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HDQU Q4 2012

Human Development Quarterly Update — Q4 2012

Latest research findings

The post-2015 development goals should be easy to grasp and convey a causal narrative

Varun Gauri [1] argues that, unlike human rights treaties, the Millennium Development Goals' targets and goals were not psychologically, morally, or politically salient. He argues that the goals and targets for the proposed second round of development goals should be easier to grasp and embed within them a causal narrative about the causes and remedies of global poverty. Their formulation and implementation should also draw on national institutions and processes, which most people find more persuasive than discussions at the international level. Gauri develops these ideas and presents examples for how post-2015 development goals and targets might be presented in ways that are more compelling.

Rainfall shocks have short- but not long-run effects on weight-for-height, height-for-age, and the incidence of diarrhea

Mariano Rabassa, Emmanuel Skoufias, and Hanan Jacoby [2] investigate the effect of weather shocks on children's anthropometrics using the two most recent rounds of the Nigeria Demographic and Health Survey. Climate data for each survey cluster are interpolated using daily weather-station records from the national network. The findings reveal that rainfall shocks have a statistically significant and robust impact on child health in the short run for both weight-for-height and height-for-age, and the incidence of diarrhea. However, children seem to catch up with their cohort rapidly after experiencing a shock, and the impacts are the same for young boys and girls, suggesting that there is no gender-based discrimination in the allocation of resources within households.

How a weakness in Stata’s simulation function went unnoticed for 4 years

Large-scale simulation-based studies rely on at least three properties of pseudorandom number sequences: they behave in many ways like truly random numbers; they can be replicated; and they can be generated in parallel. There has been some divergence, however, between empirical techniques employing random numbers, and the standard battery of tests used to validate them. A random number generator that passes tests for any single stream of random numbers may fail the same tests when it is used to generate multiple streams in parallel. The lack of systematic testing of parallel streams leaves statistical software with important potential vulnerabilities. Owen Ozier [3] shows one such vulnerability in Stata's rnormal function that went unnoticed for almost four years, and how to detect it.


New articles and books

Localizing development: Does participation work?

In a new Policy Research Report “Localizing Development: Does Participation Work?” [4], Ghazala Mansuri and Vijayendra Rao bring analytical rigor to a field that has been the subject of intense debate and advocacy, and billions of dollars in development aid. They briefly review the history of participatory development, and argue that its two modalities – community-based development and local decentralization – should be treated under the broader unifying umbrella of local development. The authors suggest that a distinction between organic participation (endogenous efforts by civic activists to bring about change) and induced participation (large-scale efforts to engineer participation at the local level via projects) is key, and focus on the challenges of inducing participation.

Health and nutrition

Standardized patients reveal appalling quality of primary care

Jishnu Das, Alaka Holla, Veena Das, Manoj Mohanan, Diana Tabak, and Brian Chan [5] report on the quality of care delivered by private and public providers of primary health care services in rural and urban India. To measure quality, the authors used standardized patients recruited from the local community and trained to present consistent cases of illness to providers. They found low overall levels of medical training among health care providers; in rural Madhya Pradesh, for example, 67 percent of health care providers who were sampled reported no medical qualifications at all. They found only small differences between trained and untrained doctors in such areas as adherence to clinical checklists. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics.

When antiretroviral therapy is perceived as efficacious, risky sexual behaviors increase

Damien de Walque, Harounan Kazianga, and Mead Over [6] study the effect of increased access to antiretroviral therapy (ART) for AIDS on self-reported risky sexual behavior, using data collected in Mozambique in 2007 and 2008. The survey sampled both households from randomly selected HIV positive individuals and comparison households from the general population. Controlling for unobserved individual characteristics, their findings support the hypothesis of disinhibition behaviors, in which people report more sexual risk taking when they perceive ART as more efficacious. However, over the study period, the authors find that increased experience with ART at the nearest health facility has decreased, rather than increased, the perceived efficacy of ART. To the degree that the perceived efficacy of ART has declined, perhaps because people have known more patients who have failed treatment, people’s sexual behavior has become more cautious. The authors stress that their identification strategy reveals associations, and therefore their findings should not be interpreted as causal.

