Owen Ozier. Deworming improves child cognition. Eventually
October 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?
Damien de Walque, Martina Björkman Nyqvist and Jakob Svensson. From “Power to the People” to “Information is Power”
October 2014 - Poor quality plagues public service provision in many developing countries. For example, doctors in Tanzania completed less than 25% of the essential checklist for patients with malaria, a disease that is endemic in the country. Indian doctors asked an average of one question per patient (“What’s wrong with you?”). In Uganda, the average absence rate among primary school teachers was 27% and 37% among primary health center staff.
Adam Wagstaff. We just learned a whole lot more about achieving Universal Health Coverage
August 2014 - Subsidized health insurance is unlikely to lead to Universal Health Coverage (UHC); insurance coverage doesn’t always improve financial protection and when it does, doesn’t necessarily eliminate financial protection concerns; and tackling provider incentives may be just as – if not more – important in the UHC agenda as demand-side initiatives. These are the three big and somewhat counterintuitive conclusions of the Health Equity and Financial Protection in Asia (HEFPA) research project that I jointly coordinated with Eddy van Doorslaer and Owen O’Donnell.
Adam Wagstaff and Ravi Kanbur. Inequality of opportunity: the new motherhood and apple pie?
August 2014 - On the face of it, questioning the usefulness of “inequality of opportunity” seems about as wrongheaded as questioning the merits of family vacations, Thanksgiving or dessert trolleys. What’s not to like about it? Well, as we argue in a recent World Bank working paper, the idea is not quite as useful as it might at first glance appear, and is in fact rather dangerous. But turned upside down, it might yet be useful.
Adam Wagstaff and Caryn Bredenkamp. Were the poor left behind by the health MDGs?
July 2014 - Thanks to Thomas Piketty, we’ve heard a lot this year about rising inequality. And with just over a year to go before the MDG ‘window’ closes, we’ve also heard a lot about the ‘post-2015 agenda’. In a paper with Leander Buisman that just came out in the World Bank Research Observer, we bring these two themes together and ask: “Were the poor left behind by the health MDGs?” Influenced perhaps by all the talk of rising income inequality, there are certainly plenty of pessimistic folks out there who think that health inequalities, too, are on the rise; that the better off are likely to have seen much faster improvements in MDG indicators than the poor.
Transactional Sex as Risk-Coping Behavior
Spring/Summer 2014 - Transactional sex rises after shocks, suggesting that access to insurance or savings may have public health implications.
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Damien de Walque. Stratified randomization and the FIFA World Cup
June 2014 - When I start working on a new impact evaluation, I often begin with a workshop in the country where the study will be conducted. The workshop brings together government officials, both at the central level and from the regions and provinces where the intervention will take place, other stakeholders such as NGOs or other UN organizations, and representatives of the research institution that will implement the survey.
Is Workfare Really Cost-Effective?
Winter 2014 - India’s Mahatma Gandhi National Rural Employment Guarantee Scheme, established through a 2005 law, is explicitly aimed at reducing rural poverty.
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Adam Wagstaff. A guide to the top World Bank blogs and blogposts of 2013
December 2013 - In both 2011 and 2012, I did a roundup of the most read 200 World Bank blogposts of the year, and compared the performance of the various World Bank blogs in terms of readership. What did blogging at the World Bank in 2013 look like?
Adam Wagstaff. How and why do countries vary so much in their use of health services?
December 2013 - I’ve been struck recently by how little we (or at least I) seem to know about variations in use of health services across the world, and what drives them. Do people in, say, India or Mali use doctors “a lot” or “a little”. Even harder: do they “overuse” or “underuse” doctors? At least we could say whether doctor utilization rates in these countries are low or high compared to the rate for the developing world as a whole.
Adam Wagstaff. What exactly is the public-private mix in health care?
December 2013 - I’ve been in quite a few meetings recently and read quite a lot of documents where people have made claims about the relative sizes of the public and private sectors in health care delivery. A recent report from the World Bank Group on the private sector in Africa claims that “the private health sector now provides half of all health services in the region.” A document I reviewed recently claimed that “much” of medical care is provided by the private sector – an assertion I hear quite often.
Damien de Walque. Risking Your Health
November 2013 - All over the world, people engage in behaviors that are risky for their health. They smoke, use illicit drugs, drink too much alcohol, eat unhealthy food or adopt sedentary lifestyles, and have risky sexual encounters. As a consequence, they endanger their health, reduce their own life expectancy, and often impose harmful consequences on others.
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Jishnu Das. Is the New York Times Ethicist a Better Economist than…..The Economist?
November 2013 - The Sunday before last I woke up to a couple of articles in the New York Times Magazine and The Economist. In the first article, the New York Times ethicist was asked a question about Halloween candy: Are dentists who purchase candy from kids (thus protecting their teeth) and donate it to poor families engaging in “thoughtless, unethical and unprofessional” behavior?
Adam Wagstaff. The Academic Sting Operation
October 2013 - Nobody likes to be stung. Doctors regard it as unethical. Publishers say it betrays the trust of their profession. But the fact is, as three recent studies have demonstrated, sting operations can be extremely effective at exposing questionable professional practices, and answering questions that other methods can't credibly answer.
Dominique van de Walle. Long Term Impacts of Household Electrification in Rural India
October 2013 - It is estimated that 1.3 billion people in 2009 were still without electricity. Many rural households in the developing world continue to cook with wood and biomass (mainly dung), and spend a lot of time collecting and preparing fuel for domestic use. Across the world, these time (and resulting health) burdens are thought to be higher for women and the children under their care.
Expanding Social Insurance Coverage in Urban China
Fall 2013 - Among developing countries, China is unique not only in its rapid growth over the past 30 years but also in its simultaneous gradual transition from a planned economy.
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Adam Wagstaff. Health and the Post-2015 Development Agenda: Stuck in the Doldrums?
June 2013 - The high-level panel report on the post-2015 development agenda...offers a nice opportunity to reflect on how---over the last 15 years---we have seen some serious global shifts in values, expectations and motivations.
Damien de Walque. Public randomization ceremonies
June 2013 - Randomization might- at first – sound like a scary word for health policy makers and professionals. They read medical journals and know from their training that randomized trials are scientifically rigorous designs to evaluate the impact of a program. But their first inclination might be to prefer to have the randomized trial in somebody else’s backyard. Randomization seems politically difficult. How to explain it to the people who will have to wait for the new intervention?
RBF website: English | French
Adam Wagstaff. Were Gordon Brown and I right? Were poor children actually left behind by the Millennium Development Goals for education?
June 2013 - It’s quite fun being picked up by a prime minister. Not literally of course. Unless you happen to be a baby seized from your mother’s arms during an election campaign, in which case it must be rather exciting, and quite possibly the highlight of the day. No, I mean being picked up in print.
Jishnu Das. A Data Guide to Sir Michael Barber’s “The Good News from Pakistan”
June 2013 - Shanta’s blog reported on Sir Michael Barber’s approach to implementing service delivery or “Deliverology”. Sir Michael was back at the World Bank on June 6th to present “The Good News from Pakistan”, where he outlined the impressive changes in Punjab, Pakistan as a result of his leadership in delivering deliverology. As a discussant, with Dhushyanth Raju’s inputs (Dhushyanth is a Senior Economist in the World Bank's South Asia education team), I examined and triangulated the existing data. Despite my original excitement about the method and the results after reading the report, I am reluctantly forced to conclude that at the moment the data do not support the report’s claims (see my presentation).
Adam Wagstaff. Cost-effectiveness vs. universal health coverage. Is the future random?
May 2013 - I've been blogging a bit about Universal Health Coverage (UHC) recently. In my "old wine in a new bottle" post, I argued that UHC is ultimately about ensuring that rich and poor alike get the care they need, and that nobody suffers undue financial hardship from getting the care they need. In my "Mrs Gauri" post, I used my colleague Varun Gauri's mother as a guinea pig to see whether the general public feels that UHC is a morally powerful concept and whether it could be expressed in a way that the general public would find accessible.
Shanta Devarajan and Jishnu Das. User fees and abuser fees
April 2013 - If user fees for health have been so vilified (including in comments on this blog), why are we bringing the subject up again? Because new evidence calls into question the prevailing view, namely that removing user fees leads to: (i) increased use of health services and hence to (ii) improved health outcomes. Confirming (i), the recent literature shows that (ii) does not always follow.
Adam Wgastaff. Reconciling the two “sciences of delivery”
April 2013 - Last week on Let’s Talk Development, I asked what the term “science of delivery” (SOD) means. I suggested that SOD is about moving from thinking about “what to deliver” to “how to deliver”. We know, for example, the interventions that cut child mortality (bednets, vaccinations, breastfeeding, etc.) but these interventions reach too few children, and the trick is to get them delivered to more.
Adam Wagstaff. So what exactly is the “science of delivery”?
