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Casual Analysis of Unreliable Data for Strategising Child Development - A comment by D Narayana and response by Arnab Mukherji

COVID-19 has disrupted routine functioning of the economy and the delivery of welfare programs everywhere. Using the case of Karnataka, this paper document the size of the economic impact on both the state and its households, and the status of various child-specific schemes managed by the Government of Karnataka over 2020- 21. With shrinking household consumption and rising deficits of the state, there is need for operational focus on child development to ensure a healthy future for children in India. Using district level data from NFHS 5, this paper proposes a simple and easy- to-implement prioritization framework, which can be used to identify geographic focus for child development schemes in Karnataka, in order to address deficits that matter for the Global Hunger Index in a time of tightening budget constraints for both the state and households.

Background Hypothyroidism is a common endocrine disorder worldwide. Studies on the prevalence of hypothyroidism in different geographical territories of India are sparse. Data on the prevalence of hypothyroidism in India's coal mine areas are lacking. Therefore, we conducted a cross-sectional study to determine the prevalence of hypothyroidism in the adult population living in the coal mine areas of West Bokaro, Jharkhand, India. Methods In total, 1484 individuals of both sexes attending the outpatient department (OPD) of Tata Central Hospital, West Bokaro, Jharkhand, with varied symptoms were screened for thyroid-stimulating hormone (TSH) levels from January 2021 to February 2022. The age of the study participants ranged from 15 to 80 years. Results In total, 366 participants had hypothyroidism (subclinical as well as overt). The prevalence of hypothyroidism was greater in women than in men. Among the 366 patients with hypothyroidism, 311 were women and 55 were men, and the ratio was 5.5:1. The percentage of the population having hypothyroidism was 24% in this study, which is higher than that reported in other parts of India; however, our results are similar to those of a study conducted in Assam in 2017. Among patients with high TSH levels, 47%, 25%, and 19% had TSH in the range of 5.6-7.5, 7.6-10.6, and 10.6-20 μU/mL, respectively. Conclusions Subclinical and overt hypothyroidism are common in eastern India. Patients with undiagnosed fatigue and weight gain must be screened for TSH levels. Hypothyroidism is no longer a rarity, and coal mine areas are no exception to this phenomenon. A population‑based epidemiological study of thyroid disorders in coal mine areas is an urgent need.

Using the 2010 Transparency and Disclosure norms in India as a discontinuity in the institutional regime within which credit rating agencies operated, we use a difference-in-difference estimator to study how the market reacts to rating changes when regulatory norms require a higher level of transparency. Using data on the market and bank-based instruments from India we show that the market places greater premiums when ratings are generated in a regime with greater transparency and disclosure requirements. We find that the results are driven mostly by downgrades in ratings rather than upgrades, suggesting that the market responds more aggressively to downgrades. Transparency norms for credit rating agencies is an important governance feature even in emerging country credit markets.

Economic inequality determines collective goods provisioning as well as common pool resources outcomes. However, there is little theoretical or empirical understanding of how (if) inequality influences loss of commons. Using a comprehensive nationally representative dataset from India, we show why this relationship is ambiguous when local commons are governed under an incomplete decentralization regime where higher levels of government retain substantial residuary powers. We establish a non-monotonic relationship between economic inequality and local privatization of the commons within villages. However, economic inequality increases the likelihood of state-facilitated leasing of commons to private interests. We also delineate the role of social heterogeneity in alienation of commons. We use several empirical strategies to establish the robustness of our findings and mitigate possible endogeneity.

In this paper, we analyse two frequently used measures of the demand for health care, namely hospital visits and out-of-pocket health care expenditure, which have been analysed separately in the existing literature. Given that these two measures of healthcare demand are highly likely to be closely correlated, we propose a framework to jointly model hospital visits and out-of-pocket medical expenditure. Furthermore, the joint framework allows for the presence of non-linear effects of covariates using splines to capture the effects of aging on healthcare demand. Sample heterogeneity is modelled robustly with the random effects following Dirichlet process priors with explicit cross-part correlation. The findings of our empirical analysis of the U.S. Health and Retirement Survey indicate that the demand for healthcare varies with age and gender and exhibits significant cross-part correlation that provides a rich understanding of how aging affects health care demand, which is of particular policy relevance in the context of an aging population.