Sexual transmission of HIV – cost-benefit analysis in the Copenhagen Consensus

Damien de Walque participated in the comparative cost-benefit analysis of responses to HIV/AIDS organized by the Copenhagen Consensus. In his write-up [7], he focuses on the prevention of sexual transmission and stressed the need for more and better impact evaluations and the importance of considering potential behavioral responses to medical prevention interventions. He also discusses the perspectives offered by new prevention interventions currently experimented: i) the "treatment for prevention" approach proposing to test regularly a large fraction of the population and treat immediately with anti-retroviral therapies those who are positive so that the pool of HIV positive people would be less infectious; ii) pre-exposure prophylaxis for HIV prevention proposing to give anti-retroviral drugs to HIV negative individuals at high risk; and iii) conditional cash transfers aimed at preventing HIV and other sexually transmitted infections.

Seasonal variations in environmental conditions at the time of birth affect child health

Recruiting Michael Lokshin and Sergiy Radyakin [8] use data from three waves of India National Family Health Survey to explore the relationship between the month of birth and the health outcomes of young children in India. They find that children born during the monsoon months have lower anthropometric scores compared to children born during the fall-winter months. Further results reveal the importance of seasonal variations in environmental conditions at the time of birth in determining health outcomes of young children in India.

Gender gaps

Women report higher levels of distress than men, especially in families with adverse reproductive outcomes

Women report significantly higher levels of mental distress than men in community studies around the world. Jishnu Das, Ranendra Kumar Das, and Veena Das [9] provide further evidence on the origins of this mental health gender-gap using data from 789 adults, primarily spousal pairs, from 300 families in Delhi, India. The authors first find that gender differences in education, household expenditures and age do not explain the mental health gender-gap. In contrast, women report significantly higher levels of distress than men in families with adverse reproductive outcomes, particularly the death of a child. Mental health is strongly correlated with physical health for both men and women, but there is little evidence of a differential response by sex. The authors complement this empirical description with anthropological analysis based on ethnographic interviews with 100 men and 100 women.

Inequitable attitudes and couple discordance are associated with a higher risk of intimate partner violence

Intimate partner violence (IPV) is widely prevalent in Tanzania. Inequitable gender norms manifest in men’s and women’s attitudes about power and decision making in intimate relationships and are likely to play an important role in determining the prevalence of IPV. Suneeta Krishnan, Divya Vohra, Damien deWalque, Carol Medlin, Rose Nathan and William Dow [10] examine the relationship between couples’ attitudes about IPV, relationship power, and sexual decision making, concordance on these issues, and women’s reports of IPV over 12 months. Women expressed less equitable attitudes than men at baseline. Over time, participants’ attitudes tended to become more equitable and women’s reports of IPV declined substantially. Multivariable logistic regression analyses suggested that inequitable attitudes and couple discordance were associated with higher risk of IPV.

Education insights

A child’s ability positively influences their own enrollment probability, but negatively influences that of younger siblings

Richard Akresh, Emilie Bagby, Danien de Walque and Harounan Kazianga [11] explore how child ability influences parents’ decisions to invest in their children’s human capital. The authors use a direct measure of child ability for all primary school-aged children, regardless of current school enrollment. They explicitly incorporate direct measures of the ability of each child’s siblings (both absolute and relative measures) to show how sibling rivalry exerts an impact on the parents’ decision of whether and how much to invest in their child’s education. The authors find that children with one standard deviation higher own ability are 16% more likely to be currently enrolled, while having a higher-ability sibling lowers current enrollment by 15% and having two higher-ability siblings lowers enrollment by 30%.

