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HDQU Q1 2013

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Human Development Quarterly Update — Q1 2013

Latest research findings

How subjective beliefs about HIV infection affect life-cycle fertility: evidence from rural Malawi

Gil Shapira [1] uses simulation methods with a structural model to study the effect of subjective beliefs about HIV infection on fertility decisions in a context of high HIV prevalence and simulates the impact of different policy interventions, such as HIV testing programs and prevention of mother-to-child transmission, on fertility and child mortality. The model successfully fits the fertility patterns in the data, as well as the distribution of reported beliefs about own HIV status. The simulation results show that the presence of HIV reduces the average number of births a woman has during her life-cycle by 0.15, and that HIV testing can reduce the fertility of infected women, leading to a reduction of child mortality and orphanhood.

Buying votes vs. supplying public services: political incentives to under-invest in pro-poor policies

Using unique survey data, Stuti Khemani [2] finds evidence that vote-buying in poor economies is associated with lower provision of public services that disproportionately benefit the poor and worse child health. Various features of the data and the institutional context allow the rejection of alternative hypotheses, such as poverty driving both vote buying and health outcomes. The data come from the Philippines, a country context that allows for measuring vote-buying during elections and services delivered by the administrative unit controlled by winners of those elections.

Cash transfers and child schooling: evidence from a randomized evaluation of the role of conditionality

Richard Akresh, Damien de Walque and Harounan Kazianga [3] conducted a randomized experiment in rural Burkina Faso to estimate the impact of alternative cash transfer delivery mechanisms on education. The two-year pilot program randomly distributed cash transfers that were either conditional or unconditional. Families under the conditional schemes were required to have their children ages 7-15 enrolled in school and attending classes regularly. There were no such requirements under the unconditional programs. Conditional transfers were found to be significantly more effective than the unconditional transfers in improving the enrollment of "marginal children" who are initially less likely to go to school, such as girls, younger children, and lower-ability children.

Using provider performance incentives to increase HIV testing and counseling services in Rwanda

Paying for performance (P4P) provides financial rewards to medical care providers for improvements in performance measured by specific utilization and quality of care indicators. In 2006, Rwanda began a paying for performance scheme to improve health services delivery, including HIV/AIDS services. In this study Damien de Walque, Paul J. Gertler, Sergio Bautista-Arredondo, Ada Kwan, Christel Vermeersch, Jean de Dieu Bizimana, Agnes Binagwaho and Jeanine Condo. [4] examine the scheme's impact on individuals’ and couples’ HIV testing and counseling, using data from a prospective quasi-experimental design. The study finds a positive impact of P4P with an increase of 6.1 percentage points in the probability of individuals having ever been tested. Larger impacts are found for married individuals. The P4P impact is also larger for the probability that both partners have ever been tested, especially among discordant couples in which only one of the partners is HIV positive.


New articles and books

Access to water, women’s work and child outcomes

Poor rural women in the developing world spend considerable time collecting water. Do women living in places where more time is needed for water collection tend to participate less in income-earning market-based activities? Do the education outcomes of their children tend to be worse? We use micro data for nine developing countries to help address these questions. The primary aim in this study by Gayatri Koolwal and Dominique van de Walle [5] is to describe the patterns in the data rather than to infer causality, although they do treat the household-level access to water as endogenous, assuming that community-level access is exogenous conditional on a wide range of geographic factors. Better access to water is not found to be associated with greater off-farm paid work but is associated with less unpaid work for women. In countries where substantial gender gaps in schooling exist, both boys’ and girls’ enrollments also tend to be better.

Inter-subjective meaning and collective action developing societies: theory, evidence, and policy implications

The capacity to act collectively is not just a matter of groups sharing interests, incentives and values (or being sufficiently small), as standard economic theory predicts, but a prior and shared understanding of the constituent elements of problem(s) and possible solutions. From this standpoint, the failure to act collectively can stem at least in part from relevant groups failing to ascribe a common intersubjective meaning to situations, processes and events. Varun Gauri, Michael Woolcock and Deval Desai [6] develop a conceptual account of intersubjective meanings, explain its relevance to development practice and research, and examine its implications for development work related to building the rule of law and managing common pool resources.

