countries. The reports were based on household data gathered through the Demographic and Health Survey (DHS) program, and show for each wealth quintile in each country the average values of a variety of health sector indicators. The datasheets include summary measures of inequality

A second round of reports prepared more recently covers 34 DHS country surveys undertaken since the initial round, and also provides expanded tabulations of data from the 45 DHS surveys covered in the earlier round. The resulting reports cover all 78 DHS surveys undertaken in 56 countries between approximately 1990 and 2002; and provide data concerning up to 117 HNP and related household indicators in each survey.Country reports available here.


Early Childhood Development
Contact:Harold Alderman ( and Elizabeth M. King ( 

The economic returns to improving cognitive development of preschool children in developed countries have been shown to be long lasting and in many cases, far exceed the costs. This work examines interventions to achieve a significant improvements in the potential of young children in developing countries.

  • Alderman, Harold. 2007. "Improving Nutrition through Community Growth Promotion: Longitudinal Study of Nutrition and Early Child Development Program in Uganda." World Development 35(8): 1376-89.
  • Alderman, Harold, Jere R. Behrman, and John Hoddinott. 2007. "Economic and Nutritional Analyses Offer Substantial Synergies for Understanding Human Nutrition." Journal of Nutrition 137: 537-544.
  • Behrman, Jere R., Yingmei, Cheng and Petra E Todd. 2004. "Evaluating Preschool Programs when Length of Exposure to the Program Varies: A Nonparametric Approach." Review of Economics and Statistics 86(1): 108-32.
  • Ghuman, Sharon, Jere R. Behrman, Socorro Gultiano, Graeme Armecin, Isabelita Bas, Paulita Duazo, Elizabeth M. King, and Nanette Lee. 2006. "Early childhood development: A review of findings from a longitudinal study in the Philippines." East Asian Economic Perspectives 17(2): 1-24.
  • Ghuman, Sharon, Jere Behrman, Judith Borja, Socorro Gultiano, and Elizabeth M. King. 2005. "Family Background, Service Providers, and Early Childhood Development in the Philippines: Proxies and Interactions." Economic Development and Cultural Change 54(1): 129-164. 
  • Graeme, Armecin, Jere Behrman, Paulita Duazo, Sharon Ghuman, Socorro Gultiano, Elizabeth M. King, and Nanette Lee. 2006. "Early Childhood Development through an Integrated Program: Evidence from the Philippines." World Bank Policy Research Working Paper 3922.

Measurement of Health Equity
Contact:Adam Wagstaff ( )

This work involves developing methods to measure and analyze equity in the health sector, with a view to monitoring trends over time, comparing equity across countries, understanding the causes of inequality, and analyzing the impacts of programs on equity in the health sector. The work covers health outcomes, health care utilization, and the finance of health care.  

Health sector inequalities

  • Kakwani, N., and  A. Wagstaff, E. van Doorslaer. 1997. “Socioeconomic inequalities in health: Measurement, computation and statistical inference.” Journal of Econometrics 77(1): 87-104.
  • Wagstaff, A. 2000.  “Socioeconomic inequalities in child mortality: Comparisons across nine developing countries. Bulletin of the World Health Organization 78(1): 19-29.
  • Wagstaff, A. 2002. “Inequality aversion, health inequalities, and health achievement.” Journal of Health Economics 21(4): 627–641.
  • Wagstaff, A., and N. Watanabe. 2003. “What difference does the choice of SES make in health inequality measurement?” Health Econ 12(10): 885-90.
  • Wagstaff, A. 2003. “Child health on a dollar a day: some tentative cross-country comparisons.” Soc Sci Med 57(9):1529-38.
  • Wagstaff, A., and E. van Doorslaer. 2004. “Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations.” Health Econ 13(3): 297-301.
  • Wagstaff, A. 2005. “The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality.” Health Econ 14(4): 429-32.
Decomposition of health sector inequalities
  • Wagstaff, A., and E. van Doorslaer, N. Watanabe. 2003. “On decomposing the causes of health sector inequalities, with an application to malnutrition inequalities in Vietnam.” Journal of Econometrics 112(1): 207-223.
  • Wagstaff, A. 2005. “Inequality decomposition and geographic targeting with applications to China and Vietnam.” Health Econ 14(6): 649-53.
  • Wagstaff A., and N. N. Nguyen. 2003. “Poverty and survival prospects of Vietnamese children under Doi Moi.” In Economic Growth, Poverty and Household Welfare: Policy Lessons from Vietnam, eds., P. Glewwe, N. Agrawal, D. Dollar. Washington DC: World Bank.
  • O' Donnell, O, E. van Doorslaer, and A. Wagstaff. 2006. “Decomposition of inequalities in health and health care.”  In The Elgar Companion to Health Economics, ed. A.M. Jones. Cheltenham: Edward Elgar, 2006.

