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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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Use of standardised patients to assess quality of healthcare in Nairobi, Kenya: a pilot, cross-sectional study with international comparisons
Daniels, B., A. Dolinger, G. Bedoya, K. Rogo, A. Goicoechea, J. Coarasa, F. Wafula, N. Mwaura, R. Kimeu and J. Das
BMJ Global Health 2(2): 1-11, June 2017.
The quality of clinical care can be reliably measured in multiple settings using standardised patients (SPs), but this methodology has not been extensively used in Sub-Saharan Africa. This study validates the use of SPs for a variety of tracer conditions in Nairobi, Kenya, and provides new results on the quality of care in sampled primary care clinics.

A systematic tale of two differing reviews: evaluating the evidence on public and private sector quality of primary care in low and middle income countries
Jorge Coarasa, Jishnu Das, Elizabeth Gummerson, and Asaf Bitton
Global Health 13 (1): 24., April 2017.
Systematic reviews are powerful tools for summarizing vast amounts of data in controversial areas; but their utility is limited by methodological choices and assumptions. Two systematic reviews of literature on the quality of private sector primary care in low and middle income countries (LMIC), published in the same journal within a year, reached conflicting conclusions. The difference in findings reflects different review methodologies, but more importantly, a weak underlying body of literature. A detailed examination of the literature cited in both reviews shows that only one of the underlying studies met the gold standard for methodological robustness. Given the current policy momentum on universal health coverage and primary health care reform across the globe, there is an urgent need for high quality empirical evidence on the quality of private versus public sector primary health care in LMIC.

Observations of infection prevention and control practices in primary health care, Kenya
Guadalupe Bedoya, Amy Dolinger, Khama Rogo, Njeri Mwaura, Francis Wafula, Jorge Coarasa, Ana Goicoechea, and Jishnu Das
Bulletin of the World Health Organization, March 2017.
We used an observational, patient-tracking tool to assess compliance with infection prevention and control practices by 1680 health-care workers during outpatient interactions with 14 328 patients at 935 health-care facilities in 2015. Compliance was assessed in five domains: hand hygiene; protective glove use; injections and blood sampling; disinfection of reusable equipment; and waste segregation. We calculated compliance by dividing the number of correct actions performed by the number of indications and evaluated associations between compliance and the health-care workers and facility’s characteristics.Across 106 464 observed indications for an infection prevention and control practice, the mean compliance was 0.318 (95% confidence interval, CI: 0.315 to 0.321). The compliance ranged from 0.023 (95% CI: 0.021 to 0.024) for hand hygiene to 0.871 (95% CI: 0.866 to 0.876) for injection and blood sampling safety. Compliance was weakly associated with the facility’s characteristics (e.g. public or private, or level of specialization) and the health-care worker’s knowledge of, and training in, infection prevention and control practices.The observational tool was effective for assessing compliance with infection prevention and control practices across multiple domains in primary health care in a low-income country. Compliance varied widely across infection prevention and control domains. The weak associations observed between compliance and the characteristics of health-care workers and facilities, such as knowledge and the availability of supplies, suggest that a broader focus on behavioural change is required.

Enhancing quality of medical care in low income and middle income countries through simulation-based initiatives: recommendations of the Simnovate Global Health Domain Group
Lekha Puri, Jishnu Das, Madhukar Pai, Priya Agrawal, J Edward Fitzgerald, Edward Kelley, Sarah Kesler, Kedar Mate, Manoj Mohanan, Allan Okrainec, and Rajesh Aggarwal
BMJ Simulation and Technology Enhanced Learning, 3(Suppl 1):S15-S22, March 2017
Quality of medical care in low income and middle income countries (LMICs) is variable, resulting in significant medical errors and adverse patient outcomes. Integration of simulation-based training and assessment may be considered to enhance quality of patient care in LMICs. The aim of this study was to consider the role of simulation in LMICs, to directly impact health professions education, measurement and assessment.

