Search

Can cash aid harm nonrecipients by raising local prices? We show that a household-targeted cash transfer in the Philippines increases the prices of perishable foods in some markets and raises stunting among nonbeneficiary children by 11 percentage points (34%). Impacts increase in the size of the village income shock and remoteness---and are sustained two and a half years after program introduction. Price effects from an experimental sample are confirmed with national expenditure surveys collected during program scale-up. Household-targeted cash transfers can thus generate local spillovers that undermine program goals. Selected geographic targeting may avoid price spillovers at moderate additional cost.

The identification of key determinants of aid effectiveness is a long-standing question in the development community. This paper reviews the literature on aid effectiveness at the project level and then extends the inquiry in a variety of dimensions with new data on World Bank investment project financing. It confirms that the country institutional setting and quality of project supervision are associated with project success, as identified previously. However, many aspects of the development project cycle, especially project design, have been difficult to measure and therefore under-investigated. The paper finds that project design, as proxied by the estimated value added of design staff, the presence of prior analytic work, and other specially collected measures, is a significant predictor of ultimate project success. These factors generally grow in predictive importance as the income level of the country rises. The results also indicate that a key determinant of the staff's contribution is their experience with previous World Bank projects, but not other characteristics such as age, education, or country location. Key inputs to the project production process associated with subsequent performance are not captured in routine data systems, although it is feasible to do so. Further, the conceptualization and measurement of the success of project-based aid should be revisited by evaluative bodies to reflect a project's theorized contribution to development outcomes.

Although many education and health programs aim to improve early childhood development, it is challenging to assess developmental levels of infants and small children through large household surveys. The Caregiver Reported Early Development Instruments (CREDI) has been proposed as an adaptable, practical, and low‐cost instrument for measuring the developmental status of children under 3 years of age at scale, as it is relatively short and collected by caregiver report. This study employed the CREDI to measure the development of a sample of 994 children ages 22–35 months in rural India and compared the results to those obtained using the Bayley Scales of Infant and Toddler Development (Bayley‐III), a reliable and widely used instrument, albeit one not always suited to large‐scale data collection efforts given its length, cost, and complexity of administration. The CREDI validation exercise showed that caregivers can provide assessments in keeping with the more interactive (hence more time‐consuming and training‐intensive) Bayley‐III instrument. Noteworthy, there was no indication that concordance of the instruments differed by education of the caregiver. This is important as it points to alternate feasible tools to measure child development outcomes through large‐scale surveys., The Caregiver Reported Early Development Instruments (CREDI) has been proposed as an adaptable, practical, and low‐cost tool for measuring the developmental status of children under 3 years of age at scale, as it is relatively short and collected by caregiver report. This study employed the CREDI to measure the development of a sample of 994 children ages 22–35 months in rural India and compared the results to those obtained using the Bayley Scales of Infant and Toddler Development, a reliable and widely used instrument.

Financial incentives for health providers and households are increasingly used to improve reproductive, maternal, and child health service coverage in low- and middle-income countries. This study provides a quantitative synthesis of their effectiveness. A systematic review was conducted of the effects of performance-based financing, voucher, and conditional cash transfer programs on six reproductive, maternal, and child health service indicators, with eligible evidence coming from randomized controlled trials and studies using double-difference, instrumental variables, and regression discontinuity designs. Four literature searches were conducted between September 2016 and March 2021 using seven academic databases, Google Scholar, development agency and think tank websites, and previous systematic reviews. Random effects meta-analysis was used to obtain mean effect sizes. From 58 eligible references 212 impact estimates were extracted, which were synthesized into 130 program-specific effect sizes. Financial incentives increase coverage of all considered reproductive, maternal, and child health indicators, but mean effects sizes are of modest magnitude. Effect size heterogeneity is typically low to moderate, and there is no indication that study bias risk, baseline indicator levels, or a combination of provider- and household-level incentives impact effect sizes. There is, however, weak evidence that mean effect sizes are somewhat smaller for performance-based financing than for voucher and conditional cash transfer programs, and that the increase in income, rather than the incentive itself, drives coverage improvements. Financial incentives improve reproductive, maternal, and child health service coverage. If future research confirms the preliminary finding that performance-based financing has smaller effects, voucher and conditional cash transfer programs are the preferred policy option among incentive interventions to achieve higher reproductive, maternal, and child health service coverage. The relative effectiveness and efficiency of incentives compared with unconditional increases of provider and household incomes, however, need to be studied further.

This paper examines the relationship between physical activity and individual productivity among agricultural workers paid on a piece-rate basis. In the context studied, physical activity has a clear correspondence with worker effort. Agricultural workers’ physical activity is directly observed from accelerometer data and is robustly associated with their daily productivity. In addition the impact of a health intervention, which provides malaria testing and treatment, on physical activity and productivity, indicates that the increased daily productivity of workers who are offered this program is explained by worker effort reallocation from low-intensity to high-intensity work within a fixed time period. This demonstrates, in settings when individual productivity is observed, that physical activity measures can help disentangle productivity effects due to effort. When productivity is unobserved, physical activity measures may proxy for individual productivity in physically demanding tasks. The challenges and limitations of physical activity measurement using accelerometers is discussed including their potential use for alternative contexts and the importance of field and data analysis protocols.

Agricultural and other physically demanding sectors are important sources of growth in developing countries, but prevalent diseases such as malaria can adversely impact the productivity and labor supply of workers. We estimate the impact of malaria infection on worker earnings, labor supply, daily productivity, and task selection by using a phased-in design where we randomize the study week in which piece-rate workers at a large sugarcane plantation in Nigeria are offered malaria testing and treatment. Two estimation strategies indicate a significant and substantial intent to treat effect of the intervention. The program increases worker weekly earnings by 11%–13% over the weeks following the offer, depending on the reference period, estimated using a between-worker estimator that exploits the experimental design. A within-worker estimate provides similar but smaller estimates of 8%–10%. We identify different pathways through which this effect occurs. For workers who test positive for malaria, the treatment of illness principally increases labor supply, leading to higher earnings. For workers who test negative, the health information leads to increased earnings via augmented daily productivity. This productivity response arises, in part, from selection into higher return tasks within their job at the plantation. The results underline the importance of medical treatment but also of improved access to information about one's health status, as the absence of either leads workers to work less or choose lower return tasks when working.