Food-for-education schemes raised enrollment, improved math scores among girls, and less child labor

Harounan Kazianga, Damien de Walque and Harold Alderman [12] report the results of a prospective randomized trial to assess the impact of two food-for-education schemes on education and child labor outcomes for children from low-income households in northern rural Burkina Faso. The two food-for-education programs under consideration are, on the one hand, school meals where students are provided with lunch each school day, and, on the other hand, take-home rations which provide girls with 10 kg of cereal flour each month, conditional on 90% attendance rate. After the program ran for one academic year, both programs increased enrolment by 3-5 percentage points. The scores on mathematics improved for girls in both school meals and take-home rations villages. The interventions also led to adjustment in child labor, with children (especially girls) with access to food-for-education programs, in particular the take-home rations, shifting away from on farm labor and off-farm productive tasks which possibly are more incompatible with school hours.

Human rights and development

Thinking through human rights-based approaches to development

Varun Gauri [13] sets out to organize thinking around human rights-based approaches to development (HRBAs) and to review available empirical evidence regarding their benefits, risks, and limitations. He proposes a typology distinguishing four types of rights-based approaches: global compliance based on international and regional treaties; human rights-based programming on the part of donors and governments; rights talk; and legal mobilization. Gauri briefly reviews the politics of the first three modalities before examining legal mobilization for social and economic rights in greater detail. Litigation for social and economic rights is increasing in frequency and scope in several countries, and exhibits appealing attributes such as inclusiveness and deliberative quality. Still, there are potential problems with this form of human rights-based mobilization, including middle class capture, the potential counter-majoritarianism of courts, and difficulties in compliance. The conclusions to each section lay out the key research questions regarding HRBAs.

Human rights as demands for communicative action

There are multiple determinants of health and education outcomes, and multiple actors who influence each of those various determinants. How, then, asks Varun Gauri [14], should a human rights based approach allocate duties and responsibilities among these various actors? Many have argued that it is simply impossible, and that therefore there can be no such thing as a human right to social and economic goods and services. But courts in many countries are in fact enforcing social and economic rights, such as health and education. How are they resolving the ambiguity regarding the allocation of duties? Courts in Colombia, India, South Africa, Indonesia, and elsewhere are urging parties to move from an adversarial to an investigative mode, imposing requirements that parties argue in good faith, and structuring a public forum of communication. In effect, judicial practice involves requiring respondents to engage in communicative, instead of strategic, action.

Development agency corner

Citations of the World Bank's publications suggest it is not merely a proselytizer  

The World Bank is a prolific publisher; for example, it has published more journal articles in economics than any university except Harvard. But what about the Bank’s impact on development thinking? Using citation data from Google Scholar, Ravallion and Wagstaff [15] find that it is hard to discern more than a negligible impact for a great many Bank publications. However, a sizeable minority of its journal articles and books have been highly cited. Compared to leading research universities, and other international institutions, the Bank's ranking in terms of widely-used citation-based indices is no lower than for its journal article counts. This suggests that the Bank's research does much more than proselytize. 

Troubling tradeoffs in the Human Development Index

The UNDP’s 20th Human Development Report introduced a new version of its famous Human Development Index (HDI), which aggregates country-level attainments in life expectancy, schooling, and income. The main change was to relax the past assumption of perfect substitutability between its components. Martin Ravlallion [16] argues that most users will not, however, realize that the new HDI has also greatly reduced its implicit weight on longevity in poor countries, relative to rich ones. By contrast, the new HDI's valuations of extra schooling are now very high-many times the economic returns. Ravallion proposes an alternative index that embodies less troubling tradeoffs while still allowing imperfect substitution.