April 2013 - The World Bank’s president, Jim Kim, has now made two major speeches outlining his vision for the institution – one at the Annual Meetings the other at Georgetown University on April 2 ahead of the upcoming Spring Meetings.
Adam Wagstaff. Should inequality be reflected in the new international development goals?
March 2013 - The last few months have been a busy time for inequality. And over the last few days the poor thing got busier still. Inequality is now dancing on two stages. It must be really quite dizzy.
We need an inequality goal. No we don’t. Yes we do
One of the two stages is the post-2015 development goals. At some point, someone seems to have decided that reducing inequality needs to be an explicit commitment in the post-2105 goals. The UN System Task Team on the Post-2015 UN Development Agenda wrote a report on inequality and argued that “addressing inequalities is in everyone’s best interest.”
Adam Wagstaff. Using an iPad to increase your productivity: a roundup
March 2013 - It's a while since I blogged about the iPad. I thought it might be useful to pull all my tips on this handy little gadget (including some new ones) together in one post. I'm going to focus for the most part on using it to improve productivity, but there will be some thoughts at the end on using the iPad to have a little fun.
Adam Wagstaff. Universal Health Coverage and the post-2015 development goal agenda. And Mrs Gauri
March 2013 - In a recent blogpost I asked whether Universal Health Coverage (UHC) is old wine in a new bottle, and if so whether that’s so bad.
I argued that UHC is ultimately about making sure that “everyone – whether rich or poor – gets the care they need without suffering undue financial hardship as a result.” I suggested UHC embraces three important concepts:
• equity: linking care to need, not to ability pay;
• financial protection: making sure that people's use of needed care doesn't leave their family in poverty; and
• quality of care: making sure providers make the right diagnosis, and prescribe a treatment that's appropriate and affordable.
Adam Wagstaff. A Sketch of a Ministerial Meeting on Universal Health Coverage
February 2013 - I had been warned—I found it hard to believe—that WHO ministerial meetings can be rather dull affairs of little consequence. Ministers typically take it in turn to read their prepared speeches; their fellow ministers appear to be listening attentively through their headsets but some, it seems, have been known to zap through the simultaneous translation channels in search of lighter entertainment. Speeches aren’t played over the loudspeakers for fear of waking jetlagged ministers from their afternoon naps. WHO is a very considerate organization: it likes to make sure that while on its premises visitors reach “a state of complete physical, mental and social well-being.”
Adam Wagstaff. Universal health coverage: Old wine in a new bottle? If so, is that so bad?
February 2013 - It's easy to see how the concept of universal health coverage (UHC) became so elusive.
At the start, the idea must have seemed straightforward enough. Lots of countries "covered" only part of their population, and several were making efforts to expand coverage to "uncovered" populations. China, for example, started out on this process in 2003, trying to expand coverage to the rural population that lost coverage when the old rural cooperative medical scheme collapsed following the de-collectivization of agriculture in 1978.
Damien de Walque. Transferts monétaires conditionnels au Burkina Faso: Pour quels enfants les conditions sont-elle importantes?
February 2013 - Auteurs: Richard Akresh, Damien de Walque et Harounan Kazianga
Dans une récente étude, nous présentons les impacts sur l’éducation d’un projet-pilote de transferts monétaires au Burkina Faso1, dans la Province du Nahouri. Ce projet-pilote est accompagné d’une évaluation d’impact expérimentale randomisée pour mesurer et comparer, dans le même contexte en zone rurale au Burkina Faso, l’efficacité de transferts monétaires conditionnels et non-conditionnels qui ciblent les ménages pauvres.
Varun Gauri. MDGs that Nudge
January 2013 - What should replace the Millennium Development Goals (MDGs) when they expire in 2015?
Ask your mom or dad.
In a recent working paper, I argue that we need MDGs that nudge – MDGs that frame development issues in ways that capture the attention and enthusiasm of non-experts (regular people).
Damien de Walque. For Which Children Do Conditions Matter in Conditional Cash Transfers?
January 2013 - Co-authored with Richard Akresh and Harounan Kazianga.
Social safety nets are actively promoted in developing countries both as responses to financial crises and as mechanisms to alleviate poverty. Conditional cash transfers, which are now common in Latin America but remain rare in other regions, are also seen a way to reduce future poverty by investing in the human capital of the next generation (Fiszbein and Schady, 2009). While both conditional cash transfers (CCTs) and unconditional cash transfers (UCTs) provide poor households with resources, UCT programs do not impose conditionality constraints. An important question is whether and how conditions influence the outcomes they seek to improve.
Stuti Khemani. Buying Votes versus Supplying Public Services
January 2013 - There is one simple answer to the “what-will-it-take-to-end-poverty” question: it will take courageous politicians who actually implement the policies we already know are needed. Politicians, even the well-intentioned ones, are too often unable to implement good policies, because bad policies are needed for their political survival. For example, vote-buying, the direct exchange of “gifts” or money for political support during elections is widespread in many developing countries. For the first time, new research provides direct empirical evidence that where vote-buying practices are more prevalent, governments invest less in pro-poor services.
Adam Wagstaff. Human Development and Inequality of Opportunity: a rejoinder to Ferreira
January 2013 - My colleague and (I hope still) friend, Chico Ferreira recently took the trouble to write a comment on my earlier LTD post on measuring inequality of opportunity in the context of human development. Early on in his comment, Chico also paid me the compliment of a being a “clever guy”, which was nice until I read on and found that while he agreed with some of what I said there was a lot he didn’t like. Now Chico is a really clever guy, and this is an area he knows a lot about. So I realize I’m treading on thin ice when I say I’m not completely convinced about his ripostes. But let me take the risk. Chico’s not just super-clever – he’s also very nice. So if the ice cracks and I fall in, I think there’s a good chance he’ll pull me out.
Adam Wagstaff. Some thoughts on human development, equal opportunity, and universal coverage
January 2013 - I was asked recently to advise on some ongoing work on human development, equal opportunities, and universal coverage. The work was building on previous work undertaken by the World Bank in its Latin America and the Caribbean (LAC) region that had developed a new index known as the Human Opportunity Index (HOI).
Adam Wagstaff. A guide to the top World Bank blogs and blog posts of 2012
December 2012 - Last year I wrote a post listing the most read 100 World Bank blogposts of 2011. I also compared the Bank’s 26 English-language blogs with one another in terms of how many posts they got in the top-200. 2012 was an even more successful year for World Bank bloggers.
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.
Adam Wagstaff. Who’s writing what in the ‘Knowledge Bank’? And is it being used?
October 2012 - An organization with ‘motor company’ in its name might produce several types of vehicle (cars, trucks, etc.) in several variations (models) at several different plants, and might sell these vehicles in several different regions of the world. The company wouldn’t last long if it didn’t know how many of each model – and at what cost – it was producing in each plant, and how many – and at what price – it was selling in each region. In the World Bank – where we like to think of ourselves as the ‘knowledge bank’ – we produce several types of document in several vice presidencies (VPUs) and we make them available in hard copy and in electronic format in all regions of the world.
Adam Wagstaff. Should you trust a medical journal?
September 2012 - While we non-physicians may feel a bit peeved when we hear “Trust me, I’m a doctor”, our medical friends do seem to have evidence on their side. GfK, apparently one of the world’s leading market research companies, have developed a GfK Trust Index, and yes they found that doctors are one of the most trusted professions, behind postal workers, teachers and the fire service. World Bank managers might like to know that bankers and (top) managers come close to the bottom, just above advertising professionals and politicians.
Adam Wagstaff. Tracking withdrawals from the ‘Knowledge Bank’
September 2012 - As I reported in my last post, Jim Kim’s arrival as World Bank President has reinvigorated the debate about the idea of the World Bank being a ‘knowledge bank’. In the post, I argued that the knowledge produced by the Bank – whether gleaned from its lending operations, or from its research and other analytic work – is a global public good, and that we should therefore assess the success of the institution in its knowledge work not in terms of how specific ‘client’ governments value the outputs of its knowledge work but rather in terms of how people around the world use and value them.
Adam Wagstaff. So what exactly is a “knowledge bank”?
September 2012 - Unsurprisingly, with the recent arrival of a new president fresh from the groves of academia, the halls and meeting rooms of the World Bank are buzzing once again with talk of the “Knowledge Bank” or KB for short. But what exactly is a “knowledge bank”?
To my mind the paper that pins the idea down best is “Positioning the World Bank” by Chris Gilbert, Andrew Powell and David Vines in the Economic Journal in 1999.
Adam Wagstaff. Measuring universal health coverage – plus ça change?
September 2012 - In case you hadn’t noticed, there’s a growing clamor for a global commitment to universal health coverage (UHC). You might have seen the recent special issue of the Lancet on “the struggle for UHC”. Inevitably, accompanying this clamor, there’s been a lot of wracking of brains on how to measure progress toward UHC. With the excitement of a new political agenda, there’s understandably a desire to carve out a new measurement agenda too. While not wanting dampen people’s enthusiasm for the UHC cause, I would like us to reflect whether on the measurement agenda we’re building enough on what’s been done before.