The coronavirus-19 pandemic and its secondary effects threaten the continuity of essential health services delivery, which may lead to worsened population health and a protracted public health crisis. We quantify such disruptions, focusing on maternal and child health, in eight sub-Saharan countries. Service volumes are extracted from administrative systems for 63 954 facilities in eight countries: Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone and Somalia. Using an interrupted time series design and an ordinary least squares regression model with facility-level fixed effects, we analyze data from January 2018 to February 2020 to predict what service utilization levels would have been in March–July 2020 in the absence of the pandemic, accounting for both secular trends and seasonality. Estimates of disruption are derived by comparing the predicted and observed service utilization levels during the pandemic period. All countries experienced service disruptions for at least 1 month, but the magnitude and duration of the disruptions vary. Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. We estimate a cumulative shortfall of 5 149 491 outpatient consultations and 328 961 third-dose pentavalent vaccinations during the 5 months in these eight countries. Decreases in maternal health service utilization are less generalized, although significant declines in institutional deliveries, antenatal care and postnatal care were detected in some countries. There is a need to better understand the factors determining the magnitude and duration of such disruptions in order to design interventions that would respond to the shortfall in care. Service delivery modifications need to be both highly contextualized and integrated as a core component of future epidemic response and planning.

Faced with COVID-19 (Coronavirus), countries are taking drastic action based on little information. Two tests can help governments shorten and soften economically costly suppression measures while still containing the novel coronavirus (COVID-19) pandemic. The first—a PCR assay—identifies people currently infected by testing for the presence of live virus in the subject. The second—an antibody test—identifies those rendered immune after being infected by searching for COVID-19-specific antibodies. The first test can help contain the disease because it facilitates the identification of infected persons, the tracing of their contacts, and isolation in the very early stages of an epidemic—or after a period of suppression, in case of a resurgent epidemic. The second can help us assess the extent of immunity in the general population or subgroups, to finetune social isolation and to manage health care resources. Wide application of the two tests could transform the battle against COVID-19 (Coronavirus), but implementing either on a large scale in developing countries presents challenges. The first test is generally available, but needs to be processed in adequately equipped laboratories with trained staff. The second test is easy to perform and can be processed quickly on the spot, but at this stage it is produced and available only on a limited basis in a few countries. This policy brief reviews the use of both tests, suggests strategies to target their use, and discusses the benefits and costs of such strategies. If PCR assay testing, together with tracing and isolation, helps reduce the duration of suppression measures by two weeks, and antibody testing allows one-fifth of the immune return to work early, the gain could be about 2 percent of national income, or about $8 billion for a country like the Philippines. Because the estimated economic benefits of the tests are likely to far outweigh the cost, the international community must help countries develop the capacity to process the first test and procure the second.