Using a multicity sample from India, we exploit city and fortnightly variation in air pollution to identify its causal effect on the incidence of a common respiratory ailment among children—cough. We account for key sources of confounding in this relationship with a two-way fixed effects estimation strategy. Our results show that air pollution, specifically, particulate matter, has a large and negative health effect that is robust to alternative specifications. These effects are three times larger for children living in slums in comparison to children living outside slums. This suggests that improving urban air quality can lead to equity-enhancing health gains in developing countries. In addition, our falsification tests are able to rule out the possibility that the identified effects are due to other diseases unrelated to air pollution.

This paper estimates the impact of social health insurance on financial risk by utilizing data from a natural experiment created by the phased roll-out of a social health insurance program for the poor in India. We estimate the distributional impact of insurance on of out-of-pocket costs and incorporate these results with a stylized expected utility model to compute associated welfare effects. We adjust the standard model, accounting for conditions of developing countries by incorporating consumption floors, informal borrowing, and asset selling which allow us to separate the value of financial risk reduction from consumption smoothing and asset protection. Results show that insurance reduces out-of-pocket costs, particularly in higher quantiles of the distribution. We find reductions in the frequency and amount of money borrowed for health reasons. Finally, we find that the value of financial risk reduction outweighs total per household costs of the insurance program by two to five times.

Using three months of data from financial diaries tracking daily cash flows of a group of microfinance borrowers in two urban slums in Karnataka, India, we show that the burgeoning microfinance sector faces a number of constraints. These households are borrowing from multiple sources, specifically multiple MFIs. Secondly, a large fraction of each household's budget is spent servicing loans with the two largest components of budget being loan repayment and food expenditure. Finally, households are observed to recycle their debts with over 27 per cent of fresh borrowings being spent on existing debts. These households in the urban slums of Ramanagaram are organizing their lives around multiple MFI memberships, multiple group meetings in a week and numerous repayment schedules. Apart from the stress to MFI clients of managing debts of small amounts from various MFIs, the Indian MFI sector will have to learn to grapple with the fallout of multiple memberships.

We analyse two frequently used measures of the demand for health—hospital visits and out-of-pocket health care expenditure—which have been analysed separately in the existing literature. Given that these two measures of health demand are highly likely to be closely correlated, we propose a framework to jointly model hospital visits and out-of-pocket medical expenditure, which allows for the presence of nonlinear effects of covariates using splines to capture the effects of aging on health demand. The findings from our empirical analysis of the US Health and Retirement Survey indicate that the demand for health varies with age.

Purpose Oral, breast, and cervical cancers are amenable to early detection and account for a third of India’s cancer burden. We convened a symposium of diverse stakeholders to identify gaps in evidence, policy, and advocacy for the primary and secondary prevention of these cancers and recommendations to accelerate these efforts. Methods Indian and global experts from government, academia, private sector (health care, media), donor organizations, and civil society (including cancer survivors and patient advocates) presented and discussed challenges and solutions related to strategic communication and implementation of prevention, early detection, and treatment linkages. Results Innovative approaches to implementing and scaling up primary and secondary prevention were discussed using examples from India and elsewhere in the world. Participants also reflected on existing global guidelines and national cancer prevention policies and experiences. Conclusions Symposium participants proposed implementation-focused research, advocacy, and policy/program priorities to strengthen primary and secondary prevention efforts in India to address the burden of oral, breast, and cervical cancers and improve survival.