What Are the Health Effects of Universal Health Care?
Summer 2012 - The developing world—and some of the developed world too—is in the midst of a major push toward universal health coverage. A key objective is to narrow gaps in coverage and thus improve the population’s health. Improvements in health would be of value in their own right.
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FOCUS: Aid Effectiveness
Spring 2012 - Donor organizations recognize that political support for maintaining or increasing levels of aid depends on improving perceptions of its effectiveness. In 2005,in response to concerns about the quality of aid, the Paris Declaration on Aid Effectiveness moved implementation issues to the top of the international aid effectiveness agenda.
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Retirement Behavior among China’s Older Workers
Spring 2012 - In China as in other countries, developing and developed, population aging raises the prospect that both formal and informal mechanisms for supporting the elderly will come under strain over the next 20 years.
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Adam Wagstaff. Yet more on coping with information overload with an iPad
May 2012 - Last year I wrote a couple of posts on coping with information overload using an iPad, one in July and the other in December. The iPad world continues to develop apace, so here's a quick update, this one - as requested - complete with links to the apps.
Owen Ozier. Early Childhood Interventions Conference
May 2012 - Why aren't all early childhood interventions most effective at the same age? Should we be checking that our randomizations are balanced according to genes that influence behavior? Should we be gathering biological outcomes, in addition to economic ones, even when the intervention does not involve biology?
Early childhood interventions - usually working through either health or education – can have very long-lasting effects, some of which are even transmitted to the next generation. Two weekends ago, the Chicago Initiative for Economic Development and Early Childhood (CEDEC) held a conference to survey what is known in this area and provide a forum for sharing findings from recent projects.
Varun Gauri. The Law’s Majestic Equality?
April 2012 - Literary writers do not think much of the law. In the last century, Anatole France wrote, mordantly: “The majestic equality of the laws prohibits the rich and the poor alike from sleeping under bridges, begging in the streets and stealing bread.” More recently, Aarvind Adiga says, “The jails of Delhi are full of drivers who are there behind bars because they are taking the blame for their good, solid middle-class masters. . . . The judges? Wouldn't they see through this obviously forced confession? But they are in the racket too. They take their bribe, they ignore the discrepancies in the case. And life goes on.”
Adam Wagstaff. A vast treasure trove of development knowledge just opened up
April 2012 - Today's launch of the World Bank's Open Knowledge Repository (OKR) and Open Access Policy might not seem a big deal. But it is.
The knowledge bank’s assets are huge, but until today were hard to access
The Bank is a huge producer of knowledge on development. This knowledge surfaces in formal publications of the Bank – the institution publishes books and flagship reports like the World Development Report. It also surfaces in publications of external publishers, including journal articles – up to now, these external publications haven't been seen by the Bank as part of its knowledge output despite the fact they dwarf the Bank's own publications in volume and in citations. The Bank's knowledge also surfaces in reports, and in informal "knowledge products" like briefing notes and other web content.
Adam Wagstaff. Are the Knowledge Bank’s staff under-specialized?
March 2012 - Ideas often come from unexpected quarters. Last week, Ricardo Hausmann came to the World Bank to talk about his work on economic complexity. I missed the seminar, but afterwards read his Atlas of Economic Complexity: Mapping Paths to Prosperity. (I had actually already looked at the stunning – but rather confusing charts – of his coauthor Cesar Hidalgo after reading Tim Harford’s great new book Adapt: Why Success Always Starts with Failure.)
Damien de Walque. Rewarding safe sex
March 2012 - Prevention strategies have had limited impact on the trajectory of the HIV/AIDS epidemic. New, innovative approaches to behavioral change are needed to stem the epidemic.
In a joint effort with many colleagues, and in collaboration with the Ifakara Health Institute in Tanzania and, the University of California at Berkeley, we launched a study with the acronym RESPECT (“Rewarding STI Prevention and Control in Tanzania”).
Adam Wagstaff. Humanizing health systems
February 2012 - In 1960, I wouldn’t have been writing this blog post. For a start I was just a baby at the time. Second, we were several decades away from 1994 when Justin Hall – then a student at Swarthmore – would sit down and tap out the world’s first blog. Most importantly of all, though, according to Google’s ngram viewer, people didn’t write about health systems much in 1960 (see chart). Usage of the term in books took off only in the mid 1960s, waned in the 1980s, and then started rising again in the 1990s. This doesn’t look like a statistical artifact. Usage of the term “Nobel prize” has stayed relatively constant over the period, and while the term “health economics” has also trended upwards, the growth has been much slower. So “health systems” is a fairly new term – and it’s on the rise.
Damien de Walque. Professional Hazard: Migrant Miners Are More Likely to Be Infected with HIV
February 2012 - Swaziland and Lesotho are among the countries with the highest HIV prevalence in the world.
Recent nationally representative estimates reveal an adult HIV prevalence equal to 26% in Swaziland1 and 23.2% in Lesotho.
These countries have two other main features in common: they are small countries bordering South Africa and, during the past decades, they were exposed to massive recruitment efforts to work in South African mines. For more than a century, about 60 percent of those employed in the mining sector in the Republic of South Africa were migrant workers from Lesotho and Swaziland.
Philip Keefer and Stuti Khemani. Do Informed Citizens Receive More, or Pay More?
February 2012 - One widely-accepted political economy research finding is that informed citizens receive greater benefits from government transfer programs. The evidence for the impact of information comes from particular contexts—disaster relief in India and welfare payments in the USA during the Great Depression. Do other contexts yield similar results? New research on the distribution of anti-malaria bed nets in Benin suggests: “No.” Instead, local health officials charged more informed households for bed nets that they could have given them for free.
Stuti Khemani and Philip Keefer. Who ends up being more accountable - governments or citizens?
February 2012 - In our (justifiable) enthusiasm for transparency, we rarely ask whether information provision leads private citizens to help themselves, thereby relieving governments of their responsibilities. If so, we may not be quite there (yet) in finding tools that improve government accountability.
Adam Wagstaff. A New Year’s Guide to the top World Bank blog posts of 2011
December 2011 - 2011 was a highly successful year for World Bank blogs; four posts chalked up more than 10,000 views over the year; the year saw the launch of the highly successful Development Impact blog; and two of the Bank’s blogs (Development Impact and Africa Can End Poverty) have featured in Palgrave’s top-50 Economics blogs. The table below lists the top-100 World Bank blog posts of 2011 based on page views over the period November 1, 2010 – November 19, 2011. For those interested, click here to see how the Bank’s 26 English-language blogs compare to one another in terms of the number of posts they have in the top-50, top-100, and top-200. (Keep in mind, however, that Development Impact was running for only part of this period.)
Rachel Heath. Stitching together the future: the effects of the garment industry on girls’ schooling in Bangladesh
December 2011 - We want to increase (girls) education… but what’s the best way to do this?
A lot of education policy has been based on the philosophy immortalized in the classic movie Field of Dreams: "Build it and they will come.” That is, researchers and policymakers have examines the effects of programs that lower the direct or indirect costs of schooling, for instance, through building schools (Burde and Linden 2010), providing conditional cash transfers to parents (Fiszbein and Schady 2008 and references therein) or directly to students (Baird, McIntosh, and Ozler 2011) or inputs such as textbooks (Glewwe, Kremer, and Moulin 2009), school meals (Vermeersch and Kremer 2004), or uniforms (Evans et al 2009).
Adam Wagstaff. More on coping with information overload with an iPad
December 2011 - In July I wrote a post on this blog about coping with information overload using an iPad. Rather to my surprise, a few people actually read it. Four months on I thought I'd share with you some new apps and new uses of old apps. It turns out that four months is a long time in the iPad world right now.
Berk Özler. What the HIV prevention gel trial failure implies for trials in economics
December 2011 - For the World AIDS Day, there is a sign at the World Bank that states that taking ARVs reduces rate of HIV transmission by 96%. If this was last year, a sign somewhere may well have read “A cheap microbicidal gel that women can use up to 12 hours before sexual intercourse reduces HIV infection risk by more than half – when used consistently.” Well, sadly, it turns out, so much for that.
Adam Wagstaff. A Thanksgiving guide to the top World Bank blogposts of 2011
November 2011 - Here’s some reading material for Thanksgiving in the event you get some time to yourself. The list below of the Bank’s most-read 100 blog posts in 2011 contains some real gems.
Before you start reading, you might be curious how the Bank’s 26 English-language blogs compare to one another in terms of the number of blog posts they have in the top-50, top-100, and top-200.
Adam Wagstaff. Are the Knowledge Bank’s assets actually being used? The case of the World Bank’s Human Development sector
November 2011 - According to its first-ever Knowledge Report, published earlier this year, the World Bank spends over $600 million a year on “core knowledge services” – research, economic and sector work, technical assistance, “knowledge management”, training, and the like. Yet as the authors of report concede, precious little is known about the impact of this spending.
