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Human Development and Public Services

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Overview

This research program spans the full gamut of human development — education, health, labor markets, and social protection. It examines the performance of the sectors in terms of levels and inequalities in utilization, quality and outcomes, as well as methods for improving performance, whether aimed at households, service providers, politicians and policymakers, or donors.    More »

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Examining the Quality of Medicines at Kenyan Healthcare Facilities: A Validation of an Alternative Post-Market Surveillance Model That Uses Standardized Patients
Wafula, Francis, Amy Dolinger, Benjamin Daniels, Njeri Mwaura, Guadalupe Bedoya, Khama Rogo, Ana Goicoechea, Jishnu Das, and Bernard Olayo.
Real World Outcomes/, October 2016.
Promoting access to medicines requires concurrent efforts to strengthen quality assurance for sustained impact. Although problems of substandard and falsified medicines have been documented in low- and middle-income countries, reliable information on quality is rarely available. The aim of this study was to validate an alternative post-market surveillance model to complement existing models.The study used standardized patients or mystery clients (people recruited from the local community and trained to pose as real patients) to collect medicine samples after presenting a pre-specified condition. The patients presented four standardized conditions to 42 blinded facilities in Nairobi, Kenya, resulting in 166 patient–clinician interactions and dispensing of 300 medicines at facilities or nearby retail pharmacies. The medicine samples obtained thus resemble those that would be given to real patients.

Socioeconomic Status and Quality Of Care in Rural India: New Evidence from Provider and Household Surveys
Jishnu Das and Aakash Mohpal
Health Affairs 35 (10): 1764-73, October 2016
To assess socioeconomic differences in access to high-quality health care services, we collected novel data on illnesses that required primary care from 23,275 households in 100 villages in Madhya Pradesh, India. We matched the primary care visits for those illnesses to characteristics of the health care providers that members of the households visited. People in the average village in our sample could access eleven providers, of whom 71 percent were in the private sector and 49 percent had no formal medical training. The private sector accounted for 89 percent of the primary care visits in our sample, with 77 percent of the visits made to providers with no formal training. Both access to and use of more knowledgeable providers increased with socioeconomic status, mostly as a result of differences across districts and villages. Strikingly, people in high- and low-socioeconomic-status households in the same village visited equally knowledgeable providers. It was the poor people who lived in poor communities who received especially low-quality care.

The impact of training informal health care providers in India: A randomized controlled trial
Jishnu Das, Abhijit Chowdhury, Reshmaan Hussam, Abhijit V. Banerjee
Science 354(6308): 1-11.
Health care providers without formal medical qualifications provide more than 70% of all primary care in rural India.Training these informal providers may be one way to improve the quality of carewhere fewalternatives exist.We report on a randomized controlled trial assessing a program that provided 72 sessions of training over 9 months to 152 informal providers (out of 304). Using standardized patients (“mystery clients”),we assessed clinical practice for three different conditions to which both providers and trainers were blinded during the intervention, representative of the range of conditions that these providers normally diagnose and treat. Training increased correct case management by 7.9 percentage points (14.2%) but did not affect the use of unnecessary medicines and antibiotics. At a program cost of $175 per trainee, our results suggest that multitopic medical training offers an effective short-run strategy to improve health care.

Use of standardised patients to assess antibiotic dispensing for tuberculosis by pharmacies in urban India: a cross-sectional study
Satyanarayana, S., A. Kwan, B. Daniels, R. Subbaraman, A. McDowell, S. Bergkvist, R. K. Das, V. Das, J. Das, and M. Pai
The Lancet Infectious Diseases 16 (11): 1261–1268, November 2016.

India's total antibiotic use is the highest of any country. Patients often receive prescription-only drugs directly from pharmacies. We assessed the medical advice and drug dispensing practices of pharmacies for standardised patients with presumed and confirmed tuberculosis in India.