Redressing grievances and complaints regarding basic service delivery

Redress procedures are important for basic fairness. In addition, they can help address accountability problems in the implementation of social policies and provide information to policy makers regarding policy design. To function effectively, argues Varun Gauri [7], a system of redress requires a well-designed and inter-linked supply of redress procedures as well as, especially if rights consciousness is not well-developed in a society, a set of organizations that stimulate and aggregate demand for redress. On the supply side, this paper identifies three kinds of redress procedures: administrative venues within government agencies, independent institutions outside government departments, and courts. On the demand side, the key institutions are non-governmental organizations/civil society organizations and the news media, both of which require a receptive political and economic climate to function effectively. Overall, procedures for redressing grievances and complaints regarding basic service delivery are under-developed in many countries, and deserve further analysis, piloting, and support.

Students today, teachers tomorrow? identifying constraints on the provision of education

With an estimated 115 million children not attending primary school in the developing world, increasing access to education is critical. Resource constraints limit the effectiveness of demand-based subsidies. In this paper Tahir Andrabi, Jishnu Das and Asim Ijaz Khwaja [8] focus on the importance of a supply-side factor – the availability of low-cost teachers – and the resulting ability of the market to offer affordable education. The authors first show that private schools are three times more likely to emerge in villages with government girls' secondary schools (GSS). Identification is obtained by using official school construction guidelines as an instrument for the presence of GSS. In contrast, there is little or no relationship between the presence of a private school and girls' primary or boys' primary and secondary government schools. In support of a supply-channel, the authors then show that, for villages that received a GSS, there are over twice as many educated women and that private school teachers' wages are 27 percent lower in these villages. In an environment with poor female education and low mobility, GSS substantially increase the local supply of skilled women lowering wages locally and allowing the market to offer affordable education. These findings highlight the prominent role of women as teachers in facilitating educational access and resonate with similar historical evidence from developed economies. The students of today are the teachers of tomorrow.

Aid and donor trust in recipient country systems

The 2005 Paris Declaration on Aid Effectiveness sets targets for increased use by donors of recipient country systems for managing aid. The target is premised on a view that country systems are strengthened when donors trust recipients to manage aid funds, but undermined when donors manage aid through their own separate parallel systems. Stephen Knack [9] provides an analytical framework for understanding donors’ decisions to trust or bypass country systems. Empirical tests are conducted using data from three OECD-DAC surveys designed to monitor progress toward Paris Declaration goals. Tests show that use of recipient country systems is positively related to (1) the donor's reputational stake in the country's development, as proxied by the donor's share of aid provided to the recipient; (2) the trustworthiness or quality of those systems, as measured by cross-country corruption indicators; and (3) donors’ risk tolerance, as proxied by public support for aid provision in donor countries. Findings are robust to corrections for potential sample selection, omitted variables or endogeneity bias.

Trends and socioeconomic gradients in adult mortality around the developing world

Damien de Walque and Deon Filmer [10] combine data from 84 Demographic and Health Surveys from 46 countries to analyze trends and socioeconomic differences in adult mortality, calculating mortality based on the sibling mortality reports collected from female respondents aged 15–49. The analysis yields four main findings. First, adult mortality is different from child mortality: while under-5 mortality shows a definite improving trend over time, adult mortality does not, especially in sub-Saharan Africa. The second main finding is the increase in adult mortality in sub-Saharan African countries. The increase is dramatic among those most affected by the HIV/AIDS pandemic. Mortality rates in the highest HIV-prevalence countries of southern Africa exceed those in countries that experienced episodes of armed conflict. Third, even in sub-Saharan countries where HIV prevalence is not as high, mortality rates appear to be at best stagnating, and even increasing in several cases. Finally, the main dimension along which mortality appears to differ in the aggregate is by sex. Adult mortality rates in sub-Saharan Africa have risen substantially higher for men than for women—especially so in the high HIV-prevalence countries. On the whole, the data do not show large gaps by urban/rural residence or by school attainment.


And on the blogs

Stuti Khemani blogs on Let’s Talk Development about the need for courageous politicians who implement the policies known to be effective. Politicians, even the well-intentioned ones, are too often unable to implement good policies, because bad policies are needed for their political survival.