Berk Özler. Family Planning Whack-a-Mole
November 2011 - Since I reviewed, back in April, the paper by Ashraf, Field, and Lee on the effect of providing vouchers for injectable contraceptives to women in reducing unwanted pregnancies in Lusaka, Zambia, I had been worrying about the use of these modern, convenient, and reliable technologies in those parts of the world in which HIV is highly prevalent. My thinking was that if there is a causal relationship between adopting modern contraceptives and risky sexual behaviors (such as unprotected sex), then the same technology that reduces pregnancies can also increase HIV transmission. And, in areas with high HIV prevalence and among certain sub-populations (such as uninfected individuals in serodiscordant couples), it is not clear whether this trade-off favors promoting family planning over concerns with HIV.
Jed Friedman. Pooling risk, saving for health, looking inside the body: what mobile phones may soon allow us to do everywhere
November 2011 - On my return from a long work trip in Thailand and the Philippines, I stopped at the University of Southern California to attend the 4th global health supply chain summit. I typically enjoy attending meetings outside my immediate discipline since I get to hear about new ideas in fields far from my own. This conference was no exception. What caught my eye were the many talks concerned with new applications of mobile technologies and how they may eventually be used to improve population health and welfare.
Emanuela Galasso, Margaret Grosh, et al. More than we expected: what we would like to know about Conditional Cash Transfers—Part I
November 2011 - A week ago we hosted an informal workshop with some academic researchers, policymakers and World Bank staff to review "The second generation of evaluations" of CCT programs. We finally have the website, where you can see all the presentations made available by the authors and video of the event. Two posts in the Development Impact blog (here and here) go into more detail on the effectiveness of conditions — their theory, evidence and the conflicting values around them. In blog posts today and tomorrow we’ll summarize discussion of the whole workshop.
Emanuela Galasso, Margaret Grosh, et al. More than we expected: what we would like to know about Conditional Cash Transfers—Part II
November 2011 - A week ago we hosted an informal workshop with some academic researchers, policymakers and World Bank staff to review "The second generation of evaluations" of CCT programs. Yesterday's post recounted where we stand with respect to 'Opening the Black Box', parsing out what we can about which design features help to produce the human capital impacts that are one of the programs' twin goals. Today we summarize the rest of the discussion.
Berk Özler and Francisco Ferreira. Conditions work! But are they a good thing? (Part II)
November 2011 - Yesterday, in Part I of this post, we argued the extant empirical evidence suggests that the conditions cause a substantial amount of the desired behavior change intended by CCT programs. In other words: the “substitution effect” due to the condition may well be larger than the “income effect” of the transfers. For example, in the case of the Malawi experiment, the income effect was responsible for less than half of the total impact on school enrollment.
Berk Özler. When Medical Progress is not Enough
October 2011 - In this article in the NYT from a few weeks back, there is this quote from Dr. Stefano Bertozzi, director of H.I.V. and tuberculosis for the Bill and Melinda Gates Foundation:
“That we have men that are willing to be circumcised and we haven’t been able to mobilize the resources to get them circumcised — it’s really inexcusable that it’s taking as long as it is. This is the equivalent of a 60 percent effective vaccine for men. It’s my No. 1 priority in Africa. It’s clearly the most obvious, most cost-effective intervention we could use to dramatically change the course of H.I.V. in the near future.”
Berk Özler and Francisco Ferreira. Conditions work! But are they a good thing? (Part I)
October 2011 - One of the questions discussed at the recent World Bank workshop on the "Second Generation of CCT Evaluations" (website, complete with at least some of the presentations, here) was the role of the first C in the performance of the CCT: how important is the condition in accounting for the outcomes of conditional cash transfer programs? Are we just wasting time and resources by monitoring and enforcing conditions, when simply giving out the cash with no strings attached would do an equally good – or perhaps an even better – job?
Markus Goldstein. When policy goes wrong: The effects of US restrictions on abortion
October 2011 - Two weeks ago, David flagged an interesting paper by Bendavid, Avila and Miller in the Bulletin of the WHO which reminded me of a paper I had been following by Kelly Jones, a revised version of which has just been posted. Both of these papers look at the effect of the U.S. Mexico City Policy (a.k.a. the Global Gag Rule) and are interesting not only for their results, but also because they provide a nice example of how we can do evaluations of wide-sweeping policies.
Berk Özler. Cash Transfers: What have we learned so far? What are the implications for policy? What more do we need to know?
October 2011 - Tomorrow and on Tuesday (October 24-25), there is a workshop at the World Bank titled “CCTs: The Second Generation of Evaluations.” If you are at the World Bank or in the DC area, you may want to make your way to this event, as it promises to be a good one – focusing on research conducted on the topic in the past three years or so. The website is here, according to which, there are three main goals: (i) present key results from selected recent high-quality impact evaluations, (ii) discuss the implications of those new lessons for policy (as well as their external validity) and (iii) identify gaps in existing knowledge regarding CCTs.
Adam Wagstaff. Beyond Universal Coverage Part III
October 2011 - Should we try to incorporate the cost of forgone care into a measure of financial protection?
In my first post on UC in this series I argued that UC is best thought of as a means to achieving lower inequalities and improved financial protection in the health sector, but that in practice UC is unlikely to be sufficient – and may not even be necessary – for us to achieve these goals.
In this post, I want to probe a little on the measurement of financial protection; in particular I want to ask whether it should incorporate an allowance for forgone care.
Adam Wagstaff. Beyond Universal Coverage Part II
October 2011- Quantity inequalities may be dwarfed by quality inequalities
In my last post on UC I argued that UC is best thought of as a means to achieving lower inequalities and improved financial protection in the health sector, but that in practice UC is unlikely to be sufficient – and may not even be necessary – for us to achieve these goals.
In this post, I argue that our focus on narrowing inequalities in the quantity of care is leading us to ignore another and potentially more important type of inequality in the health sector: inequality in the quality of care.
Adam Wagstaff. Beyond Universal Coverage Part I
October 2011 - Health sector inequalities and financial protection – is UC enough?
Since the publication of the 2010 World Health Report “Health Systems Financing: The Path to Universal Coverage”, the “universal coverage” (UC) agenda has accelerated worldwide.
In this post, I ask how far UC is likely to narrow health sector inequalities and improve financial protection. In the next two I pick up a couple of other themes: the need to look beyond the quantity of care to the quality of care; and how far we should try to incorporate the cost of forgone care into a measure of financial protection.
Markus Goldstein and Jishnu Das. The perfectionists versus the reductionists
September 2011 - Women perform 66 percent of the world’s work, and produce 50 percent of the food, yet earn only 10 percent of the income….
--Former President Bill Clinton addressing the annual meeting of the Clinton Global Initiative (September 2009). Impressive, heart-wrenching, charity-inducing, get off your sofa and go do something heart breaking, But Wrong. It’s a problem isn’t it? Almost all those twitter-sized 140 character, pull-all-the-right-heart-strings messages (& yes, the “oh-we-did-so-great” messages like David gently took aim at) are usually wrong. Or at least don’t stand up to detailed scrutiny without many, many caveats.
Markus Goldstein. Education, fertility and HIV: It’s complicated
September 2011 - An interesting, recently revised working paper by Duflo, Dupas and Kremer looks at the effects of providing school uniforms, teacher training on HIV education, and the two combined. This paper is useful in a number of dimensions – it gives us some sense of the longer term effects of these programs, the methodology is interesting (and informative), and finally, of course, the results are pretty intriguing and definitely food for thought.
Varun Gauri. Are you poor? Then file a lawsuit
September 2011 - In 2010, the Delhi High Court issued a landmark ruling on the right of poor women to access maternity benefit schemes. The case involved Fatema, a woman suffering epilepsy, who went into labor in May, 2009. Although Fatema’s mother went to the hospital to request an ambulance and assistance, as the baby girl was also suffering an epileptic seizure, she was turned away.
Adam Wagstaff and Sofi Bergkvist. Health System Innovation in India Part III
August 2011 - Taking high-quality affordable primary care to the rural poor with the help of handheld computers, telemedicine, and P4P.
In our first post in this series, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In our last post, we outlined the Aarogyasri scheme—a novel government-sponsored health insurance program in the state of Andhra Pradesh that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care. In this post, we discuss an innovative private-sector approach to delivering and financing primary health care in rural Andhra Pradesh.
Radio Access and Service Delivery in Benin
Summer 2011 - In many developing countries citizens are unable to hold governments accountable for better service delivery, but they also underestimate the benefits of the services that government offers. Donors have long believed that access to mass media addresses both problems. They finance community radio, especially in Africa, to reinforce accountability in new democracies, and they support mass media programming to encourage households to change their health
practices and to send their children to school.
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Trends in Adult Mortality around the Developing World
Summer 2011 - In a new paper de Walque and Filmer combine data from 84 Demographic and Health Surveys from 46 developing countries to analyze trends and socioeconomic differences in adult mortality. They calculate mortality based on the sibling mortality reports collected from female respondents ages 15–49.