Measurement of equity in health finance

  • Wagstaff, A., and E. van Doorslaer. 2003. “Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998.” Health Econ 12(11): 921-34.
  • Wagstaff, A. 2002. “Reflections on and alternatives to WHO's fairness of financial contribution index.” Health Econ 11(2): 103-15.
  • Wagstaff, A., and M. Lindelow. Forthcoming. “Progressivity in the financing of decentralized government health programs: a decomposition.” Health Economics.

Policy Aspects of Health and Poverty
Contact: Adam Wagstaff (

What are the causes of health sector inequalities? How can policies reduce inequalities? What can international organizations do to reduce them? These are the broad questions addressed in this policy part of the research program. Some of the research focuses specifically on inequalities in child health. Some of the research focuses on a specific country.

  • Wagstaff, A. 2001. “Economics, health and development: Some ethical dilemmas facing the World Bank and the international community.” Journal of Medical Ethics 27(4): 262-267.
  • Claeson, M, C.G. Griffin, T. Johnston, M. McLachlan, A. Soucat, A. Wagstaff, A. Yazbeck. 2002. “Health, Nutrition and Population.” In: A Sourcebook for Poverty Reduction Strategies, ed. J. Klugman. Washington, DC: World Bank.
  • Wagstaff, A. 2002. “Poverty and health sector inequalities.” Bulletin of the World Health Organization 80(2): 97-105.
  • Wagstaff, A. 2002. “Pobreza y desigualdades en el sector de la salud.” Rev Panam Salud Publica 11(5-6): 316-26.
  • Wagstaff, A. 2002. “Inequalities in health in developing countries: Swimming against the tide?” World Bank Policy Research Working Paper 2795.
  • Peters, D.H., A.S. Yazbeck, R. Sharma, G. Ramana, L. H. Pritchett, A. Wagstaff. 2002. Better Health Systems for India's Poor: Findings, Analysis and Options. Washington DC: World Bank.
  • Victora, C.G., A. Wagstaff, J.A. Schellenberg, D. Gwatkin, M. Claeson, J.P. Habicht. 2003. “Applying an equity lens to child health and mortality: more of the same is not enough.” Lancet 362(9379): 233-41.
  • Wagstaff, A., F. Bustreo, J. Bryce, M. Claeson. 2004. “Child health: reaching the poor.” Am J Public Health 94(5): 726-36.

Targeting and Impacts among the Poor of Health Programs
Contact: Adam Wagstaff (

Do health programs reach the poor? And if they do, do they have the intended impact on utilization and health outcomes? This research looks at the targeting of health programs, and at the extent to which programs have a similar impact on the poor and better-off.

Reaching the Poor with Health, Nutrition, and Population Services reports the results of a number of studies undertaken by non-Bank researchers, funded through a competitive tender process managed by the World Bank. The studies document the extent to which health services reach the poor, how changes in policies and programs improved the distribution, and why. The volume is downloadable in full here.