Damien de Walque, Richard Akresh and Harounan Kazianga blog on Development Impact about their new study that sheds light on whether and how conditions in cash transfer programs influence the outcomes they seek to improve. They have a French-language post on the same subject on Africa Can.

Berk Ozler blogs on Development Impact the decision of Taranaki District Health Board in New Zealand to make the emergency contraceptive pill freely available through pharmacies for youth aged 12 to 24. Ozler also has a post about a recent study finding that a community intervention (a package that improves take-up, provides community engagement, and post-test support) reduced HIV incidence by 14% more than standard-of-care VCT.

Markus Goldstein has a post on Development Impact about the coexistence of malaria and fake drugs. He reports on a paper showing how bad this problem is in Uganda, and providing an innovative way to deal with it.

Varun Gauri blogs about his paper on “MDG’s that nudge”, arguing that MDGs that are psychologically, morally, and politically salient are more likely to change behavior”. He suggests if you want to propose a new development goal, it’s wise first to see if it resonates with your mother.

Adam Wagstaff has a trio of blog posts about Universal Health Coverage (UHC). In the first he asks whether UHC is old wine in a new bottle, and if so whether that’s a bad thing. The second is a sketch of the ministerial meeting on UHC held at the WHO HQ in Geneva. The third looks at the moral salience of UHC, and asks whether UHC is likely to resonate with Varun Gauri’s mother. Mrs Gauri commented on the post, saying she agrees with UHC.

Adam Wagstaff wrote a post on Let’s Talk Development that’s critical of the Bank’s work on equality of opportunity, especially its Human Opportunity Index. Chico Ferreira, one of the proponents of the index, replied to the post, and Wagstaff posted a rejoinder.
Adam Wagstaff has a post on Let’s Talk Development asking whether inequality should be reflected in the international development goals. The post gives a sneak preview of new evidence showing differential progress among the poorest 40% and richest 60% on several key health-related MDGs.

Adam Wagstaff also has a post about increasing one’s productivity using the iPad.



  1. Shapira, G., How Subjective Beliefs about HIV Infection Affect Life-Cycle Fertility: Evidence from Rural Malawi. 2013, Washington, DC: The World Bank, Policy Research Working Paper #6343.
  2. Khemani, S., Buying votes vs. supplying public services: political incentives to under-invest in pro-poor policies. 2013, Washington, DC: The World Bank, Policy Research Working Paper #6339.
  3. Akresh, R., D. de Walque, and H. Kazianga, Cash Transfers and Child Schooling: Evidence from a Randomized Evaluation of the Role of Conditionality. 2013, Washington, DC: The World Bank, Policy Research Working Paper #6340.
  4. de Walque, D., P.J. Gertler, S. Bautista-Arredondo, A. Kwan, C. Vermeersch, J. de Dieu Bizimana, A. Binagwaho, and J. Condo, Using Provider Performance Incentives to Increase HIV Testing and Counseling Services in Rwanda. 2013, Washington, DC: World Bank #6364.
  5. Koolwal, G. and D. van de Walle, Access to Water, Women’s Work and Child Outcomes. Economic Development and Cultural Change, 2013. 61(2): p. 369-405.
  6. Gauri, V., M. Woolcock, and D. Desai, Inter-subjective Meaning and Collective Action Developing Societies: Theory, Evidence, and Policy Implications. Journal of Development Studies, 2013. 49(1): p. 160-172.
  7. Gauri, V., Redressing Grievances and Complaints Regarding Basic Service Delivery. World Development, 2013. 41(1): p. 109-119.
  8. Andrabi, T., J. Das, and A.I. Khwaja, Students Today, Teachers Tomorrow? Identifying Constraints on the Provision of Education. Journal of Public Economics, 2013 (Online 17 January). 100: p. 1-14.
  9. Knack, S., Aid and Donor Trust in Recipient Country Systems. Journal of Development Economics, 2013. 101: p. 316–329.
  10. de Walque, D. and D. Filmer, Trends and Socioeconomic Gradients in Adult Mortality around the Developing World Population and Development Review, 2013. 39(1): p. 1-29.

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