To evaluate the cost-effectiveness of results-based financing and input-based financing to increase use and quality of maternal and child health services in rural areas of Zambia.In a cluster-randomized trial from April 2012 to June 2014, 30 districts were allocated to three groups: results-based financing (increased funding tied to performance on pre-agreed indicators), input-based financing (increased funding not tied to performance) or control (no additional funding), serving populations of 1.33, 1.26 and 1.40 million people, respectively. We assessed incremental financial costs for programme implementation and verification, consumables and supervision. We evaluated coverage and quality effectiveness of maternal and child health services before and after the trial, using data from household and facility surveys, and converted these to quality-adjusted life years (QALYs) gained.Coverage and quality of care increased significantly more in results-based financing than control districts: difference in differences for coverage were 12.8% for institutional deliveries, 8.2% postnatal care, 19.5% injectable contraceptives, 3.0% intermittent preventive treatment in pregnancy and 6.1% to 29.4% vaccinations. In input-based financing districts, coverage increased significantly more versus the control for institutional deliveries (17.5%) and postnatal care (13.2%). Compared with control districts, 641 more lives were saved (lower-upper bounds: 580-700) in results-based financing districts and 362 lives (lower-upper bounds: 293-430) in input-based financing districts. The corresponding incremental cost-effectiveness ratios were 809 United States dollars (US$) and US$ 413 per QALY gained, respectively.Compared with the control, both results-based financing and input-based financing were cost-effective in Zambia.Évaluer le rapport coût-efficacité du financement axé sur les résultats et du financement axé sur les apports pour accroître l'utilisation et la qualité des services de santé maternelle et infantile dans les zones rurales de Zambie.Dans un essai randomisé par grappes mené d'avril 2012 à juin 2014, 30 districts ont été répartis en trois groupes: financement axé sur les résultats (hausse du financement liée aux performances vis-à-vis d'indicateurs préalablement définis), financement axé sur les apports (hausse du financement non liée aux performances) et groupe témoin (pas de financement supplémentaire), qui représentaient respectivement une population de 1,33, 1,26 et 1,40 millions de personnes. Nous avons estimé les coûts financiers supplémentaires de la mise en œuvre et de la vérification des programmes, des consommables et de la supervision. Nous avons évalué la couverture et la qualité des services de santé maternelle et infantile avant et après l'essai, à l'aide de données provenant d'enquêtes auprès des ménages et des établissements, et les avons converties en années de vie ajustées par la qualité (AVAQ) gagnées.La couverture et la qualité des soins ont nettement plus augmenté dans les districts recevant un financement axé sur les résultats que dans les districts témoins: la différence des différences en matière de couverture était de 12,8% pour les accouchements dans des structures médicales, de 8,2% pour les soins postnataux, de 19,5% pour les contraceptifs injectables, de 3,0% pour les traitements préventifs intermittents pendant la grossesse et de 6,1% à 29,4% pour les vaccinations. Dans les districts recevant un financement axé sur les apports, la couverture a nettement plus augmenté que dans les districts témoins pour ce qui est des accouchements dans des structures médicales (17,5%) et des soins postnataux (13,2%). Par rapport aux districts témoins, 641 vies supplémentaires ont été sauvées (bornes inférieure-supérieure: 580–700) dans les districts recevant un financement axé sur les résultats et 362 vies (bornes inférieure-supérieure: 293–430) dans les districts recevant un financement axé sur les apports. Les ratios coût-efficacité correspondants étaient respectivement de 809 dollars des États-Unis ($ US) et 413 $ US en plus par AVAQ gagnée.Comparés au groupe témoin, le financement axé sur les résultats et le financement axé sur les apports présentaient tous deux un rapport coût-efficacité positif en Zambie.Evaluar la relación entre el gasto y la efectividad de la financiación basada en los resultados y la financiación basada en insumos para aumentar el uso y la calidad de los servicios de salud materno-infantil en las zonas rurales de Zambia.En un ensayo aleatorio por conglomerados de abril de 2012 a junio de 2014, se asignaron 30 distritos a tres grupos: financiamiento basado en resultados (aumento de fondos ligados al desempeño en indicadores previamente acordados), financiamiento basado en insumos (aumento de fondos no vinculados a rendimiento) o control (sin financiación adicional), atendiendo poblaciones de 1,33, 1,26 y 1,40 millones de personas, respectivamente. Evaluamos los gastos financieros incrementales para la implementación y verificación del programa, los consumibles y la supervisión. Evaluamos la cobertura y la efectividad de la calidad de los servicios de salud materno-infantil antes y después del ensayo, utilizando datos de encuestas domiciliarias y de establecimientos, y los convertimos en años de vida ajustados por calidad (QALY) obtenidos.La cobertura y la calidad de la atención aumentaron más significativamente en el financiamiento basado en resultados que en los distritos de control: la diferencia de diferencias para la cobertura fue 12,8% para partos institucionales, 8,2% para el cuidado postnatal, 19,5% para anticonceptivos inyectables, 3,0% para el tratamiento preventivo intermitente en embarazo y de 6,1% a 29,4% para vacunas. En los distritos de financiación basados ​​en insumos, la cobertura aumentó más significativamente en comparación con el control para los partos institucionales (17,5%) y la atención posnatal (13,2%). En comparación con los distritos de control, se salvaron 641 vidas más (límites inferiores-superiores: 580-700) en distritos de financiamiento basado en resultados y 362 vidas (límites inferiores-superiores: 293-430) en distritos de financiamiento basados ​​en insumos. Las correspondientes ratios incrementales entre gasto y efectividad fueron de 809 dólares estadounidenses (USD) y de 413 USD por AVA, respectivamente.En comparación con el control, tanto el financiamiento basado en resultados como el basado en insumos fueron rentables en Zambia.تقييم فعالية تكلفة التمويل القائم على النتائج والتمويل القائم على المدخلات لزيادة استخدام خدمات الأمومة والطفولة الصحية وجودتها في المناطق القروية بزامبيا.في تجربة عنقودية معشاة استمرت من أبريل/نيسان 2012 إلى يونيو/حزيران 2014، قسم البنك الدولي 30 مقاطعة إلى ثلاث مجموعات: تمويل قائم على النتائج (حيث ترتبط زيادة التمويل بالأداء القائم على مؤشرات مُتفق عليها مُسبقًا)، أو تمويل قائم على المدخلات (حيث لا يوجد ارتباط بين زيادة التمويل والأداء) أو التحكم (لا يوجد تمويل إضافي)، وذلك لخدمة مجتمعات سكانية يبلغ تعدادها 1.33، و1.26 و1.40 مليون نسمة، على الترتيب. حيث قمنا بتقدير التكاليف المالية الإضافية اللازمة لتطبيق البرنامج والتحقق من المواد الاستهلاكية والإشراف. وقمنا بتقييم تغطية خدمات الأمومة والطفولة الصحية وفعالية جودتها قبل التجربة وبعدها، باستخدام البيانات المستخرجة من الاستقصاءات المنزلية والخدمية، وتحويل هذه البيانات إلى عدد سنوات عمر معدلة بحسب جودة الحياة (QALYs) المكتسبة.تصاعدت التغطية والجودة بشكل مميز أكثر في التمويل القائم على النتائج عن مقاطعات التحكم: فرق الاختلافات للتغطية كان 12.8% للولادة بالمؤسسات، 8.2% للرعاية بعد الولادة، و19.5% لوسائل منع الحمل التي تؤخذ بالحقن، و3.0% العلاج الوقائي الدوري أثناء الحمل و6.1% إلى 29.4% للتحصينات. في مقاطعات التمويل القائم على المدخلات، تصاعدت التغطية بشكل مميز أكثر مقابل التحكم بالنسبة للولادة بالمؤسسات (17.5%) والرعاية بعد الولادة (13.2%). مقارنةً بمقاطعات التحكم، حيث تم إنقاذ 641 شخصاً إضافياً (الحدود الدنيا-العليا: 580-700) في مقاطعات التمويل القائم على النتائج و362 شخصاً (الحدود الدنيا-العليا: 293-430) في مقاطعات التمويل القائم على المدخلات. وكانت معدلات فعالية التكلفة الإضافية 809 دولار أمريكي (US$) و413 دولار أمريكي لكل عدد سنوات عمر معدلة بحسب جودة الحياة المكتسبة على الترتيب.مقارنةً بالتحكم، كانت نتائج كلاً من التمويل القائم على النتائج والتمويل القائم على المدخلات أكثر فعالية من حيث التكلفة في زامبيا.旨在评估基于结果融资和基于投入融资的成本效益，以提高赞比亚农村地区妇幼保健服务的使用率和质量。.在 2012 年 4 月至 2014 年 6 月的一项集群随机化试验中，30 个地区被划分为三组：基于结果融资（增加资金与拟议指标的绩效挂钩）、基于投入融资（增加资金未与绩效捆绑）或对照组（无额外资金），服务人群分别为 133 万、126 万和 140 万。我们评估了项目实施和验证、消耗品和监督的增量财务成本。我们使用来自家庭和机构的调查数据，评估了试验前后的母婴健康服务的覆盖率和质量有效性，并将这些数据转换为获得的质量调整寿命年 (QALYs)。.基于结果融资的覆盖率和护理质量明显高于对照组：住院分娩覆盖率的双重差分分析为 12.8％，产后护理为 8.2％，注射避孕药为 19.5％，妊娠间歇性预防性治疗为 3.0％，接种疫苗为 6.1％ 至 29.4％。与对照组相比，在基于投入融资的地区，住院分娩 (17.5％) 和产后护理 (13.2％) 的覆盖率显著增加。与对照组相比，基于结果融资的地区挽救了 641 条生命（下限-上限：580-700），基于投入融资的地区挽救了 362 条生命（下限-上限：293-430）。相应的增量成本效益比率分别为每质量调整寿命年增加 809 美元 (US$) 和 413 美元 (US$)。.与对照组相比，基于结果融资和基于投入融资在赞比亚均具有成本效益。.Оценка рентабельности финансирования на основе результатов и затратного финансирования для улучшения использования и повышения качества медицинского обслуживания матерей и детей в сельской местности Замбии.В кластерном рандомизированном исследовании, проводившемся с апреля 2012 г. по июнь 2014 г., 30 районов были поделены на три группы: финансирование по результатам (увеличение финансирования по результатам деятельности согласно предварительно согласованным показателям), затратное финансирование (увеличение финансирования, не зависящее от результатов деятельности) и контрольная группа (отсутствие дополнительного финансирования). Эти группы подразумевали обслуживание 1,33; 1,26 и 1,40 млн человек соответственно. Была проведена оценка дополнительных финансовых расходов, связанных с реализацией и контролем выполнения программы, расходными материалами и надзором. Авторы проанализировали охват населения, а также качество и эффективность медицинского обслуживания матерей и детей до и после проведения исследования, используя данные, полученные в ходе опросов семейств и медицинских учреждений, и получили показатель продолжительности жизни, скорректированный по качеству (QALY).Охват населения и качество медицинского обслуживания значительно возросли в группе финансирования по результатам в сравнении с районами контрольной группы: разница различий в охвате населения составила 12,8% для родов в медицинских учреждениях, 8,2% для послеродового ухода, 19,5% для инъекционных контрацептивов, 3,0% для периодического профилактического лечения во время беременности и от 6,1 до 29,4% для вакцинаций. В районах группы затратного финансирования охват населения медицинским обслуживанием значительно увеличился в сравнении с контрольной группой для родов в медицинских учреждениях (17,5%) и послеродового ухода (13,2%). В сравнении с районами контрольной группы в районах группы финансирования по результатам было спасено на 641 жизнь больше (нижняя-верхняя границы: 580–700), а в районах группы затратного финансирования — на 362 жизни больше (нижняя-верхняя границы: 293–430). Соответствующие коэффициенты прироста рентабельности составили соответственно 809 и 413 долларов США для полученных показателей продолжительности жизни, скорректированных по качеству (QALY).Группы финансирования по результатам и группы затратного финансирования оказались более рентабельными в сравнении с контрольной группой в Замбии.