A variety of impact evaluations of health sector policies have also been undertaken within this research program, examining the targeting of specific programs and their impact among the poor and better-off. These include so far: the World Bank’s Health VIII project in China, Vietnam’s health fund for the poor, and China’s new rural health insurance program—the new cooperative medical scheme.

  • de Walgue, Damien. 2007. "Does education affect smoking behaviors? Evidence using the Vietnam draft as an instrument for college education." Journal of Health Economics 26: 877-95.
  • Wagstaff, A.,  and S. Yu. 2007. “Do health sector reforms have their intended impacts? The World Bank's Health VIII project in Gansu province, China.” Journal of Health Economics 26(3): 535 .
  • Wagstaff, A. 2007. “Health insurance for the poor: initial impacts of Vietnam's health care fund for the poor.” World Bank Policy Research Working Paper 4134.
  • Wagstaff, A., M. Lindelow, G. Jun, X. Ling, and Q. Juncheng. 2007. “Extending health insurance to the rural population: an impact evaluation of China's new cooperative medical scheme.” World Bank Policy Research Working Paper 4150.


Health Financing and Delivery

Absenteeism of Teachers and Health Workers
:  F. Halsey Rogers (

This multi-country study assesses absenteeism using a variant of the Qualitative Service Delivery Survey in which surprise visits are carried out in primary schools and health clinics. These surveys combine direct verification of the attendance of teachers and medical personnel with detailed data gathering on facility and provider characteristics.

This work began as part of the Making Services Work for the Poor: World Development Report (2004) and have been done in Bangladesh (where results have already drawn a lot of attention), Ecuador, India (20 separate states), Indonesia, Peru, and Uganda. Beyond documenting the extent and patterns of teacher absenteeism, the study explores provider and institutional factors that shape absenteeism patterns and the impact of teacher absenteeism on student performance.

Health Finance and Delivery in East Asia
Contact: Adam Wagstaff (

This research program explores a broad range of issues in relation to the financing and delivery of health services, especially in East Asia. The issues include health insurance, especially social health insurance, the ways households cope with health shocks, the organization and payment of providers, and the role and impacts of programs, including World Bank projects in the health sector .

Researchers: Adam Wagstaff, Magnus Lindelow (World Bank)    Health Finance and Delivery in China   China’s health system—once widely admired by health specialists the world over—has lagged other sectors in the reform process. It is now widely agreed to be in need of modernizing. This research examines the situation vis-à-vis health providers, the impacts of several recent reforms (including the urban and rural health insurance schemes, as well as reforms introduced through the World Bank’s Health VIII project), and explores reform options for the future .

  • Wagstaff, A., and S. Yu. 2007. “Do health sector reforms have their intended impacts?: The World Bank's Health VIII project in Gansu province, China.” Journal of Health Economics 26(3): 535.
  • Leung, G.M., A. Wagstaff, M. Lindelow, and J.R. Lu. Forthcoming. “The health systems of China, Hong Kong and Taiwan.” In Encyclopedia of Public Health, ed. K. Heggenhougen. Amsterdam: North Holland.
  • Wagstaff, A., M. Lindelow, G. Jun, X. Ling, Q. Juncheng. 2007. “Extending health insurance to the rural population : an impact evaluation of China ' s new cooperative medical scheme.” World Bank Policy Research Working Paper 4150.
  • Wagstaff, A., and M. Lindelow. 2007. “Health reform in China: Where next?”  In China: Public Finance for a Harmonious Society, eds., L. Jiwei and W. Shuilin. Washington DC: World Bank.
  • Eggleston, K, Li Ling, Q. Meng, M. Lindelow, and A. Wagstaff. 2006. “Health service delivery in China: a literature review.” World Bank Policy Research Working Paper  3978.
  • Wagstaff, A., and M. Lindelow. 2005. “Can insurance increase financial risk? The curious case of health insurance in China.” World Bank  Policy Research Working Paper  3741.
  • Lindelow, M., and A. Wagstaff. 2005. “Health shocks in China : are the poor and uninsured less protected?” World Bank Policy Research Working Paper  3740.