Objectives To evaluate the effects of a government insurance program covering tertiary care for people below the poverty line in Karnataka, India, on out-of-pocket expenditures, hospital use, and mortality. Design Geographic regression discontinuity study. Setting 572 villages in Karnataka, India. Participants 31 476 households (22 796 below poverty line and 8680 above poverty line) in 300 villages where the scheme was implemented and 28 633 households (21 767 below poverty line and 6866 above poverty line) in 272 neighboring matched villages ineligible for the scheme. Intervention A government insurance program (Vajpayee Arogyashree scheme) that provided free tertiary care to households below the poverty line in about half of villages in Karnataka from February 2010 to August 2012. Main outcome measure Out-of-pocket expenditures, hospital use, and mortality. Results Among households below the poverty line, the mortality rate from conditions potentially responsive to services covered by the scheme (mostly cardiac conditions and cancer) was 0.32% in households eligible for the scheme compared with 0.90% among ineligible households just south of the eligibility border (difference of 0.58 percentage points, 95% confidence interval 0.40 to 0.75; P

In this paper, we analyse two frequently used measures of the demand for health care, namely hospital visits and out-of-pocket health care expenditure, which have been analysed separately in the existing literature. Given that these two measures of healthcare demand are highly likely to be closely correlated, we propose a framework to jointly model hospital visits and out-of-pocket medical expenditure. Furthermore, the joint framework allows for the presence of non-linear effects of covariates using splines to capture the effects of aging on healthcare demand. Sample heterogeneity is modelled robustly with the random effects following Dirichlet process priors with explicit cross-part correlation. The findings of our empirical analysis of the U.S. Health and Retirement Survey indicate that the demand for healthcare varies with age and gender and exhibits significant cross-part correlation that provides a rich understanding of how aging affects health care demand, which is of particular policy relevance in the context of an aging population.

We propose a joint model to combine models for hospital visits and out-of-pocket medical expenditures. It allows for the presence of non-linear effects of covariates using splines to capture the effects of aging on healthcare demand. Sample heterogeneity is modeled robustly with the random effects following Dirichlet process priors with explicit cross-part correlation. We validate our model using a simulation study. We apply this model to Health and Retirement Survey data and show that healthcare varies with age and gender and exhibits significant cross-part correlation that provides a richer understanding of how aging affects healthcare demand.

Economic development and inequality is known to have an impact on health outcomes. We show this to be true in India where we study the effect of economic status on under and over nutrition. Inequality is measured using income or assets and we show that both matter for malnutrition. We find women are at much higher risk of being malnourished and this risk increases with age. Our results suggest that while under nutrition should remain a policy priority, rising over nutrition in the population cannot be ignored by nutritional planners.

Inventory Management has emerged as one of the important tools to improve operational efficiency over the last 30-40 years across the globe. Japanese companies such as Toyota pioneered lean manufacturing, which emphasizes on the need to maintain low inventory levels across the supply chain through practices like JIT, Kanban and vendor managed inventory etc. Anecdotal evidence suggests that, inventory levels in general have been falling in the Indian manufacturing industries too in the recent past. The Japanese influence on the Indian manufacturing industry began with the entry of Suzuki into the Indian automobile industry in mid eighties. Since then, the principles of lean manufacturing have permeated across many industries, especially the automotive sector in India. However, there is scant empirical research in the literature that documents the inventory trends and the determining factors in India. The current study aims at filling this gap through a comprehensive inventory trend analysis in the Indian automotive industry during the 14 year period 1992-2005 with an objective to determine the inventory trends and identify the influencing factors. We use advanced econometric models to study the impact of various factors, such as the firm’s cluster, tier, export and import intensity on inventory levels. The study finds that average inventory has been steadily declining, with all three inventory components, viz., raw material, work-in-process and finished goods inventory contributing to this decline. The results suggest that the efficient working capital management and the quality improvement efforts of Tier 1 firms have been one of the major contributions to the decline in average inventory levels in the Indian auto industry.

This article investigates the role of public funds in ensuring that primary schools in India have at least a certain minimum number of instructional days. Using data on primary schools from three districts, we first document that the distribution of instructional days may reasonably be thought of as a binary variable where a school is either functional (Le., with more than 201 instructional days) or is not (i.e., has less than 201 instructional days). Secondly, we show that receiving any public funds is important for schools to be functional; however, the marginal effect of doses of public funding diminishes with larger amounts of funding. Finally, monitoring schools in terms of the number of academic visits, visits by BR.C and CRC coordinators as well as the presence of head teachers are important in ensuring that primary schools are functional in the sense that we have defined. These findings seem to point to important ways to improve the quality of primary schooling in India.

