Building or Bypassing Recipient Country Systems: Are Donors Defying the Paris Declaration?
April 2013 - The 2005 Paris Declaration committed donors to increased use by donors of recipient country systems for managing aid, particularly in recipient countries with higher-quality systems. This study investigates the degree to which donors’ use of country systems is in fact positively related to their quality, using indicators explicitly endorsed for this purpose by the Paris Declaration and covering the 2005-2010 period. Tests confirm a positive and significant relationship that is robust to corrections for potential sample selection, omitted variables, and endogeneity bias. Findings suggest that donors have modified at least some of their aid practices in ways that build rather than undermine administrative capacity and accountability mechanisms in recipient countries.
Working Paper 6423 Using Provider Performance Incentives to Increase HIV Testing and Counseling Services in Rwanda
February 2013 - 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. This study examines the scheme's impact on individual 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.
Working Paper 6364 How Subjective Beliefs about HIV Infection Affect Life-Cycle Fertility: Evidence from Rural Malawi
January 2013 - This paper 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.
Working Paper 6343 Previous Working Papers
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 | 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 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. Previous Blogs & Research Briefs
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Pai, M. and J. Das (2013). "Management of Tuberculosis in India: Time for a deeper dive into quality." The National Medical Journal of India 26(2): 1-4.
The diagnosis and treatment of tuberculosis (TB) remains a persistent challenge for health services in India. While the Revised National TB Control Programme (RNTCP) has announced ‘universal access to quality TB diagnosis and treatment for all TB patients in the community’ as its new goal in the new National Strategic Plan (2012–17), there seems to be no clear strategy to systematically measure and document the quality of TB care, in both public and private sectors... Gauri, V. (2013). "Too legal to work." The Indian Express, 1-2.
A highly legalised system of complaints redress may undermine, not enhance, accountability
To err is human, and government officials are human indeed. For that reason, Parliament's consideration of the right of citizens for time-bound delivery of and services bill is a welcome development.
The bill squarely addresses one of the two objectives of grievance redress systems — basic fairness. When someone is unjustly denied something to which they are entitled as a matter of legal or constitutional right, it is crucial for government, as a condition of basic fairness and reciprocity, to facilitate the expression of complaints, and soon upon receiving a well-founded complaint, to fix the problem... Das, J., S. Dercon, et al. (2013). "School Inputs, Household Substitution, and Test Scores." American Economic Journal: Applied Economics 5(2): 29-57.
Empirical studies of the relationship between school inputs and test scores typically do not account for household responses to changes in school inputs. Evidence from India and Zambia shows that student test scores are higher when schools receive unanticipated grants, but there is no impact of grants that are anticipated. We show that the most likely mechanism for this result is that households offset their own spending in response to anticipated grants. Our results confirm the importance of optimal household responses and suggest caution when interpreting estimates of school inputs on learning outcomes as parameters of an education production function... Andrabi, T., J. Das, et al. (2013). "Students Today, Teachers Tomorrow? Identifying Constraints on the Provision of Education." Journal of Public Economics 100: 1-14.
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. This paper focuses 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... Previous Journal Articles
| Localizing Development: Does Participation Work?
November 2012 - The Policy Research Report Localizing Development: Does Participation Work? brings analytical rigor to a field that has been the subject of intense debate and advocacy, and billions of dollars in development aid. It briefly reviews the history of participatory development and argues that its two modalities, community-based development and local decentralization, should be treated under the broader unifying umbrella of local development. It suggests 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 focuses on the challenges of inducing participation.
Order | Download The Elderly and Old Age Support in Rural China. Directions in Development Series
March 2012 - The Elderly and Old Age Support in Rural China examines projected demographic changes that will affect the economic well-being of China’s rural elderly over the next 20 years, taking into account both China’s sharp demographic transition and the continued migration of young adults to cities. The projected old age dependency ratio of 34 percent in China’s rural areas by 2030 suggests that support of the elderly is likely to be an increasing burden on China’s families.
Order | Download Health Equity and Financial Protection: Streamlined Analysis with ADePT Software
May 2011 - ADePT Health is a free-standing computer program that allows users to produce quickly - and with the minimal risk of errors - most tables that have become standard in applied health and equity analysis. ADePT produces summary statistics and charts that allow inequalities to be compared across countries and over time. This manual explains the methods ADePT uses, how to prepare data for it, how to navigate the ADePT interface to generate the desired tables and charts, and how to interpret them.
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Making Schools Work: New Evidence on Accountability Reforms
February 2011 - This book is about the threats to education quality in the developing world that cannot be explained by lack of resources. It reviews the observed phenomenon of service delivery failures in public education: cases where programs and policies increase the inputs to education but do not produce effective services where it counts – in schools and classrooms. It documents what we know about the extent and costs of such failures across low and middle-income countries. And it further develops the conceptual model posited in the World Development Report 2004: that a root cause of low-quality and inequitable public services – not only in education—is the weak accountability of providers to both their supervisors and clients.
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