First, adult mortality is different from child mortality. While under-five mortality shows a definite improving trend over time, adult mortality does not. Moreover, the cross-sectional association between under-five mortality and national income is quite a bit stronger than that for adult mortality.
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Adam Wagstaff and Sofi Bergkvist. Health System Innovation in India Part II: Aarogyarsi
August 2011 - More than health insurance for the poor
In our last post, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In this post, we outline a novel government-sponsored health insurance program in the state of Andhra Pradesh (AP)—a program that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care.
Berk Özler. Evaluating a large cash transfer program? Don’t ignore Regression Discontinuity Design
August 2011 - One of the more common requests I receive from colleagues in the World Bank’s operational units is support on evaluating the impact of a large cash transfer program, usually carried out by the national government. Despite the fact that our government counterparts are much more willing to consider a randomized promotion impact evaluation (IE) design these days, still this is often not possible. This could be, for example, because it has already been announced that the program is going to be implemented in certain areas starting on a certain date. When randomization is unavailable in such cases, one of the tools available to us is regression discontinuity design (RDD), which does not get considered as frequently as it should be in my experience.
Jed Friedman. The promise of participatory women’s groups in South Asia: Can education and empowerment save lives?
July 2011 - Each year almost 4 million children die within the first four weeks of life, many from preventable or treatable causes. Much programmatic aid is now devoted to devising ways to ensure that simple effective health practices, such as ensuring a more sterile birth environment, are adopted on a wide scale. A number of recent evaluations from South Asia suggest that the active involvement of local women’s groups in problem solving can be among the most cost-effective interventions to prevent deaths.
Jed Friedman. Reporting from the International Health Economics Association 8th World Congress
July 2011 - I’m currently attending this large conference in lovely Toronto and trying to pack-in as many sessions as possible. A handful of papers have stood out to me – two evaluations of on-going pay-for-performance schemes in health and two methodological papers related to the economics of obesity. Though I am excited to share them with readers, we need to remember that these are all works in progress to varying degrees – most of them not yet even working papers – and so all reported findings should be taken with the caveat that they are subject to change.
Adam Wagstaff and Sofi Bergkvist. Health System Innovation in India Part I: India’s health system challenges
July 2011 - India’s health system faces some major challenges. In some respects, the hill India’s health system has to climb is steeper than that facing other developing countries. The good news is that the innovation that India is famous for in other sectors, as well as in health technology, is now starting to make itself felt in the health system. Not only may these ideas benefit India’s poor; they may also provide food for thought for other countries.
Adam Wagstaff. Coping with information overload—with an iPad
July 2011 - Life before the web was neatly compartmentalized. Research was produced by researchers who wrote articles for academic journals; news was written up by professional journalists who wrote for newspapers and talked on news broadcasts on the TV and the radio; policy was made by politicians and policymakers behind closed doors in smoke-filled ministries in capital cities; and entertainment was crafted by professionals and delivered in theaters, cinemas and on the TV.
David McKenzie. The new big randomized trial that you should know about – randomized Medicaid
July 2011 - Given the massive debate in the U.S. about government health insurance, the just released results of a new experiment are justly making headlines. In 2004, the state of Oregon, due to budgetary shortfalls, closed its public health insurance program for low-income people. In early 2008, the state decided it had enough budget to fund 10,000 new spots. Given that it expected demand for these new slots to far exceed supply, the state Government opened up a sign-up window, getting 90,000 people to sign-up for a waitlist, and then used random lottery draws to select people from the waitlist.
Damien de Walque and Deon Filmer. HIV/AIDS, the silent war in Africa
July 2011 - Under-5 mortality is often used—perhaps implicitly—as a measure of “population health”. But what is happening to adult mortality in Africa?
In a recent working paper, we combine data from 84 Demographic and Health Surveys from 46 countries, and calculate mortality based on the sibling mortality reports collected from female respondents aged 15-49. The working paper is available here and the database we used for the analysis can be found here.
Berk Özler. Social barriers to schooling help explain persistent educational inequities
July 2011 - Today's post comes from guest bloggers Hanan Jacoby and Ghazala Mansuri...
In thinking about why girls’ educational attainment is relatively low and has been slow to improve in many parts of south Asia, social scientists appeal to two kinds of arguments: (1) Parents have ingrained preferences favoring human capital investment in sons over daughters and/or (2) the economic returns to education remain substantially higher for males than for females.
David McKenzie. An underappreciated benefit of experiments: convincing politicians when their pet projects don’t work
July 2011 - New York City has suspended payments in a pay-for-performance program for teachers after an experiment found the program had not worked. From the New York Post:
Another attempt by the city to improve student performance through cash payments has failed, much to the surprise of Mayor Bloomberg.
"I would have thought it would have had a bigger effect," the mayor said, responding to findings that millions of dollars in bonuses paid to teachers over the last three years to boost student test scores didn't do a thing to upgrade their underperforming schools.
Berk Özler. Hurting People while Trying to Help?
June 2011 - A piece in this week’s Nature reports that a large vaccine trial for HPV, which can cause cervical cancer, is in trouble in India due to serious violations of ethical rules and informed consent. The trial, which was hoping to assess the acceptance of the vaccine and the cost of administering the vaccine in different parts of the country, apparently had headmasters of the girls’ schools signing consent forms in addition to other violations. Can you imagine someone sticking a needle in your teenage daughter’s arm without your or, if she is old enough, her own informed consent? According to the director of the vaccine project “…All necessary ethical approvals were there; the problem was how different individuals or teams implemented it."
Jed Friedman. What makes health workers get up in the morning? Paying-for-performance and worker motivation
June 2011 - Economists have long noted that the price mechanism can be effective at modifying human behavior. Psychologists classify this aspect of behavior motivation as extrinsic motivation, meaning that the behavior is induced by external pressure. If I increase my hours worked due to an overtime premium then I can be said to exhibit extrinsic motivation - I am responding to the price schedule offered me. In contrast to extrinsic motivation, psychologists posit intrinsic motivation as arising from within the individual. If the overtime premium is not needed for me to put in maximal hours because of my enjoyment or satisfaction in completing the job then I am intrinsically motivated to work long hours.
Jed Friedman. Verifying the performance in pay-for-performance: What little we know and how we can learn
June 2011 - Numerous recent discussions on the future of development financing focus on the delivery of results and how to mainstream accounting for results in aid flows (see here for one review paper by Nemat Shafik). This “results based approach” to aid is gathering steam in many contexts. Recent examples include the UK’s Department for International Development (DFID) which has recently adopted a results based approach to allocate aid across countries and sectors. Another is Results Based Financing for Health (RBF) where the World Bank, with financing from the Norwegian government and DFID, is piloting RBF schemes in the health sector in various developing countries.
Berk Özler. What happens when people refuse to update their beliefs?
June 2011 - Last week I wrote about “treatment as prevention.” Because being treated by a combination of ARV drugs effectively prevents the transmission of HIV from an infected person to his (her) uninfected partner, the idea is that if we were to test as many people as possible, find out who is infected, and offer them ARVs, we could make significant headway in preventing the spread of HIV. In other words, test and treat.
Berk Özler. Advocating a treatment that may not help the treated?
June 2011 - Last month, NIAID released news that treating HIV-infected partners in mostly heterosexual HIV-discordant couples at 13 sites around the world reduced HIV transmission to the HIV-negative partner by 96%. This is obviously great news and an important scientific advance. Its implications may well be far reaching in terms of HIV prevention in the future. But, I am not sure they justify ‘test and treat’ as prevention policy touted in some corners now.
Jed Friedman. Speak to the computer: the promise and challenges of measuring secrets through computer assisted interview
June 2011 - Markus’s previous post on the measurement of sensitive information has started the ball rolling on a major topic that we all confront in field work – accurate measurement. This is an especially acute issue for studies that investigate socially undesirable or stigmatized behaviors such as risky sexual practices or illegal activities.
David McKenzie. A new impact note series
May 2011 - I've just been alerted to the From Evidence to Policy series produced by the World Bank's Human Development network. These short and slick notes present some of the key findings from impact evaluations the World Bank has been doing in the HD area. Their latest note looks at results from a randomized experiment that tested whether paying healthclinics in Rwanda performance incentives improved health quality.
Berk Özler. Is it OK to flash money to snip the goods?
May 2011 - I was circumcised in the hospital as a very young infant. Most children do get circumcised in Turkey, although I suspect that many are not as lucky as I was, including my younger brother, who went through the ordeal when he was around six years-old. I remember him in some pain and discomfort for what seemed like a long period of time to me at the time, even though it was probably no longer than a few weeks if not days…
Jed Friedman. What happens when the power goes out? Using blackouts to help understand the determinants of infant health
May 2011 - Low birth weight, usually defined as less than 2500 grams at birth, is an important determinant of infant mortality. It is also significantly associated with adverse outcomes well into adulthood such as reduced school attainment and lower earnings. Maternal nutrition is a key determinant of low birth weight and it’s no surprise that nutrition interventions targeted at pregnant mothers can have significant impacts. Maternal nutrition and general maternal well-being are, in turn, partly a function of household resources. Income support programs such as conditional cash transfers can also help to raise infant birth weight. The link that runs from income support during pregnancy through maternal nutrition and reduced low birth weight to increased schooling attainment and adult productivity highlights the potentially life-long impacts of such temporary transfers.