Health Finance and Delivery in Vietnam
Vietnam’s health system continues to rely heavily on out-of-pocket payments prompting concerns about financial risk and health inequalities. This research examines financial protection and inequality in Vietnam’s health system and the impacts of programs on these goals.

  • Wagstaff, A., and E. van Doorslaer. 2003. “Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998.” Health Econ 12(11): 921-34.
  • Wagstaff, A. 2007. “The economic consequences of health shocks: Evidence from Vietnam.” J Health Econ 26(1): 82-100.
  • Wagstaff, A. 2007. “Health insurance for the poor: initial impacts of Vietnam's health care fund for the poor.”  World Bank Policy Research Working Paper  4134.
  • Wagstaff, A., and M. Pradhan. 2005. “Health insurance impacts on health and nonmedical consumption in a developing country.” World Bank Policy Research Working Paper  3563. 
  • Wagstaff, A., and E. van Doorslaer, and N. Watanabe. 2003. “On decomposing the causes of health sector inequalities, with an application to malnutrition inequalities in Vietnam.” Journal of Econometrics 112(1): 207-223.
  • Wagstaff, A. 2005. “Inequality decomposition and geographic targeting with applications to China and Vietnam.” Health Econ 14(6): 649-53.
  • Wagstaff, A., N.N. Nguyen. 2003. “Poverty and survival prospects of Vietnamese children under Doi Moi.”  In Economic Growth, Poverty and Household Welfare: Policy Lessons from Vietnam, eds., P. Glewwe, N. Agrawal, and D. Dollar. Washington DC: World Bank.

Cross-Cutting Health System Reform Issues
Contact: Adam Wagstaff (

Health systems the world over—not just in East Asia—face similar challenges: how to improve health outcomes for everyone and how to provide financial protection against the risk associated with illness. Their policy instruments are also largely the same: health insurance, different ways of paying providers, changes to the way providers are organized, and so on. This research looks at a variety of cross-cutting issues, and attempts to see what lessons can be learned.

  • Wagstaff, A. 2007. “Health systems in East Asia: what can developing countries learn from Japan and the Asian Tigers?” Health Economics 16(5): 441-456.
  • Wagstaff, A. 2007. “Social health insurance reexamined.” World Bank Policy Research Working Paper  4111. ( Available in Russian)

Public Health Systems and Communicable Disease Control
Contact: Monica Das Gupta (

Public health services are conceptually distinct from medical services.  They have as a key goal reducing a population’s exposure to disease caused, for example, by vectors and unsanitary environments.  Thus they involve such disparate activities as assuring food safety and other health regulations; monitoring waste disposal and water systems; improving slaughterhouse hygiene and cattle-keeping practices; cleaning irrigation canals to discourage vector breeding; and advocacy to improve personal health behaviors and build citizen demand for better public health outcomes.

Yet donor interventions have largely focused on the provision of curative care and personal prophylactic interventions such as immunization — since these lie within the direct purview of the health sector and are easy to design and monitor. This is inadequate for dealing with many major diseases, such as malaria and diarrheal diseases. The recent outbreaks of avian flu highlight the need for a broader range of measures for protecting public health. This research program seeks to help fill the gap in our understanding of how to design effective public health systems. 