Geeks’ section

Asset indices proxy consumption best when shocks are small, and consumption includes a lot spending on publicly-consumed household goods

The use of asset indices in welfare analysis and poverty targeting is increasing, especially in cases in which data on expenditures are unavailable or hard to collect. Deon Filmer and Kinnon Scott [17] find that inferences about inequalities in education, health care use, fertility, and child mortality, as well as labor market outcomes, are quite robust to the economic status measure used. Different measures – most significantly per capita expenditures versus the class of asset indices – do not, however, yield identical household rankings. Rankings are most similar in settings with small transitory shocks to expenditure or with little random measurement error in expenditure, and least similar in settings where individually consumed goods are the main component of expenditures.

Practical guidance on the use of bivariate probit and linear IV estimators

Richard Chiburis, Jishnu Das, and Michael Lokshin [18] compare asymptotic and finite sample properties of linear instrumental variables and the bivariate probit estimator in models with an endogenous binary treatment and binary outcome. Their results provide guidance on the choice of model specification and help to explain large differences in the estimates depending on the specification chosen.

Beyond Baseline and Follow-Up: The Case for More T in Experiments

The vast majority of randomized experiments in economics rely on a single baseline and single follow-up survey. David McKenzie [19] argues that while such a design is suitable for study of highly autocorrelated and relatively precisely measured outcomes in health and education, it is unlikely to be optimal for measuring noisy and relatively less autocorrelated outcomes such as business profits, and household incomes and expenditures. Taking multiple measurements of such outcomes at relatively short intervals allows one to average out noise, increasing power. When the outcomes have low autocorrelation and budget is limited, it can make sense to do no baseline at all. Moreover, for such outcomes, more power can be achieved with multiple follow-ups than allocating the same total sample size over a single follow-up and baseline. McKenzie also highlights the large gains in power from ANCOVA analysis rather than difference-in-differences analysis when autocorrelations are low.


Research in the news

The Health Affairs article by Jishnu Das, Alaka Holla, Veena Das, Manoj Mohanan, Diana Tabak, and Brian Chan [5] on the poor quality care in India revealed by their standardized patient study in India was picked up The Herald, Goa’s largest English-language daily, The Indian Express, the Deccan Herald, the British Medical Journal,  and Spy Ghana. Das told the BMJ: “We’re questioning assumptions that a combination of qualifications and equipment can guarantee quality. We find this is not necessarily true.”

And on the blogs

Daniel Brinks and Varun Gauri’s “The Law’s Majestic Equality” [20] is picked up in a blogpost by Toni Williams on the University of Miami Law School’s Equality Jotwell blog. Williams remarks: “A rich paper and a stimulating read, Law’s Majestic Equality yielded few definitive answers, but its claims about the progressive potential of some types of socio-economic rights litigation pose plenty of theoretical questions, methodological questions, and political questions about the equality project of getting rights right.”

Shanta Devarajan and Jishnu Das caused something of a firestorm in their post on the Africa Can blog where they suggest solving the drug problem in Africa “empower[ing] poor people with the ability to hold health workers and drug providers accountable.  One way would be to charge market prices for drugs, but give poor people (and only poor people) vouchers or additional cash to buy the drugs.  And why not do the same for clinical services?” The subsequent online debate is well worth a read.

The Das et al. Health Affairs article was blogged about by Amanda Glassman on the Global Health Policy blog, and by Adam Wagstaff on Let’s Talk Development (LTD).

Wagstaff has a number of other posts on LTD. Who’s writing what in the ‘Knowledge Bank’? And is it being used? looks at counts downloads by VPU from the Bank’s Documents and Reports database. Among VPUs other than DEC, HDN ranks #2 in the Bank on per capita counts and downloads. Other posts from Wagstaff include: How can health systems “systematic reviews” actually become systematic?When the snow fell on health systems research: a symposium sketchWhere in the world is a hospitalization least affordable?; and A guide to the top World Bank blogs and blog posts of 2012.
Owen Ozier has a short post on the All About Finance blog on his ongoing impact evaluation of an International Rescue Committee project that the BBC featured.