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The power of information in improving school performance
Tahir Andrabi, Jishnu Das, and Asim Ijaz Khwaja
VoxDev blog, 26 June 2017

Giving parents information on the performance of schools in Pakistan improved test scores and enrolment, and reduced the cost of private school tuitionProviding information to citizens can improve services for the poor, swiftly and at relatively low cost. That, encouragingly, is the lesson emerging from recent experiments in Uganda (Björkman and Svensson 2009), India (Banerjee et al. 2011), and Indonesia (Banerjee et al. 2015) as well as observational research in the US (Hoxby 2000) in sectors as diverse as health, voting behaviour, access to subsidised food and education.Buoyed by these positive results, we were interested in investigating the impact of information (specifically, school and child report cards) on education markets, but with a two-fold twist (Andrabi et al. 2013). First, we work in an environment where there are both public and private schools; the latter receive no subsidies and face little (if any) de facto regulation in terms of prices or standards setting. Second, we were interested in what would happen if we intervened in an entire market, rather than a subset of consumers within the market.

Informational constraints on antipoverty programmes: Evidence for Africa
Caitlin Brown, Dominique van de Walle, and Martin Ravallion
VoxEU blog, 30 March 2017

Policymakers face challenges when trying to identify the right targets for antipoverty programmes. This column assesses whether the data typically available to policymakers in sub-Saharan Africa are up to the task. Commonly used proxy means tests are found to perform worse than simpler methods in identifying poor households. Moreover, analyses of nutritional status reveal substantial inequality within households, suggesting that household-based measures are not very effective in identifying disadvantaged individuals.

(re) Searching for impact: Further thoughts
Jishnu Das
Future Development blog, 13 April 2017

I was also directed to discussions of research and impact such as social anthropologist Marilyn Strathern’s talk on impact in research funding (hat tip to Andrew Brandel at the Institut für die Wissenschaften vom Menschen, Vienna) and the fascinating panel at the recent American Economic Association meetings on the problems with publishing in the economics profession (h/t my colleague Quy-Toan Do). Strathern’s discussion on the tension between research as a description of the present and the funder’s desire for prediction provides much food for thought on the fundamental role of research. Similarly, the AEA panel’s take on an increasing obsession with publishing in the top-5 journals and the damage it may cause to the economics profession is a must-listen for those interested in how academia is responsive and concerned with the incentives generated within the profession.Three further points arose in the discussion that followed.

The Bank punches above its weight. But where and why?
Steve Knack, Brad Parks, Takaaki Masaki
Let’s Talk Development blog, 6 April 2017

In October 2015, the Washington Post ran a story that compared the World Bank’s performance to that of other bilateral and multilateral development finance institutions. It identified the Bank as a leader among its peers in the value-for-money that it provides to its shareholders (and their taxpayers).

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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?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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Effect of stress on later-life health: evidence from the Vietnam war draft
John Cawley, Damien de Walque, Daniel Grossman
Working Paper 8063, May 2017

A substantial literature has examined the impact of stress during the early stages of life on later-life health. This paper contributes to that literature by examining the later-life health impact of stress during adolescence and early adulthood, using a novel proxy for stress: risk of military induction in the United States during the Vietnam War. The paper estimates that a 10 percentage point (2 standard deviation) increase in induction risk in young adulthood is associated with a 1.5 percentage point (8 percent) increase in the probability of being obese, and a 1 percentage point (10 percent) increase in the probability of being in fair or poor health later in life. These findings do not appear to be due to cohort effects; the associations exist only for men who did not serve in the war, and are not present for women or men who did serve. These findings add to the evidence on the lasting consequences of stress, and indicate that induction risk during the Vietnam War may, in certain contexts, be an invalid instrument for education or marriage, because it appears to have a direct impact on health.