David McKenzie. Fighting Malaria with Microfinance?
May 2011 - Diseases like malaria, diarrhea and intestinal worms plague hundreds of millions of people in the developing world. A major puzzle for development researchers and practitioners is why the poor do not purchase available prevention technologies that could reduce the burden of these diseases. While much of the recent literature has focused on price elasticities of demand and behavioral explanations, another potential explanation is that liquidity constraints prevent the poor from undertaking profitable health investments. If this is the main barrier, microfinance could potentially help overcome it.
David McKenzie. Teachers don’t matter says Nobel Laureate: A new study in Science, and why economists would never publish it…
May 2011 - At a recent seminar someone joked that the effect size in any education intervention is always 0.1 standard deviations, regardless of what the intervention actually is. So a new study published last week in Science which has a 2.5 standard deviation effect certainly deserves attention. And then there is the small matter of one of the authors (Carl Wieman) being a Nobel Laureate in Physics and a Science advisor to President Obama.
Berk Özler. You are in school. Or, so you say…
May 2011 - Regardless of whether we do empirical or theoretical work, we all have to utilize information given to us by others. In the field of development economics, we rely heavily on surveys of individuals, households, facilities, or firms to find out about all sorts of things. However, this reliance has been diminishing over time: we now also collect biological data, try to incorporate more direct observation of human behavior, or conduct audits of firms. And, this is with good reason: self-reports can provide a poor reflection of reality.
Berk Özler. Reporting from the 8th Midwest International Economic Development Conference
April 2011 - I attended this conference at Madison, WI last week, which was quite pleasant except the weather – it snowed! On the other hand, the fried cheese curds and scotch ales consumed with friends and colleagues (especially those that traveled thousands of miles to get there: that prize almost always goes to John Gibson from University of Waikato in New Zealand) in the afterhours were nice. So was meeting new people and seeing new work in progress. It could be a small N problem, but it seems to me that there are a lot more people working on two broad areas: savings instruments and gender discrimination. There was a special session on experiments in saving. There were many good papers and a smaller number of not so great ones, but two papers stuck with me more than the others. They both concern malaria in sub-Saharan Africa.
Berk Özler. Stuff you cannot randomize...
April 2011 - I have been thinking about marriage recently. No, not about my own marital status, but marriage among school-age girls and its effects on future outcomes… While many arguments are made to curb teen marriages (and pregnancies), it is not clear whether these events themselves are the cause of poor future outcomes or they are simply correlated with other background characteristics that are prognostic of future outcomes. A brief survey of the literature indeed suggests that the evidence is mixed; especially when it comes to the effects of teen childbearing on future outcomes.
Adam Wagstaff. Health reform: A consensus emerging in Asia?
April 2011 - Amanda Glassman’s blog post on Ghana’s health insurance program and the firestorm it produced (hat tip to Mead Over) is a reminder of the passions that health reform debates still generate. This is intriguing because my sense is that while we health-reform aficionados are berating one another in the blogosphere, policymakers in Asia are quietly iterating toward something of a consensus on a whole swathe of key issues on health reform. The process isn’t always driven by hard evidence, but that’s because there isn’t much hard evidence either way. I certainly don’t see compelling evidence against the emerging consensus—if that’s what it is. And what’s emerging is rather interesting.
David McKenzie. Dean Karlan’s new book: RCTs – this time it’s personal!
April 2011 - More than Good Intentions: How a new economics is helping to solve global poverty is a personalized helicopter tour of many recent randomized controlled trials (RCTs) in developing countries. It is written by Dean Karlan, who has been a researcher in many of these experiments, and Jacob Appel, who worked for Dean in implementing many of these experiments in Ghana. The personal stories of people Jake has come across on his travels are used by the authors as a lens to illustrate broader points in the constraints that keep people poor and the policies that might overcome these constraints.
Deon Filmer. Can Disseminating Information Lead to Better Learning Outcomes?
April 2011 - When my wife and I were looking for where to live in Washington DC, an important part of the decision was the quality of the local public school that our children would (eventually) attend. But how to judge quality? Talking to lots of people was the first step. Taking schools tours was another. But researching test scores was a key factor. We wanted a school with a good learning environment, a sense that parents had a positive feeling about the place—but also wanted to know that the school had a track record of good learning outcomes.
Berk Özler. Is there an 'unmet need' for birth control
April 2011 - Update: Lant Pritchett has kindly responded to my invitation and posted his thoughts: "No need for unmet need." Check out the comments section.
A water cooler conversation (yes, geeky conversations about development are more common than VCU-Butler matchup in the Final Four around here, sigh…) I was having with a couple of colleagues last week made me wonder if the answer to the question in the title of this post is not clear. One of my colleagues, an economist, started by saying that she came into this thinking that ‘unmet need’ was a hyped-up notion with no good evidence behind it – a position she (and I) suspected is held by many economists: we think some demographers made this stuff up!
Jed Friedman. On experimental evaluations of systems interventions
April 2011 - A quick look at the burgeoning literature on policy evaluations will reveal a preponderance of evaluations of demand side schemes such as conditional cash transfers. There is an obvious reason for this beyond the promise that such interventions hold: the technology of treatment allows for large sample randomized evaluations, either at the household or community/village level. As long as financing is sufficient to sample an adequate number of study units, study power will not be a concern.
Access to HIV/AIDS Treatment and Risky Sexual Behaviors
Winter 2011 - In December 2009 an estimated 5.2 million people in developing countries were receiving antiretroviral therapy (ART) and in Sub-Saharan Africa nearly 37 percent of people eligible for treatment were able to access those lifesaving medicines, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). This is an extraordinary achievement when one considers that as recently as 2003 only a few privileged HIV/AIDS patients had access to ART in Africa. The scaling up of ART in Africa has saved many lives and will continue to do so.
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Damien de Walque, H. Kazianga, et al. Could easier access to AIDS treatment increase risky sexual behaviors?
February 2011 - By the end of 2009, an estimated 5.2 million people in low- and middle-income countries received antiretroviral therapy (ART). In sub-Saharan Africa, nearly 37% [34%–40%] of people eligible for treatment had access to those life-saving medicines (UNAIDS 2010). This is an extraordinary achievement, considering that as recently as 2003, relatively few people living with HIV/AIDS had access to ART in Africa. The scaling-up of ART in Africa and other regions has saved the lives of countless people and we hope will continue to do so.
Stuti Khemani. Do informed citizens hold governments accountable? It depends...
February 2011 - We are increasingly—and more openly than ever—grappling with what to do about the problems of politics and government accountability. Much emphasis and faith seem to be placed on the role of information and transparency. Using information interventions to enable civil society to hold their governments accountable seems so eminently sensible that it’s become an end in and of itself, an “already known” and ticked box. Is it?
Adam Wagstaff. Four cheers for the “results agenda"
February 2011 - The development community hasn’t exactly only just woken up to the fact that development is about achieving something. Projects have had logframes since time immemorial, showing how project activities and spending are expected to lead ultimately to development outcomes—things that matter to people, like health and learning. But the “results agenda” (an agenda that dates back to 2003 but which seems to be gaining momentum) has the scope to be transformative in at least four ways.
Adam Wagstaff. Whither the development agency’s flagship report?
January 2011 - The Economist carried a couple of stories recently about how two hitherto major institutions in my home country (newspapers and pubs) have been forced to adapt in the face of changes in public preferences. Many didn’t—as a result newspaper circulation and pub numbers have both fallen dramatically. The newspapers and pubs that did survive operate very different business models from the newspapers and pubs in existence even 10 years ago.
Some data I’ve assembled make me wonder whether—like the newspaper and pub—the development-agency flagship might not also be an institution in need of reform.
Adam Wagstaff. The (gradual) democratization of development economics
January 2011 - We’ve read a good deal recently about the democratization of research. UNESCO’s Science Report 2010 showed a growth in the developing-country share of science research. As UNESCO Director General Irina Bokovo put it in her Foreword: “The distribution of research and development (R&D) efforts between North and South has changed with the emergence of new players in the global economy. A bipolar world in which science and technology (S&T) were dominated by the Triad made up of the European Union, Japan and the USA is gradually giving way to a multi-polar world, with an increasing number of public and private research hubs spreading across North and South.”