Could a partial subsidy for child education increase children's participation in paid work? In contrast to much of the theoretical and empirical child labor literature, this paper shows that child work and school participation can be complements under certain conditions. Using data from the randomized evaluation of a conditional cash transfer program in the Philippines, the analysis finds that some children, who were in neither school nor work before the program, increased participation in school and work-for-pay after the program. Earlier cash transfer programs, notably those in Mexico, Brazil, and Ecuador, increased school attendance while reducing child labor. Those programs fully offset schooling costs, while the transfers under the Philippine transfers fall short of the full costs of schooling for a typical child. As a result, some beneficiary children from poor Philippine households increased work to support their schooling. The additional earnings from this work represent a substantive share of the shortfall in the schooling costs net of transfer. The paper rules out several potential alternative explanations for the increase in child labor, including changes in household productive activities, adult labor supply, and household expenditure patterns that, in principle, can arise after a cash transfer and may also affect the supply of or demand for child labor.

We study the relationship between physical activity as a direct measure of effort and productivity. First, we evaluate the association of agricultural workers’ physical activity with their daily productivity, which is directly observed from company personnel piece-rate payment records, and find a positive correlation. Second, we estimate the impact of a health intervention that provides malaria testing and treatment on physical activity and productivity. The results indicate that the increased daily productivity of malaria positive workers who are offered this program is explained by worker effort reallocation from lower intensity to higher intensity work. This demonstrates that, when individual productivity is observed, physical activity measures can help disentangle productivity effects that are attributable to effort. When productivity is unobserved, physical activity measures may proxy for productivity in physically demanding tasks. We discuss challenges and limitations of physical activity measurement, their potential use for alternative contexts, and the importance of field and data analysis protocols.