We provide the preliminary analysis of a three month pilot study tracking the daily cash inflows and outflows of twenty households in two urban slums of Ramanagaram, indebted to micro-credit organizations. Indebtedness of many of these households to multiple MFls was a result that came out very strongly from the analysis of the daily cash transactions of these financial diaries. Secondly, a rather disturbing finding related to this, is the size of each household's budget that goes towards servicing loan repayments. Loan repayments vied with food in the expenditure profiles of most of these households. Reinforcing this is our third finding that households are observed to recycle their debts to a substantial extent as evidence by over 27% of borrowings being used to finance various kinds of borrowings (including MFI and SHG borrowings). The fact that most of these borrowings are taken as small sums from several entities also does not boost the use of these funds towards productive purposes. All this points towards some pressing issues that need to be addressed in the fast-track growth of the microfinance sector in urban India.

Immunization coverage in India is far from complete with a disproportionately large number of rural children not being immunized. We carried out this study to examine the role of health infrastructure and community health workers in expanding immunization coverage in rural India.The sample consisted of 43,416 children aged 2-35 months residing in rural India from the National Family Health Surveys (NFHS) conducted in 1993 and 1998. We estimated separate multinomial logit regression models for polio and non polio vaccines that estimated the probability that a child would receive "no cover," "some cover" or "full age-appropriate cover." The key measure of health infrastructure was a hierarchical variable that assigned each child to categories (no facility, dispensary or clinic, sub-centre, primary health care centre, and hospital) based on the best health facility available in the child's village. We also included variables capturing the availability of various types of community health workers in the village and other health infrastructure.While there was under-provision of rural health infrastructure, our results showed that the availability of health infrastructure had only a modest effect on immunization coverage. Larger and better-equipped facilities had bigger effects on immunization coverage. The presence of community health workers in the village was not associated with increased immunization coverage.Our findings suggest that expanding the availability of fixed health infrastructure is unlikely to achieve the goal of universal coverage. Reforming community outreach programmes might be better strategy for increasing immunization coverage.

This paper examines the relationship between democratic institutions and domestic crime. We model the motivation for inciting crime in a two party setting and show that investment in con‡ictual campaigning is higher in economies characterized by weak institutions. We then test this prediction on a panel of forty five countries over a period of seven years. Using elections as a defning feature of democracies and controlling for social and economic determinants of crime, we explore whether crime (measured by murders per hundred thousand people) goes up during election as compared to non-election years. We show that the relationship between crime and elections is positive and signinificant in less developed countries while there is no evidence of such a relationship in the developed countries. We also examine the impact of political systems (presidential versus parliamentary) and voting rules (proportional versus plurality systems) on the incidence of domestic crime rates. Our results show that these differences do not have a statistically significant impact on the incidence of crime during elections.

In the current paper, using a sample data of 58 firms consisting of automakers and auto component suppliers across a 14-year period, we study the factors contributing to efficient inventory management in the Indian automotive Industry. We use fixed effects regression models to document trends in inventory holdings over time and how this varies across inventory types and across tiers in the supply chain. Our results show that inventory holdings have declined differentially across tiers and across different types of inventories. We find tier-1 suppliers reduced all components of their inventories with the help of TQM and lean efforts.

Aluminium diffusion treated steel by pack process using ferroaluminium was studied for its heat exchanger tube applications properties. The laboratory and inplant corrosion studies reveal that the diffusion treated low carbon steel is extremely resistant to hot corrosion due to sulphurous gases encountered in heat exchanger tubes of sulphuric acid plants at the operating temperatures. The diffusion treated tubes have shown adequate physical properties for heat exchanger tube bundle fabrication.

This article examines the functioning of a community-driven development (CDD) project that, unlike most CDDs, was set in a homogeneous community, consisted of simple tasks, had a year-long pre-inte...

Poverty, health, and income opportunities are closely intertwined, particularly in developing countries. The importance of a strong health system remains undiminished even as challenges for managing health have become more complex. While some of the issues are common across health systems, India's health system has certain additional features that make it particularly challenging. Despite these challenges, a number of interesting business models have developed to provide low-cost care without compromising on quality of care. This paper highlights some of the India-specific issues and discusses the idea of the Right to Health as an approach to providing universal health care.