The effects of in-kind demand-side conditional transfers for improving uptake of maternal and child health services in Rwanda
Gil Shapira, Ina Kalisa, Jeanine Condo, James Humuza, Cathy Mugeni, Jeanette Walldorf
Working Paper 8060, May 2017

To diagnose and treat preventable threats to maternal and neonatal health in Sub-Saharan Africa, a policy focus has been put on increasing coverage rates of targeted health services. Exploiting an experimental design, this study evaluates the impacts of an in-kind conditional transfer intervention in Rwanda that endowed women with gifts for receiving timely antenatal and postnatal care, as well as for delivering in health facilities. The analysis finds that although health centers experienced frequent stock outs of the gifts, the rate of women who initiated antenatal care within the first four months of their pregnancy increased by 7.7 percent, and that of women who received postnatal care in the 10 days following delivery increased by 8.6 percent. No impact was found on the rate of in-facility deliveries, which independently sharply increased during the years of the implementation of the program.

Effects of performance incentives for community health worker cooperatives in Rwanda
Gil Shapira, Ina Kalisa, Jeanine Condo, James Humuza, Cathy Mugeni, Denis Nkunda, Jeanette Walldorf
Working Paper 8059, May 2017

This paper presents the results of a randomized controlled trial set to evaluate the effects of a pay-for-performance scheme that rewarded community health worker cooperatives for the utilization of five targeted maternal and child health services by their communities. The experiment took place in 19 districts in Rwanda between 2010 and 2014. The analysis finds no impact of the performance payments on coverage of the targeted services, attitudes and behaviors of community health workers, or outcomes at the cooperative level. No synergies are found between the scheme and a demand-side, in-kind transfer intervention that was independently effective in increasing coverage rates of targeted services.

Compensation, diversity and inclusion at the World Bank Group
Jishnu Das, Clement Joubert, Sander Florian Tordoir
Working Paper 8058, May 2017

This paper examines salary gaps by gender and nationality at the World Bank Group between 1987 and 2015 using a unique panel of all employees over this period. The paper develops and implements a dynamic simulation approach that models existing gaps as arising from differences in job composition at entry, entry salaries, salary growth and attrition. There are three main findings. First, 76 percent of the $27,400 salary gap across the average male and female staff at the World Bank Group can be attributed to composition effects, whereby men entered the World Bank Group at higher paid positions, particularly in the earlier half of the sample. Second, salary gaps 15 years after joining the World Bank Group can favor either men or women depending on their entry position. Third, for the most common entry-level professional position (known as Grade GF at the World Bank Group) there is a gender gap of 3.5 percent in favor of males 15 years after entry. The majority of this gap (84 percent) is due to differences in salary growth rather than differences in entry salaries or attrition. The pattern of these gaps is similar for staff from different nationalities. The dynamic decomposition method developed here thus identifies specific areas of concern and can be widely applied to the analysis of salary gaps within firms.

The Misallocation of Pay and Productivity in the Public Sector: Evidence from the Labor Market for Teachers
Natalie Bau, Jishnu Das
Working Paper 8050, May 2017

This paper uses a unique dataset of both public and private sector primary school teachers and their students to present among the first estimates in a low-income country of (a) teacher effectiveness; (b) teacher value added (TVA) and its correlates; and (c) the link between TVA and teacher wages. Teachers are highly effective in our setting: Moving a student from the 5th to the 95th percentile in the public school TVA distribution would increase mean student test scores by 0.54 standard deviations. Although the first two years of experience, as well as content knowledge, are associated with TVA, all observed teacher characteristics explain no more than 5 percent of the variation in TVA. Finally, there is no correlation between TVA and wages in the public sector (although there is in the private sector), and a policy change that shifted public hiring from permanent to temporary contracts, reducing wages by 35 percent, had no adverse impact on TVA, either immediately or after 4 years. The study confirms the importance of teachers in low income countries, extends previous experimental results on teacher contracts to a large-scale policy change, and provides striking evidence of significant misallocation between pay and productivity in the public sector.

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Publications (2008-2017)

Google map of the countries covered by selected research
The map shows research on human development by research department staff, 2008-2017.

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