Jishnu Das. Life in a School
January 2011 - We usually think of schooling as a positive learning experience. However, sometimes this is not always the case. As recent news reports in the Hindu and on NDTV from India remind us, unfortunately for some children in low-income countries, schooling can be a nasty, brutal and short experience. They may suffer physical abuse, humiliation and be forced to endure the worst possible learning environments, while returning for the same punishment day after day after day.
Damien de Walque. Is male promiscuity the main route of HIV/AIDS transmission in Africa?
January 2011 - Sexual transmission is considered to be the main source of the spread of the HIV/AIDS epidemic in Africa1.
The pervasive if unstated belief in the HIV/AIDS community is that males are primarily responsible for spreading the infection among married and cohabiting couples. A U.N. report entitled Women and HIV/AIDS: Confronting the Crisis reported: “Nearly universally, cultural expectations have encouraged men to have multiple partners, while women are expected to abstain or be faithful.” and “Faithfulness offers little protection to wives whose husbands have several partners or were infected before they were married.”
Adam Wagstaff and Jishnu Das. Who's listening to the "knowledge bank"?
November 2010 - We now know quite a lot about the supply of research on development, and about the part the World Bank plays. We know that the World Bank publishes a lot, that most research in the world is by researchers in high-income countries, and that were it not for the Bank there would be far fewer journal articles about developing countries.
Adam Wagstaff. What’s the "universal health coverage" push really about?
November 2010 - Maps, like pictures, are often worth a thousand words. The map above comes from an article in the medical journal The Lancet. The article is part of a campaign to make 2010 the year of a big push toward universal health coverage. Over the course of the next three days, over a thousand health systems researchers are gathering in Switzerland for the First Global Symposium on Health Systems Research; the theme of the symposium is "science to accelerate universal health coverage". Next week, health ministers from around the world will gather at an international ministerial conference on "Health Systems Financing – Key to Universal Coverage" hosted by the German government. At the conference, the World Health Organization will launch its 2010 World Health Report entitled “Health Systems Financing: The Path to Universal Coverage”.
Jishnu Das. Are Non-Cognitive Gains in Education More Important than Test-Scores?
November 2010 - Most educational interventions are widely considered successful if they increase test-scores -- which indicate cognitive ability. Presumably, this is because higher test-scores in school imply gains such as higher wages later on. However, non-cognitive outcomes also matter---a lot.
Jishnu Das. Too little knowledge is a dangerous thing
October 2010 - Stefan Dercon’s wordle based on our data of the countries that economists work on led Chris Blattman and Tyler Cowen to wonder why there are more papers on Latin America relative to Africa in the Journal of Development Economics, a leading journal in the field of development economics. We looked at this issue in our paper on the Geography of Academic Research; here are four figures to add to the discussion (two of them are in our paper).
Adam Wagstaff. Checking up on the assets of the knowledge bank
October 2010 - Bhanwar Gopal, an artist from the Barefoot College, prepares traditional Rajasthani masks for plays and puppet shows with material from recycled World Bank reports. "We keep getting these reports that no one reads, so we decided to put them to some use," founder Bunker Roy says. [Source and image: BBC]
Regardless of its veracity (we’ll come to that in a moment), the BBC’s story raises a couple of serious questions. Exactly how much does the Bank publish? And does it have any impact?
The second question is, of course, hard to answer. But as Martin Ravallion and I found out when we tried to answer both questions, even the first isn’t easily answered.
Jishnu Das. The Black Hole of Pakistan
October 2010 - Critics of Washington's largesse to Pakistan -- totaling roughly $18 billion dollars in civilian and military aid since 9/11 -- are quick to point out that Pakistanis still have a worryingly low opinion of the United States. A recent Pew Research Center poll found that 64 percent of Pakistanis regard the United States as an enemy. Over the past five years, Pakistan has been labeled the "front line" of the war on terror, and many media reports and polls have painted a portrait of a Pakistani public hostile to the West. Reports of Pakistan's alleged "trust deficit" seem to have had a dual effect. Some Western officials have wanted to reverse the tide by extending largesse to Pakistan, but others have been discouraged from trying to shovel additional billions of dollars just to earn the good graces of the Pakistani public.
Damien de Walque. Rivalité fraternelle au Burkina Faso | English
August 2010 - L’école, une opportunité rare, objet de choix stratégiques dans les familles.
“Ici, pour les parents, l’école n’est pas une priorité”. Cette réflexion, empreinte de fatalisme, est souvent entendue comme explication des taux de fréquentation scolaire faibles dans certaines régions d’Afrique. Une étude récente menée dans la Province du Nahouri au Burkina Faso1 suggère que la situation est plus complexe.
Jishnu Das. Notes from the Field: Comparing Three Villages in Madhya Pradesh
July 2010 - I was in the Indian state of Madhya Pradesh recently. Madhya Pradesh, or MP, as most Indians know it – is a big state in the middle of the country. It also has some of the poorest human development indicators in the country.
Jishnu Das. Notes From The Field: Playing Chicken in India
June 2010 - It’s 1998 and I am 23 years old. My thesis advisor, Abhijit Banerjee of MIT, along with some others, is trying to do, what would become his first, randomized evaluation in Rajasthan, India. The sacrificial goats appear to be me and Chris (the other research assistant on the project). Our threesome is completed by an old Yezdi motorcycle that has a tendency to go into reverse on starting it up.
Jishnu Das. Education, Test-Scores and Other Things That Matter
May 2010 - A lot of my work is on test-scores. Here is a (very partial) list of what we know about test-scores, why they may be important (and why they may not). In future blogs we hope to take up each of these topics in greater detail. We cite the papers we know below.
How Financial Crises in Donor Countries Affect Aid
Spring 2010 - The global financial crisis has been a major shock to the developing countries, reducing their income growth rate by 7 percentage points between 2007 and 2009. International aid has helped to cushion this shock, but there is now a risk that aid budgets could come under pressure. It is the donor countries that were hit first by the crisis, and as a group they suffered steep declines in income last year. Given the strains on their economies, donors’ willingness to give aid could fall, even though the need for aid remains great. A recent paper by Dang, Knack, and Rogers looks at patterns of aid giving by donor countries hit by financial crises in the past, to give some insights into what may lie ahead.
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Turning Research Into Practice: Evaluating the impact of conditional cash transfers in Burkina Faso
March 2010 - While CCT programs have proliferated in the past decade, there remain open questions and issues about their implementation and the mechanisms by which they have an impact in different institutional environments. Since 2004, Damien de Walque has been working with Operations colleagues in the Africa region to design and evaluate alternative cash transfer programs in Burkina Faso to support communities made vulnerable by HIV/AIDS. The impact evaluation aims to contribute both to the efficient design of safety nets in the country and to a better understanding of the mechanisms by which CCTs have an impact. The hope is that this may also benefit other countries in Africa and elsewhere as they implement similar CCTs or other social protection programs.
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Stuti Khemani. Pitfalls of “voice” and transparency
February 2010 - A new paper by David Yanagizawa finds tragically large effects of access to radio on violence in Rwanda, concluding that “hate radio” may explain as much as 9 percent of the genocide.
Aside from such blatant risks of propaganda through mass media, there are more subtle arguments cautioning against wholesale enthusiasm for greater transparency and information to improve governance and accountability.
Jishnu Das. The Challenges to Creating Country-Specific Policy
January 2010 - Editor's Note: Jishnu Das and Quy-Toan Do are Senior Economists in the World Bank's Development Research Group. They are authors of a working paper U.S. and Them: The Geography of Academic Research.
Sit in on policy discussions and dialogues with governments and development institutions and two themes recur time and again: “What policies, specific to our country, can improve _____ outcomes” (fill in the blank from a large list including growth, poverty, education, and health) and; “We are not sure that the policy in Y country is really relevant for us because of differences in _____ (fill in the blank from options including institutions, legal regimen, culture, and diversity among others).
Turning Research Into Practice: Measuring absence of teachers and medical providers
December 2009 - High levels of absence of teachers and doctors from schools and clinics are not only a direct barrier to better human development outcomes, but also a symptom of poor governance and accountability. Halsey Rogers reflects on how DECRG’s research on absenteeism—undertaken in part in collaboration with Operations staff—not only received extensive attention in the media and academia, but also led to shifts in the focus of lending and analytic work by Bank Operations.
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Obstacles to achieving Paris Declaration targets
December 14, 2009 - The 2005 Paris Declaration on Aid Effectiveness sets targets for increased use by donors of recipient country systems for managing aid. A consensus view holds that country systems are strengthened when donors trust recipients to manage aid funds, but undermined when donors “micro-manage” aid through their own separate parallel systems. Despite this consensus, there are many obstacles to achieving the Paris Declaration targets. Steve Knack explains...
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Turning Research Into Practice: Health Reform in China
September 2009 - In 2003 China’s government asked the World Bank to study its rural health system and propose ideas for reforming it. The assignment led to a multi-year AAA program, involving research, policy dialogue, capacity-building, and a report. Adam Wagstaff joined the team, and reflects here on the experience.
