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Teketel Addise,1 Tadesse Alemayehu,2 Nega Assefa,2 Desta Erkalo3 1Anilemo District Health Office, Hadiya Zone, Southern Ethiopia; 2College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 3College of Medicine and Health Sciences, Wachemo University, Hosanna, EthiopiaCorrespondence: Desta ErkaloCollege of Medicine and Health Sciences, Wachemo University, Hosanna, EthiopiaEmail erkde12@gmail.comBackground: Community-based health insurance (CBHI) schemes are an emerging strategy for providing financial protection against healthcare-related poverty. In Ethiopia, CBHI is being piloted in 13 districts, but community experience and satisfaction with the scheme have yet to be studied.Objective: To assess the magnitude of satisfaction and associated factors among household heads who visited health facilities with community-based health insurance schemes in the Anilemo district Hadiya Zone Southern Ethiopia.Methods: A community-based cross-sectional study design was conducted for 627 household heads in the Anilemo district, from March 1– 30, 2020. Study participants were selected using stratified random sampling for kebeles and systematic sampling for study households. Data were collected by trained data collectors using a pre-tested structured questionnaire. Descriptive statistics, bivariate, and multivariate logistic regression analyses were performed. P values less than 0.05 with 95% confidence intervals were used to determine associations between independent and dependent variables.Results: The magnitude of household heads’ satisfaction was 54.1%. Household heads age [AOR=1.70;95% CI 1.09– 2.67], households income [AOR=0.19; 95% CI 0.11– 0.35], knowledge of CBHI benefit packages [AOR=3.15; 95% CI 1.97– 5.03], agreement with laboratory services [AOR=2.25; 95% CI 1.40– 3.62], and got and agreed with prescribed drugs [AOR=2.69; 95% CI 1.66– 4.37] were significantly associated with the magnitude of household heads satisfaction with community-based health insurance.Conclusion: About half of the household heads who visited health facilities with CBHIS were satisfied. Age, household’s income, knowledge of CBHI benefit packages, agreement with laboratory service provision, availability and agreement with prescribed drugs were significant predictors of satisfaction with CBHI. Therefore, much effort could be required to increase the magnitude of the household head’s satisfaction with the scheme.Keywords: community-based health insurance, satisfaction, household heads

Uganda’s progress in reducing poverty from 1993 to 2006 is a remarkable story of success that has been well told. The narrative of Uganda’s continued, albeit it slightly slower, progress in reducing poverty since 2006 is less familiar. This was a period in which growth slowed as the gains from reforms years earlier had been fully realized, and weak infrastructure and increasing corruption increasingly constrained private sector competitiveness (World Bank 2015). This report examines Uganda’s progress in reducing poverty, with a specific focus on the period 2006 to 2013. The report shows that high growth from 2006 to 2010 benefited poverty reduction. Before turning in further detail to the key findings of the report, it is important to note that the analysis undertaken in this report is only possible because the Government of Uganda has invested in a high quality series of household surveys to document progress in wellbeing since 1993. The Uganda Bureau of Statistics has conducted high-quality household surveys that every three to four years that have provided a comparable series of data on poverty and other household characteristics for the last twenty years. Uganda is one of the few countries in the region to have achieved this level of comparable, frequent poverty monitoring over time. Without this, it would not be possible to document the lessons Uganda provides.

The rural economy in Bangladesh has been a powerful source of economic growth and has substantially reduced poverty, especially since 2000, but the remarkable transformation and unprecedented dynamism in rural Bangladesh are an underexplored, underappreciated, and largely untold story. The analysis identifies the key changes occurring in the rural economy, the principal drivers of rural incomes, the implications for policy, and related actions to foster future growth, further reduce poverty, and improve food security and nutrition. A substantial strength of this study is its empirical foundation, consisting of three sets of detailed data on rural households. Two of the datasets are unique in tracking the same set of households for more than two decades. These data make it possible to examine how change is occurring within and among rural households; they shed considerable light on trends that tend to be obscured at more aggregate levels of analysis. Nationally representative surveys and aggregate secondary data provide complementary and contextually rich insights into the household data.