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

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

Data gaps: The poor typical household surveys miss
Isis Gaddis and Dominique van de Walle, January 25.2016

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

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

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

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

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

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Conducting Ethical Economic Research: Complications from the Field
April 2016: This chapter in The Oxford Handbook of Professional Economic Ethics discusses practical issues confronted when conducting surveys as well as designing appropriate field trials. First, we look at the challenge of ensuring transparency while maintaining confidentiality. Second, we explore the role of trust in light of asymmetric information held by the surveyor and by the respondents as well as the latter’s expectations as to what their participation will set in motion. We present case studies relevant to both of these issues. Finally, we discuss the role of ethical review from the perspective of research conducted through the World Bank.
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Right to Work?Poverty in a Rising Africa: Africa Poverty Report
October 2015: According to latest World Bank estimates, the share of Africans who are poor fell from 56% in 1990 to 43% in 2012. The report argues that the poverty rate may have declined even more if the quality and comparability of the underlying data are taken into consideration. However, because of population growth many more people are poor, the report says. The most optimistic scenario shows about 330 million poor in 2012, up from about 280 million in 1990. Poverty reduction has been slowest in fragile countries, the report notes, and rural areas remain much poorer, although the urban-rural gap has narrowed.
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Right to Work?Right to Work? Assessing India's Employment Guarantee Scheme in Bihar
February 2014: India's 2005 National Rural Employment Guarantee Act creates a justiciable "right to work" by promising up to 100 days of wage employment per year to all rural households whose adult members volunteer to do unskilled manual work. Work is provided in public works projects at the stipulated minimum wage. The study finds that the scheme is falling well short of its potential impact on poverty in Bihar. Analysis of the study’s survey data points to a number of reasons. Workers are not getting all the work they want, and they are not getting the full wages due. And participation in the scheme is far from costless to them. Many report that they had to give up some other income-earning activity when they took up work. The unmet demand for work is the single most important policy-relevant factor in accounting for the gap between actual performance and the scheme’s potential impact on poverty.
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Youth Employment in SSAYouth Employment in Sub-Saharan Africa
January 2014: The report examines obstacles faced by households and firms in meeting the youth employment challenge. It focuses primarily on productivity, in agriculture, in nonfarm household enterprises (HEs), and in the modern wage sector, because productivity is the key to higher earnings as well as to more stable, less vulnerable, livelihoods. To respond to the policy makers' dilemma, the report identifies specific areas where government intervention can reduce those obstacles to productivity for households and firms, leading to brighter employment prospects for youth, their parents, and their own children.
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If Politics Is the Problem, How Can External Actors Be Part of the Solution?
Shantayanan Devarajan and Stuti Khemani
Working Paper 7761, July 2016
Despite a large body of research and evidence on the policies and institutions needed to generate growth and reduce poverty, many governments fail to adopt these policies or establish the institutions. Research advances since the 1990s have explained this syndrome, which this paper generically calls "government failure," in terms of the incentives facing politicians, and the underlying political institutions that lead to those incentives. Meanwhile, development assistance, which is intended to generate growth and reduce poverty, has hardly changed since the 1950s, when it was thought that the problem was one of market failure.

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

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

The Fiscal Cost of Weak Governance: Evidence from Teacher Absence in India
Karthik Muralidharan, Jishnu Das, Alaka Holla, and Aakash Mohpal
Working Paper 7579, February 2016
The relative return to input-augmentation versus inefficiency-reduction strategies for improving education system performance is a key open question for education policy in low-income countries. Using a new nationally-representative panel dataset of schools across 1297 villages in India, this paper shows that the large investments over the past decade have led to substantial improvements in input-based measures of school quality, but only a modest reduction in inefficiency as measured by teacher absence. In the data, 23.6 percent of teachers were absent during unannounced visits with an associated fiscal cost of $1.5 billion/year. There are two robust correlations in the nationally-representative panel data that corroborate findings from smaller-scale experiments. First, reductions in student-teacher ratios are correlated with increased teacher absence. Second, increases in the frequency of school monitoring are strongly correlated with lower teacher absence. Simulations using these results suggest that investing in better governance by increasing the frequency of monitoring could be over ten times more cost effective at increasing teacher-student contact time (net of teacher absence) than hiring more teachers. Thus, at current margins, policies that decrease the inefficiency of public spending in India are likely to yield substantially higher returns than those that augment inputs.

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Publications (2008-2016)

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The map shows research on human development by research department staff, 2008-2016.

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Last updated: 2016-12-14




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