Despite increased investments in procurement of essential medicines, their availability at health facilities remains extremely low in many low- and middle-income countries. The lack of a well-functioning supply chain for essential medicines is often the cause of this poor availability. Using a randomized trial conducted in 439 health facilities and 24 districts in Zambia, this study helps understand the optimal supply chain structure for essential medicines distribution in the public sector in low-income countries. It shows that a more direct distribution system where clinics order and receive medicines supply directly from the central agency through a cross-docking arrangement significantly reduces the duration and frequency of stockouts compared to a traditional three-level drug distribution system. As an example, the frequency of stockouts for first line pediatric malaria medicines reduced from 47.9% to 13.3% and the number of days of stockout in a quarter reduced from 27 days to 5 days. The direct flow of demand and order information from health facilities to the central supply agency reduces the problem of diffuse accountability that exists in multi-tiered distribution systems. It also shifts the locus of decision making for complex supply chain functions such as scarce stock allocation and adjustment of health facility order quantities to levels in the system where staff competency is aligned with what the function needs. Even when supply chain system redesign such as the one evaluated in this paper are demonstrated to be technically robust using rigorous evidence, they often require navigating a complex political economy within the overall health system and its actors.

Independent verification is a critical component of performance-based financing (PBF) in health care, in which facilities are offered incentives to increase the volume of specific services but the same incentives may lead them to over-report. We examine alternative strategies for targeted sampling of health clinics for independent verification. Specifically, we empirically compare several methods of random sampling and predictive modeling on data from a Zambian PBF pilot that contains reported and verified performance for quantity indicators of 140 clinics. Our results indicate that machine learning methods, particularly Random Forest, outperform other approaches and can increase the cost-effectiveness of verification activities.

Background Performance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers’ job satisfaction, motivation, and attrition in Zambia. It uses a randomized intervention/control design to evaluate before–after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group. Methods Mixed methods are employed. The quantitative portion comprises of a baseline and an endline survey. The survey and sampling scheme were designed to allow for a rigorous impact evaluation of PBF or C1 on several key performance indicators. The qualitative portion seeks to explain the pathways underlying the observed differences through interviews conducted at the beginning and at the three-year mark of the PBF program. Results Econometric analysis shows that PBF led to increased job satisfaction and decreased attrition on a subset of measures, with little effect on motivation. The C1 group also experienced some positive effects on job satisfaction. The null results of the quantitative assessment of motivation cohere with those of the qualitative assessment, which revealed that workers remain motivated by their dedication to the profession and to provide health care to the community rather than by financial incentives. The qualitative evidence also provides two explanations for higher overall job satisfaction in the C1 than in the PBF group: better working conditions and more effective supervision from the District Medical Office. The PBF group had higher satisfaction with compensation than both control groups because they have higher compensation and financial autonomy, which was intended to be part of the PBF intervention. While PBF could not address all the reasons for attrition, it did lower turnover because those health centers were staffed with qualified personnel and the personnel had role clarity. Conclusions In Zambia, the implementation of PBF schemes brought about a significant increase in job satisfaction and a decrease in attrition, but had no significant effect on motivation. Enhanced health financing also increased stated job satisfaction. Electronic supplementary material The online version of this article (doi:10.1186/s12960-017-0179-2) contains supplementary material, which is available to authorized users.

There is wide variation in how consumption is measured in household surveys both across countries and over time. This variation may confound welfare comparisons in part because these alternative survey designs produce consumption estimates that are differentially influenced by contrasting types of survey response error. Although previous studies have documented the extent of net error in alternative survey designs, little is known about the relative influence of the different response errors that underpin a survey estimate. This study leverages a recent randomized food consumption survey experiment in Tanzania to shed light on the relative influence of these various error types. The observed deviation of measured household consumption from a benchmark is decomposed into item-specific consumption incidence and consumption value so as to investigate effects related to (a) the omission of any consumption and then (b) the error in value reporting conditional on positive consumption. The results show that various survey designs exhibit widely differing error decompositions, and hence a simple summary comparison of the total recorded consumption across surveys will obscure specific error patterns and inhibit the lessons for improved consumption survey design. In light of these findings, the relative performance of common survey designs is discussed, and design lessons are drawn to enhance the accuracy of item-specific consumption reporting and, consequently, the measures of total household food consumption. ispartof: Food Policy vol:72 pages:94-111 status: published

BACKGROUND Pantawid, a conditional cash transfer (CCT) program in the Philippines, provided grants conditioned on health-related behaviors for children aged 0-5 y and schooling for those aged 10-14 y. OBJECTIVE We investigated whether Pantawid improved anthropometric measurements in children aged 6-36 mo. METHODS We estimated cross-sectional intention-to-treat effects using a 2011 cluster-randomized trial across 130 villages-65 treated and 65 control-with data collected after 31 mo of implementation. Anthropometry characteristics were measured for 241 children in treated areas and 244 children in control areas. Health service use for children aged 6-36 mo and dietary intake for those aged 6-60 mo also were measured. Outcome variables were height-for-age z scores (HAZs) and weight-for-age z scores (WAZs), stunting, severe stunting, underweight, and severely underweight. Impact also was assessed on perinatal care, institutional delivery, presence of skilled birth attendant, breastfeeding practices, immunization, growth monitoring and deworming, care-seeking, and children's intake of protein-rich foods. RESULTS Pantawid was associated with a significant reduction in severe stunting [

Does the sex composition of existing children in a family affect fertility behavior? An unusually large data set, covering 64 countries and some 5 million births, is used to show that fertility behavior responds to the presence--or absence--of sons in many regions of the developing world. The response to the absence of sons is particularly large in Central Asia and South Asia. Modernization does not appear to reduce this differential response. For example, in South Asia the fertility response to the absence of sons is larger for women with more education and has been increasing over time. The explanation appears to be that a latent demand for sons is more likely to manifest itself when fertility levels are low. As a result of this differential fertility behavior, girls tend to grow up with significantly more siblings than do boys, with potential implications for their well-being when quantity--quality tradeoffs result in fewer material and emotional resources allocated to children in larger families. Copyright The Author 2009. Published by Oxford University Press on behalf of the International Bank for Reconstruction and Development / the world bank . All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org, Oxford University Press.