Moldova has experienced rapid economic growth in the past decade, which has been accompanied by reductions in poverty and good performance in shared prosperity. Nonetheless, Moldova remains one of the poorest countries in Europe and faces challenges in sustaining the progress. The challenges for progress include spatial and cross-group inequalities, particularly because of unequal access to assets, services and economic opportunities. Moreover, strengthening the persistently weak labor markets to boost employment, especially in the nonfarm sectors, is critical for sustaining progress toward the twin goals of reducing poverty and expanding shared prosperity and for addressing the problems associated with an aging population in a fiscally responsible manner. Accordingly, ensuring the viability of the pension system and improving social assistance are necessary areas of reform, particularly in a context of fiscal pressures, the aging population, and the great vulnerability of the poor to shocks. The Moldova poverty assessment 2016 includes three prongs of analysis: this report, which explores trends and the drivers of poverty and shared prosperity, and the accompanying analyses, ‘a jobs diagnostic for Moldova’ and ‘structural transformation of Moldovan small-holder agriculture and its poverty and shared prosperity impacts.’ The jobs diagnostic explores the main labor demand and supply challenges in Moldova in more detail, while the analysis of structural transformation focuses on the agricultural sector and whether it can become a driver of progress.

This paper provides an overview of poverty and well-being trends in India since the mid-1990s. Poverty reduction since 2005 has been much faster than the earlier decade, as a result of broad-based growth across most geographic areas. Underlying this is a pattern of high mobility in economic status that has led to an emerging middle class. Still, a vast (and rising) share of the population faces significant risk of slipping back into poverty. India's poor are increasingly concentrated in low-income states with historically lower rates of economic progress. Even as India has reduced poverty faster than the developing world as a whole, the degree of poverty reduction associated with growth has been substantially lower than in some of its middle-income peers. India faces important challenges in nonmonetary dimensions of welfare as well. Despite success on important fronts, such as infant and child mortality and secondary education, progress has been slow in others, such as sanitation and nutrition, and lags behind some other countries that are at a similar stage of development.

This Systematic Country Diagnostic (SCD) identifies the binding constraints to reducing extreme poverty and promoting shared prosperity in Ethiopia. Achieving those goals requires a two pronged strategy of building on the strengths of past performance as well as introducing new elements. Progress in rural livelihoods drove poverty reduction in the past and will likely do so in the future. In addition, faster, and more inclusive, private sector-led structural change and ‘getting urbanization right’ are essential going forward. The report identifies two key challenges to sustainable progress: Ethiopia needs sustainably financed infrastructure that enables private investment to flourish and reduces reliance on public borrowing. It must also strengthen feedback mechanisms that inform policymakers of what works and what doesn’t so that the aspirations of a rapidly rising and better-educated working-age population can be met. The report is structured in two parts: Part A analyses the past and Part B identifies priorities for the future.

This paper studies welfare dynamics, especially changes associated with middle-class status in countries in the Middle East and North Africa, before and after the Arab Spring transitions, using objective and subjective welfare measures. Absent panel data, the analysis employs state-of-the-art synthetic panel techniques using repeated cross sections of expenditure data from household surveys and subjective well-being data from value surveys, which were conducted during the 2000s and the Arab Spring period. The objective welfare dynamics indicate mixed trends. About half the poor in the 2000s moved out of poverty by the end of the decade, but chronic poverty remained high; upward mobility was strong in Syria and Tunisia, but downward mobility was pronounced in Yemen and Egypt. Subjective well-being dynamics suggest negative developments in most countries during the Arab Spring transitions. Low education achievement, informal worker status, and rural residency are positively associated with lower than average chances for upward mobility, and greater than average chances for downward mobility according to both types of welfare measures.

Tunisia emerges today the only success story of the Arab Spring revolution that swept the Arab world five years ago. This poverty assessment seeks to learn from the pre and post revolution periods with a view of avoiding the repetition of past mistakes in the future. Specifically, it will provide Tunisians with a more detailed and updated diagnostics of poverty, regional disparities, trends over time and the strong links between poverty, inequality, opportunities, and vulnerability. Beyond statistics, this report will also provide a somber but more balanced alternative explanation of socioeconomic development in the country, which will hopefully complement the efforts of the Government of Tunisia to develop and implement its strategic development plan. This poverty assessment questions the extent to which growth was truly pro-poor in Tunisia and, more importantly, capable of reducing inequalities and increasing inclusion in society. This questioning sheds light on Tunisia’s prospects for a more prosperous society if substantive changes in the socioeconomic model are not introduced. The poverty assessment analysis goes into a post-2010 analysis; expanding as well the analysis of monetary poverty to broader concepts of vulnerability and equal opportunities; and by enriching traditional instruments with more sophisticated tools to measure poverty, analyze poverty dynamics, and simulate the effects of certain policy reforms for the first time in Tunisia.