  1. Heath, R.,Gauri, V., MDGs That Nudge: The Millennium Development Goals, Popular Mobilization, and the Post-2015 Development Framework, 2012, Washington, DC:  The World Bank, Policy Research Working Paper #6282.
  2. Rabassa, M., E. Skoufias, and H.G. Jacoby, Weather and child health in rural Nigeria, 2012, Washington, DC:  The World Bank, Policy Research Working Paper Series #6214.
  3. Ozier, O., Perils of Simulation: Parallel Streams and the Case of Stata’s Rnormal Command, 2012, Washington, DC:  World Bank, Policy Research Working Paper #6278.
  4. Mansuri, G. and V. Rao, Localizing Development: Does Participation Work?, in Policy Research Reports. 2012, World Bank.: Washington, DC.
  5. Das, J., A. Holla, V. Das, M. Mohanan, D. Tabak, and B. Chan, In Urban And Rural India, A Standardized Patient Study Showed Low Levels Of Provider Training And Huge Quality Gaps. Health Affairs 2012. 31(12): p. 2774-2784.
  6. de Walque, D., H. Kazianga, and M. Over, Antiretroviral Therapy Perceived Efficacy and Risky Sexual Behaviors: Evidence from Mozambique. Economic Development and Cultural Change, 2012. 61(1): p. 97-126.
  7. de walque, D., Sexual transmission of HIV: Perspective paper, in RethinkHIV: Smarter Ways to Invest in Ending HIV in Sub-Saharan Africa, B. Lomborg, Editor. 2012, Cambridge University Press: New York. p. 49-73.
  8. Lokshin, M. and S. Radyakin, Month of Birth and Children's Health in India. Journal of Human Resources, 2012. 47 (1): p. 174-203.
  9. Das, J., R.K. Das, and V. Das, The mental health gender-gap in urban India: Patterns and narratives. Social Science & Medicine, 2012. 75(9): p. 1660–1672.
  10. Krishnan, S., D. Vohra, D. deWalque, C. Medlin, R. Nathan, and W.H. Dow, Tanzanian Couples’ Perspectives on Gender Equity, Relationship Power, and Intimate Partner Violence: Findings from the RESPECT Study. AIDS Research and Treatment, 2012. 2012.
  11. Akresh, R., E. Bagby, D. de Walque, and H. Kazianga, Child Ability and Household Human Capital Investment Decisions in Burkina Faso. Economic Development and Cultural Change, 2012. 61(1): p. 157-186.
  12. Kazianga, H., D. de Walque, and H. Alderman, Educational and Child Labour Impacts of Two Food for Education Schemes: Evidence from a Randomized Trial in Rural Burkina Faso. Journal of African Economies, 2012. 21(5): p. 723–760.
  13. Gauri, V. and S. Gloppen, Human Rights Based Approaches to Development: Concepts, Evidence, and Policy Polity, 2012. 44(4): p. 485–503.
  14. Gauri, V. and D.M. Brinks, Human Rights as Demands for Communicative Action Journal of Political Philosophy, 2012. 20(4): p. 407–431.
  15. Ravallion, M. and A. Wagstaff, The World Bank's Publication Record. The Review of International Organizations, 2012. 7 (4): p. 343-68.
  16. Ravallion, M., Troubling Tradeoffs in the Human Development Index. Journal of Development Economics, 2012. 99(2): p. 201-09.
  17. Filmer, D. and K. Scott, Assessing asset indices. Demography, 2012. 49(1): p. 359-392.
  18. Chiburis, R.C., J. Das, and M. Lockshin, A practical comparison of the bivariate probit and linear IV estimators. Economics Letters, 2012. 117(3): p. 762-766.
  19. McKenzie, D., Beyond Baseline and Follow-Up: The Case for More T in Experiments. Journal of Development Economics, 2012. 99 (2): p. 210-21.
  20. Brinks, D.M. and V. Gauri, The Law’s Majestic Equality? The Distributive Impact of Litigating Social and Economic Rights. 2012, Washington, DC: World Bank, Policy Research Working Paper #5999.

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