The 1997 Indonesian financial crisis resulted in severe economic dislocation and political upheaval. Previous studies have established the detrimental consequences for economic welfare, physical health, and child education. The crisis also affected the psychological well-being of the Indonesian people. Comparing responses of the same individuals interviewed before and after the crisis, this study documents substantial increases in several dimensions of psychological distress among men and women across the age distribution. It shows larger impacts of the economic crisis on the more vulnerable groups, including those with low education, the rural landless, urban residents, and those in provinces most affected by the crisis. Elevated psychological distress persists even after the economy returns to precrisis levels, suggesting that the deleterious effects of the crisis may persist longer on the psychological well-being of the Indonesian population than on standard measures of economic well-being. Copyright The Author 2008. Published by Oxford University Press on behalf of the International Bank for Reconstruction and Development / the world bank . All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org, Oxford University Press.

There is wide variation in how consumption is measured in household surveys, both across countries and over time. This variation may confound welfare comparisons in part because these alternative survey designs produce consumption estimates differentially influenced by contrasting types of survey response error. While previous studies have documented the extent of net error in alternative survey designs, little is known about the relative influence of the different response errors that underpin a survey estimate. This study leverages a recent randomized food consumption survey experiment in Tanzania to shed light on the relative influence of these various error types. The observed deviation of measured household consumption from a benchmark is decomposed into item-specific consumption incidence and consumption value so as to investigate effects related to (a) the omission of any consumption and then (b) the error in value reporting conditional on positive consumption. Results show that various survey designs exhibit widely differing error decompositions and hence a simple summary comparison of the total recorded consumption across surveys will obscure specific error patterns and inhibit lessons for improved consumption survey design. In light of these findings, the relative performance of common survey designs are discussed and design lessons are drawn in order to enhance the accuracy of item-specific consumption reporting and, consequently, measures of total household food consumption.

There is widespread interest in estimating the number of hungry people in the world as well as trends in hunger. Current global counts rely on combining each country’s total food balance with information on distribution patterns from household consumption expenditure surveys. Recent research has advocated for calculating hunger numbers directly from these same surveys, which are increasingly available in low-income countries. For either approach, embedded in this effort are a number of important details about how household surveys are designed and how these data are then used. Using a survey experiment in Tanzania, this study finds great fragility in hunger counts stemming from alternative survey designs. As such, caution should be taken in drawing inferences on hunger over time and space based on household surveys. ispartof: Economic Development and Cultural Change vol:64 issue:4 pages:727-758 status: published

There is widespread interest in estimating the number of hungry people in the world and trends in hunger. Current global counts rely on combining each country’s total food balance with information on distribution patterns from household consumption expenditure surveys. Recent research has advocated for calculating hunger numbers directly from these same surveys. For either approach, embedded in this effort are a number of important details about how household surveys are designed and how these data are then used. Using a survey experiment in Tanzania, this study finds great fragility in hunger counts stemming from alternative survey designs. As a consequence, comparable hunger numbers will be lacking until more effort is made to either harmonize survey designs or better understand the consequences of survey design variation. ispartof: LICOS Discussion paper series 365/2015 pages:1-37 status: published

There is widespread interest in estimating the number of hungry people in the world and trends in hunger. Current global counts rely on combining each country’s total food balance with information on distribution patterns from household consumption expenditure surveys. Recent research has advocated for calculating hunger numbers directly from these same surveys. For either approach, embedded in this effort are a number of important details about how household surveys are designed and how these data are then used. Using a survey experiment in Tanzania, this study finds great fragility in hunger counts stemming from alternative survey designs. As a consequence, comparable hunger numbers will be lacking until more effort is made to either harmonize survey designs or better understand the consequences of survey design variation.

Despite increased investments in health commodity procurement, the availability of essential medicines at health facilities remains very low in many low and middle income countries. The lack of a well-functioning supply chain for essential medicines is often the cause of this poor availability. Using a randomized experiment conducted in over 400 health facilities and 24 districts in Zambia, this study helps understand the optimal supply chain structure for essential medicines distribution in the public sector in low income countries. It focuses on the availability of 15 essential medicines at the health facility level and compares between a cross-dock based two-tier distribution network and a three-tier network. The study shows that a two-tier “cross-dock” like system out-performs a traditional three-tier drug distribution system due to better information flow and better management accountability even though stock is positioned closer to the health facilities in the three-tier system. Results from the study advance existing knowledge in the area of public sector distribution system design in general and drug distribution systems in developing countries in particular.

Agricultural and other physically demanding sectors are important sources of growth in developing countries but prevalent diseases such as malaria adversely impact the productivity, labor supply, and occupational choice of workers in these sectors by reducing physical capacity. This study identifies the impact of malaria on worker earnings, labor supply, and daily productivity by randomizing the temporal order at which piece-rate workers at a large sugarcane plantation in Nigeria are offered malaria testing and treatment. The results indicate a significant and substantial intent to treat effect of the intervention – the offer of a workplace based malaria testing and treatment program increases worker earnings by approximately 10% over the weeks following the mobile clinic visit. The study further investigates the effect of health information by contrasting program effects by workers revealed health status. For workers who test positive for malaria, the treatment of illness increases labor supply, leading to higher earnings. For workers who test negative, and especially for those workers most likely to be surprised by the healthy diagnosis, the health information also leads to increased earnings via increased productivity. Possible mechanisms for this response include selection into higher return occupations as a result of changes in the perceived cost of effort. A model of the worker labor decision that includes health perceptions in the decision to supply effort suggests that, in endemic settings with poor quality health services, inaccurate health perceptions may lead workers to misallocate labor thus resulting in sub-optimal production and occupational choice. The results underline the importance of medical treatment but also of access to improved information about one’s health status, as the absence of either may lead workers to deliver lower than optimal effort levels in lower return occupations.