  • Das Gupta, Monica and Manju Rani, forthcoming. "How well does India’s federal government perform its essential public health functions?”, Health Policy. Also published as DEC Working Paper 3447, Nov. 2004. 
  • Das Gupta, Monica, Emily Mok, Lawrence Gostin, and Max Levin. Fall 2010. “Implementing Public Health Regulations in Developing Countries: Lessons from the OECD Countries” , Journal of Law, Medicine, and Ethics 38(3): 508- 519. 
  • Das Gupta, Monica, Radu Ban and Vijayendra Rao, April 2010. “The Political Economy of Village Sanitation in South India: Capture or Poor Information?”, Journal of Development Studies 46(4): 685-700. Also published as World Bank Policy Research Working Paper 4802, Dec 2008.
  • Das Gupta, Monica, B.R. Desikachari, Rajendra Shukla, T.V. Somanathan, P. Padmanaban, and K.K. Datt.  March 2010. “How Might India’s Public Health Systems Be Strengthened?: lessons from Tamil Nadu”, Economic and Political Weekly 45(10): 46-60. Also published as World Bank Policy Research Working Papers # 5073, October 2009  and # 5140, November 2009. 
  • Das Gupta, Monica, and Lawrence Gostin. April 2009. “Building Global Public Goods in Health: The roles of Donors and International Agencies” The Lancet 373: 1395-7. Also published as Policy Research Working Paper 4907.
  • Das Gupta, Monica, Ghazala Mansuri, Nistha Sinha, and Tara Vishwanath, forthcoming. “Overcoming women’s constraints to accessing health services in Pakistan: the potential of media and field outreach programs”, in Sonalde Desai and Simeen Mahmud (eds.) Gender and Access in South Asia  .
  • Das Gupta, Monica, and Manju Rani, forthcoming. “How well does India’s federal government perform its essential public health functions?”, Health Policy.
  • Das Gupta, Monica, 2007. “Public Health in India”, in Kaushik Basu (ed.) Oxford Companion to Economics in India, Oxford University Press, 2007. Also published as Washington DC: The World Bank Policy Research Working Paper No. 3787.
  • Das Gupta, Monica, Michele Gragnolati, Caryn Bredenkamp, Yi-Kyoung Lee, and Meera Shekar,  2006. “ICDS and Persistent Undernutrition: Strategies to Enhance the Impact” Economic and Political Weekly,  1193-1201, 25 March. 
  • Das Gupta, Monica, 2005.“Public Health in India: dangerous neglect”, Economic and Political Weekly 40(49): 5159-65, Dec 3. 
  • Das Gupta, Monica, Michael Lokshin, Michele Gragnolati, and Oleksiy Ivaschenko, 2005. “Improving child nutrition ?: the Integrated Child Development Services in India”, Development and Change, 36(4): 613-640.
  • Das Gupta, Monica, and Peyvand Khaleghian, 2005,“Public Management and the Essential Public Health Functions” World Development 33 (7): 1083-1099.
  • Das Gupta, Monica, Peyvand Khaleghian, and  Rakesh Sarwal 2003. “Governance of communicable disease control services: a case study and lessons from India”, Washington DC: The World Bank Policy Research Working Paper No. 3100.


Quality of Medical Care in Public and Private Sectors
Contact: Jishnu Das (

A team of researchers is taking a supply side approach, using new survey techniques, to look at the role of the medical system (and more specifically, medical providers) in health outcomes in a number of developing countries.More>>

 Related Resources


A list of publications (by year) for this unit is available here.

Policy Research Working Papers on Health
(Please use the free Adobe Acrobat Reader to view PDF PDF files)
The following policy research working papers are drawn from the World Bank's institutional archives. Each link opens a page with an abstract of the document and several download options.

Last updated: 2012-03-06


WPS6446Conducting ethical economic research: complications from the fieldAlderman, Harold; Das, Jishnu; Rao, Vijayendra2013/05
WPS6423Building or bypassing recipient country systems : are donors defying the Paris declaration ?Knack, Stephen2013/04
WPS6364Using provider performance incentives to increase HIV testing and counseling services in Rwandade Walque, Damien; Gertler, Paul J; Bautista-Arredondo, Sergio; Kwan, Ada; Vermeersch, Christel; de Dieu Bizimana, Jean; Binagwaho, Agnes; Condo, Jeanine2013/02
WPS6339Buying votes vs. supplying public services : political incentives to under-invest in pro-poor policiesKhemani, Stuti2013/01
WPS6343How subjective beliefs about HIV infection affect life-cycle fertility : evidence from rural MalawiShapira, Gil2013/01

Permanent URL for this page:

© 2016 The World Bank Group, All Rights Reserved. Legal