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Demographic and Socioeconomic Patterns of HIV/AIDS Prevalence in Africa
Fall 2009 - Despite an accumulation of evidence about patterns of HIV prevalence in Africa, many misconceptions persist. Kathleen Beegle and Damien de Walque explore the methods and unusual evidence on the link between demographic factors, socioeconomic status, and HIV/AIDS.
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Windfall revenues from both foreign aid and natural resource exports can weaken governments’ incentives to design and maintain efficient tax systems
Summer 2009 - This is the sobering conclusion to emerge from research by Stephen Knack, who urges mitigating measures such as ensuring that windfall revenues do not all go to the central government and scaling up donor-financed technical assistance aimed at building revenue-raising capacity.
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Tahir Andrabi, Jishnu Das, et al. FP: The Madrasa Myth
June 2009 - Four authors argue that in the fight to save the country's next generation, more should be done towards building up mainstream and affordable private schools in Pakistan.
On May 3, the New York Times published a lengthy description of Pakistan's education system. The article, like so many before it, rehearsed a well-known narrative in which government schools are failing while madrasas are multiplying, providing a modicum of education for Pakistan's poorest children.
Timing of Evaluations and Duration of Exposure Affect Estimates of Program Impact
Spring 2009 - Impact evaluations often ignore the importance of timing and duration. A study by Elizabeth M. King and Jere R. Behrman cautions that evaluations need to be timed right in order to ensure that impacts are adequately captured. It also argues that duration of exposure can be exploited as a means to measure impacts.
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The Preference for Sons Does Not Always Decrease with Development
February 12, 2009 - New evidence suggests development does not reduce parental preference for sons over daughters in countries where such a preference exists. Indeed, modernization may be associated with higher, not lower, son preference in some areas.
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Public Opinion Influences the Level and Effectiveness of Foreign Aid
February 2, 2009 - During severe economic downturns such as the world is experiencing, public attitudes toward aid will determine whether or not donor governments will be able to generate support from voters and taxpayers for more aid.
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Does Community Monitoring Improve Public Services? Diverging Evidence from Uganda and India
September 16, 2008 - Diverging results from evaluations of two community monitoring programs in health and education suggest that local monitoring does not guarantee better service delivery.
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Public Health in Chad: Connecting Spending and Results
August 2008 - The capture and leakage of public funds in the social sectors deprive poor people of the education and health care they need. A recent study in Chad shows that when public funds reach health centers, they make a positive difference in people’s access to health care, a reason why it is important to ensure that they do.
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Armed Conflict and Schooling: Long-term Evidence from Cambodia and Rwanda
May 25, 2008 - New data on the microeconomic impacts of war for non-combatants show that the journey out of conflict is a shaky one—for a long time, especially for young people. Two recent studies investigate the long-term effect of genocide on schooling outcomes in Cambodia and Rwanda. They both find long-term negative impacts for the affected cohorts.
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Rural to Urban Migration in China: How Do Migrant-Sending Communities Benefit?
April 8, 2008 - Research on the effects of rural to urban migration in China shows a positive relationship between consumption and income of households in migrant home communities, but no significant relationship between migration and investment in non-agricultural productive assets. The ability to migrate is also associated with a drop in secondary school enrollment.
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Improving Nutritional Status through Behavioral Change: Lessons from Madagascar
January 11, 2008 - A recent impact evaluation study of a community based nutrition program in Madagascar shows that malnutrition can be improved over the short- and long-term when mothers participate in community health programs that promote behavioral change in nutrition, feeding, and hygiene practices. The study highlights important complementarities between maternal education, knowledge, and community infrastructure to achieve improvements in children’s nutritional status.
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Schooling in Developing Countries
Spring 2008 - The expanding frontier of research on education in developing countries offers many lessons for policy.
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Improving Nutrition through Community Growth Promotion in Uganda
Spring 2008 - A rigorous evaluation confirms the efficacy of a community-based approach to promoting children’s growth.
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Infant Mortality over the Business Cycle in the Developing World
November 9, 2007 - Research on income fluctuations in per capita GDP and child survival in 59 countries shows a strong, negative association between changes in per capita GDP and infant mortality. The results suggest that over 1 million excess deaths have occurred in the developing world during 1980-2004 in countries experiencing economic contractions of 10 percent or greater.
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Democracy by Other Means? Legalizing Demand for Social and Economic Rights in the Developing World
October 9, 2007 - Are there reforms in institutional design that might make governments more accountable for failures to provide basic services and alleviate poverty? This topic has been the subject of an important debate in development economics, comparative politics, and development practice since the early 1990s, when governance became a priority for development. A principal means to increase accountability in democracies—judicial review—has received scant attention.
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China’s “Missing Girls”—Son Preference or Hepatitis B Infections?
April 2, 2007 - The evidence suggests that parental preferences overwhelmingly shape the imbalanced sex ratio in China, as elsewhere in Asia. It appears governments have been correct to assume that son preference is the main factor behind the “missing girls” and to focus their policies on changing the cultural roots of son preference.
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Youth and Citizenship
February 6, 2007 - The World Development Report 2007: Development and the Next Generation analyzes five key transitions that young people undergo as they enter adulthood—completing education, entering the labor market, taking responsibility for their own health, starting their own families, and exercising citizenship. This research brief—based on a chapter on citizenship in the report—reviews the institutions through which young people encounter their social and political world, and the implications of citizenship for development.
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Disability, Poverty, and Schooling in Developing Countries
Fall 2007 - Children with disabilities are less likely to acquire the education they need to earn high incomes and avoid poverty.
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Fungibility and the “Flypaper Effect” of Aid
Spring 2007 - Some donor aid for a road project was diverted to recipients’ own priorities—but it did stick to the road sector.
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Cushioning the Effects of Health Shocks on Households
December 18, 2006 Health shocks—in the form of a death, the onset of disability, the arrival of a new chronic illness, even an acute illness—can have devastating effects on households. Recent research sheds light on the importance of health shocks and the range and effectiveness of mechanisms to reduce their impacts.
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Fiscal Decentralization in China—Potential Next Steps
December 5, 2006 Fiscal decentralization is widely recognized as an essential component in China’s remarkable transition to a market economy. However, the intergovernmental fiscal system is now hitting a few snags—increasing regional disparities, proliferation of off-budgetary funds, deficient and unequal public services delivery, farmers’ financial burden, and rural unrest. What happened? And what happens now?
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Getting Girls into School: Evidence from Cambodia
Winter 2006 Cash incentives for families to enroll girls in school can work even in low-income countries with relatively low-quality schools.
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The Effects of Donor Fragmentation on Bureaucratic Quality in Aid-Recipient Countries
November 1, 2006 Aid-recipient countries must deal with an ever-growing array of donors and non-governmental organizations. And while sums in dollar terms for each donor have risen in the last couple of years, research using collective action theory and cross-country data suggests that the consequences of too many small donors and increasing aid fragmentation takes a toll on the overall success of aid.
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Discordant Couples and HIV/AIDS Transmission in Five African Countries
October 2, 2006 New research findings on discordant couples—where only one of the two partners is infected with HIV/AIDS—is challenging pervasive assumptions about the determinants of HIV/AIDS transmission to the general population in Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania.
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Money for Nothing, the Dire Straits of Medical Practice in Delhi
Fall 2006 Provider competence and effort both play a role in the quality of care.
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Investing in Early Childhood Development
August 28, 2006 - Profound nutritional and cognitive deficits early in life doom many children in developing countries to low educational achievement and low economic productivity. Research shows that investing in nutrition during the pre-school years—and as early as possible—reaps significant long-term human capital and economic dividends.
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Orphanhood, Poverty, and School Enrollment
June 25, 2006 - Children in developing countries are losing their parents to AIDS, war, and other tragedies. How likely are they to be less educated? A recent study examines parental survival, poverty, and school enrollment to answer the question of whether orphan status is a good predictor of lower enrollment in poor countries.
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In Quest of Institutions that Promote Fiscal Discipline
March 14, 2006 - Research analyzing political constraints to fiscal discipline in large developing countries has recently produced some provocative results on how politics influences fiscal policy. This work is being synthesized to identify a potentially powerful institutional solution to the problem of politically motivated fiscal deficits.
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A New Look at Quality of Medical Care in Low-Income Countries
February 14, 2006 - No matter how one looks at it—as differences across nations or as differences within nations—poor people systematically suffer from worse health outcomes than rich people. What role does medical care play?
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Do Macroeconomic Crises Affect Schooling and Child Health? Evidence from Peru
November 8, 2005 - Over the past two decades a large number of countries have experienced economic crises that led to sharp reductions in incomes and living standards. How has this affected schooling and health outcomes?
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Missing in Action: Teacher and Medical Provider Absence in Developing Countries
October 1, 2005 - Provider absenteeism is high in poorer countries and states. A recent study shows that absence ranges from 11 to 27 percent among primary-school teachers, and from 23 to 40 percent among medical personnel. What do the levels and patterns of these data tell us?
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