Data from the nationally representative 1994 Inter-Censal Demographic Survey are used to examine the association between family size and children s schooling in Vietnam. The data provide information on several education measures for all children over age 10, including children no longer residing in the household. Although a clear inverse bivariate association between family size and children s school attendance and educational attainment is evident, multivariate analysis controlling for urban/rural residence, region, parents’ education, household wealth, and child’s age, reveals that much of this association, especially that predicting educational attainment, is attributable to these other influences. Moreover, much of the effect that remains after statistical adjustment for the other influences is seen mainly at the largest family sizes. We consider the implications of these findings for current population policy in Vietnam and the possible features of the Vietnamese context that might account for the modest association.

There is widespread interest in the number of hungry people in the world and trends in hunger. Current global counts rely on combining each country's total food balance with information on distribution patterns from household consumption expenditure surveys. Recent research has advocated for calculating hunger numbers directly from these same surveys. For either approach, embedded in this effort are a number of important details about how household surveys are designed and how these data are then used. Using a survey experiment in Tanzania, this study finds great fragility in hunger counts stemming from alternative survey designs. As a consequence, comparable and valid hunger numbers will be lacking until more effort is made to either harmonize survey designs or better understand the consequences of survey design variation.

This paper uses data from eight different consumption questionnaires randomly assigned to 4,000 households in Tanzania to obtain evidence on the nature of measurement errors in estimates of household consumption. While there are no validation data, the design of one questionnaire and the resources put into its implementation make it likely to be substantially more accurate than the others. Comparing regressions using data from this benchmark design with results from the other questionnaires shows that errors have a negative correlation with the true value of consumption, creating a non-classical measurement error problem for which conventional statistical corrections may be ineffective.

Background The focus of India’s National Malaria Programme witnessed a paradigm shift recently from health facility to community-based approaches. The current thrust is on diagnosing and treating malaria by community health workers and prevention through free provision of long-lasting insecticidal nets. However, appropriate community awareness and practice are inevitable for the effectiveness of such efforts. In this context, the study assessed community perceptions and practice on malaria and similar febrile illnesses. This evidence base is intended to direct the roll-out of the new strategies and improve community acceptance and utilization of services. Methods A qualitative study involving 26 focus group discussions and 40 key informant interviews was conducted in two districts of Odisha State in India. The key points of discussion were centred on community perceptions and practice regarding malaria prevention and treatment. Thematic analysis of data was performed. Results The 272 respondents consisted of 50% females, three-quarter scheduled tribe community and 30% students. A half of them were literates. Malaria was reported to be the most common disease in their settings with multiple modes of transmission by the FGD participants. Adoption of prevention methods was seasonal with perceived mosquito density. The reported use of bed nets was low and the utilization was determined by seasonality, affordability, intoxication and alternate uses of nets. Although respondents were aware of malaria-related symptoms, care-seeking from traditional healers and unqualified providers was prevalent. The respondents expressed lack of trust in the community health workers due to frequent drug stock-outs. The major determinants of health care seeking were socio-cultural beliefs, age, gender, faith in the service provider, proximity, poverty, and perceived effectiveness of available services. Conclusion Apart from the socio-cultural and behavioural factors, the availability of acceptable care can modulate the community perceptions and practices on malaria management. The current community awareness on symptoms of malaria and prevention is fair, yet the prevention and treatment practices are not optimal. Promoting active community involvement and ownership in malaria control and management through strengthening community based organizations would be relevant. Further, timely availability of drugs and commodities at the community level can improve their confidence in the public health system.

Despite the popularity and widespread implementation of school feeding programs, evidence of their impact on school participation and nutritional status is mixed. In this study the authors evaluate feeding programs in three districts of the Lao People's Democratic Republic (PDR). Feeding modalities included on-site feeding, take-home rations, and a combined modality. District-level implementation of the intervention sites and selective take-up presented considerable evaluation challenges. To address these, the authors use difference-indifference estimators with propensity-score weighting to construct plausible counterfactuals. The authors find minimal evidence that school feeding increased enrolment or improved nutritional status. Several robustness checks and possible explanations for null findings are presented.

Consumption expenditure has long been the preferred measure of household living standards. However, accurate measurement is a challenge and household expenditure surveys vary widely across many dimensions, including the level of reporting, the length of the reference period, and the degree of commodity detail. These variations occur both across countries and also over time within countries. There is little current understanding of the implications of such changes for spatially and temporally consistent measurement of household consumption and poverty. A field experiment in Tanzania tests eight alternative methods to measure household consumption on a sample of 4,000 households. There are significant differences between consumption reported by the benchmark personal diary and other diary and recall formats. Under-reporting is particularly relevant in illiterate households and for urban respondents completing household diaries; recall modules measure lower consumption than a personal diary, with larger gaps among poorer households and households with more adult members. Variations in reporting accuracy by household characteristics are also discussed and differences in measured poverty as a result of survey design are explored. The study concludes with recommendations for methods of survey based consumption measurement in low-income countries.

This article synthesizes the views of participants in two roundtables that were convened in Nairobi ( March 2007) and London ( July 2008) to identify key challenges to the prioritization of mental health in Africa and possible solutions. Participants included leading development experts and policy makers from head and country offices of international donors, national directors of mental health for several African countries, key mental health and public health professionals, epidemiologists, and an international nongovernmental organization. The challenges they identified to mainstreaming mental health include lack of understanding of the contribution of mental disorders to morbidity and mortality, competition for limited resources within health reform efforts, poor distribution of interventions and lack of inclusion of mental health among core generic health indicators, lack of economic research evidence, lack of a strategic approach to human resources planning, lack of partnerships with the social development sector, and mental health professionals' need for public health skills to effectively conduct national advocacy. Potential solutions include further investment in economic research, better strategic identification of the levers and entry points for integrating mental health into health sector reform plans, more vigorous engagement of mental health professionals in general health sector reforms, strengthening the linkage between mental health and social development, and intensive resource mobilization. In summary, partnerships, underpinned by collaborative training, research, and mutual dialogue with other health and nonhealth sectors, are needed. ( Psychiatric Services 61: 229-234, 2010)

The human consequences of the current global financial crisis for the developing world are presumed to be severe yet few studies have quantified such impact. The authors estimate the additional number of infant deaths in sub-Saharan Africa likely due to the crisis and discuss possible mitigation strategies. They pool birth-level data as reported in female adult retrospective birth histories from all Demographic and Health Surveys collected in sub-Saharan Africa nations. This results in a data set of 639,000 births to 264,000 women in 30 countries. The authors use regression models with flexible controls for temporal trends to assess an infant’s likelihood of death as a function of fluctuations in national income. They then apply this estimated likelihood to expected growth shortfalls as a result of the crisis. At current growth projections, their estimates suggest there will be 30,000 - 50,000 excess infant deaths in sub-Saharan Africa. Most of these additional deaths are likely to be poorer children (born to women in rural areas and lower education levels) and are overwhelmingly female. If the crisis continues to worsen the number of deaths may grow much larger, especially those to girls. Policies that protect the income of poor households and that maintain critical health services during times of economic contraction should be considered. Interventions targeted at female infants and young girls may be particularly beneficial.

Health and income are strongly correlated both within and across countries, yet the extent to which improvements in income have a causal effect on health status remains controversial. We revisit this question with an investigation of short-term fluctuations in aggregate income and infant mortality using an unusually large dataset of 59 developing countries, covering over 1.7 million births. Our focus is on the effect of departures of income from trend on infant mortality, rather than on the relationship between long-term changes in income and infant mortality. Given that we use unit data, rather than country averages, we can control for the changing composition of women giving birth, and assess how aggregate income shocks interact with a variety of characteristics of mothers and children, such as mothers education and the gender of the child. We show that there is a large, negative association between per capita GDP and infant mortalityon average, a one percent decrease in per capita GDP is associated with an increase in mortality of between 0.24 and 0.40 infants per 1,000 children born. Female infant mortality is more sensitive than male infant mortality to economic fluctuations, especially during negative shocks to GDP, suggesting that policies that protect the health status of female infants may be especially important during economic downturns in much of the developing world.

The social and economic consequences of poor mental health in the developing world are presumed to be significant, yet remain underresearched. This study uses data from nationally representative surveys in Bosnia and Herzegovina, Indonesia, and Mexico and from special surveys in India and Tonga to show similar patterns of association between mental health and socioeconomic characteristics. Individuals who are older, female, widowed, and report poor physical health are more likely to report worse mental health. Individuals living with others with poor mental health are also significantly more likely to report worse mental health themselves. In contrast, there is little observed relation between mental health and consumption poverty or education, two common measures of socioeconomic status. Indeed, the results here suggest instead that economic and multidimensional shocks, such as illness or crisis, can have a greater impact on mental health than poverty. This may have important implications for social protection policy. Also significant, the associations between poor mental health and lower labor force participation (especially for women) and more frequent visits to health centers suggest that poor mental health can have economic consequences for households and the health system. Mental health modules could usefully be added to multipurpose household surveys in developing countries. Finally, measures of mental health appear distinct from general subjective measures of welfare such as happiness. Copyright The Author 2008. Published by Oxford University Press on behalf of the International Bank for Reconstruction and Development / the world bank . All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org, Oxford University Press.

Background One-third of the world's population suffers from micronutrient deficiencies due primarily to inadequate dietary intake. Food fortification is often touted as the most promising short- to medium-term strategy for combating these deficiencies. Despite its appealing characteristics, progress in fortification has been slow. Objective To assess the potential of household food-purchase data to fill the food-consumption information gap, which has been an important factor contributing to the slow growth of fortification programs. Methods Household income and expenditure survey (HIES) data about: (a) a population's distribution of apparent household consumption, which are essential to setting safe fortification levels, (b) the proportion of households purchasing “fortifiable” food, and (c) the quantity of food being purchased were used to proxy food-consumption data and develop suggested fortification levels. Results The usefulness of the approach in addressing several common fortification program design issues is demonstrated. HIES-based suggested fortification levels are juxtaposed with ones developed using the most common current approach, which relies upon Food and Agriculture Organization (FAO) Food Balance Sheets. Conclusions Despite its limitations, the use of HIES data constitutes a generally unexploited opportunity to address the food-consumption information gap by using survey data that nearly every country of the world is already routinely collecting. HIES data enable the design of fortification programs to become more based on country-specific data and less on general rules of thumb. The more routine use of HIES data constitutes a first step in improving the precision of fortification feasibility analyses and improving estimates of the coverage, costs, and impact of fortification programs.

A family preference for sons over daughters may manifest itself in different ways, including higher mortality, worse health status, or lower educational attainment among girls. This study focuses on one measure of son preference in the developing world, namely the likelihood of continued childbearing given the gender composition of existing children in the family. The authors use an unusually large data set, covering 65 countries and approximately 5 million births. The analysis shows that son preference is apparent in many regions of the developing world and is particularly large in South Asia and in the Eastern Europe and Central Asia region. Modernization does not appear to reduce son preference. For example, in South Asia son preference is larger for women with more education and is increasing over time. The explanation for these patterns appears to be that latent son preference in childbearing is more likely to manifest itself when fertility levels are low. As a result of son preference, girls tend to grow up with significantly more siblings than boys do, which may have implications for their wellbeing if there are quantity-quality trade-offs that result in fewer material and emotional resources allocated to children in larger families.