In recent years, Turkey has been host to more than two million Syrians seeking refuge. Initially concentrated in the southeastern regions, these refugees now reside throughout the country. There are many questions from policy makers regarding the impact of the population of Syrians Under Temporary Protection on the host community. This paper examines the impact of migrants on regional host communities from a poverty perspective. The paper does not find any negative impacts on poverty for the host community from the increasing population of Syrians Under Temporary Protection as of 2013, despite the high poverty rates experienced among the recent migrants.

Analysis of Sri Lanka’s recent progress in reducing poverty and inequality is directly relevant to the new government’s development agenda. The newly sworn-in president ran for election on a platform that featured, among other goals, inclusive growth and support to the agricultural sector. The pursuit of these and other goals of the new administration can be informed by a fuller understanding of recent developments in household living standards across the country. Yet the World Bank’s most recent poverty assessment in Sri Lanka, covering the period from 1990 to 2002, was published a decade ago. Since then, domestic economic growth, the end of the civil conflict and fluctuations in global markets has led to substantial changes in Sri Lanka’s economic environment. To inform the new government’s development policies, this report examines five topics related to recent developments in poverty and welfare. Sections two through five of the report focus on: (i) trends in poverty, welfare, and inequality since 2002, (ii) labor market outcomes associated with the observed reduction in poverty, (iii) four potential causes of this poverty reduction, (iv) the state of poverty and inequality in 2012/13, and (v) the role of social protection in reducing poverty. Section six concludes by pointing out future implications and remaining knowledge gaps to continue to reduce poverty and improve living standards. This analysis draws mainly on data from the 2002, 2006-07, 2009-10, and 2012-13 rounds of the Household Income and Expenditure Survey, supplemented by annual rounds of the labor force survey from 2002 to 2012. Since the surveys could not be conducted in parts of the Northern and Eastern provinces before 2011 due to the civil conflict, their geographical coverage varies from year to year. To ensure comparability, all historical trends presented in this report correspond to the same geographic area. With the exception of figures that are based solely on 2012-13 data, the figures exclude Northern and Eastern provinces, which account for about 12.9 percent of the total population. A more detailed description of the data is provided in appendix one.

The agricultural and food production sector plays a key role in fighting poverty and food insecurity in Moldova, but is facing critical challenges to modernize and integrate into the international market. This paper focuses on smallholder farms, which make up 95 percent of all farms, and explores their potential for growth and the poverty links. Findings reveal that structural change is slow and smallholder farm growth in Moldova is an exception, not the rule. Only a small share of smallholder farms have the interest or capacity to commercialize but need targeted support policies to grow, intensify their farm activities, and integrate into the markets. For the remaining majority, enhancing their livelihoods calls for policies beyond the agricultural sector to help farm households diversify toward non-farm income.

Labor-intensive public works programs are important social protection tools in low-income settings, intended to supplement income of poor households and improve public infrastructure. In this evaluation of the Malawi Social Action Fund, an at-scale, government-operated program, across- and within-village randomization is used to estimate effects on food security and use of fertilizer. There is no evidence that the program improves food security, and some negative spillovers to untreated households. These disappointing results hold even under modifications to the design of the program to offer work during the lean rather than harvest season or increase the frequency of payments.

Poverty in Lao PDR declined from 33.5 percent to 23.2 percent over the 10 year period between 2002/3 and 2012/13. The number of poor people declined by about half a million to 1.35 million in 2013 and Lao PDR has met its MDG target of reducing poverty to below 24 percent by 2015. Improvements in welfare are evident in the changes in other socio-economic indicators such as the ownership of televisions and access to electricity, which doubled, and the number of households living in houses built with bricks or concrete, which nearly tripled, while the proportion of those without a toilet halved. Net secondary enrollment increased from 27 percent in 2002/3 to 50 percent in 2012/13 showing significant improvements in education.

This paper quantifies the contributions to poverty reduction observed in Sri Lanka between 2002 and 2012/13. The methods adopted for the analysis generate entire counterfactual distributions to account for the contributions of demographics, labor, and non-labor incomes in explaining poverty reduction. The findings show that the most important contributor to poverty reduction was growth in labor income, stemming from an increase in the returns to salaried nonfarm workers and higher returns to self-employed farm workers. Although some of this increase in earnings may point to improvements in productivity, defined as higher units of output per worker, some of it may simply reflect increases in food and commodity prices, which have increased the marginal revenue product of labor. To the extent that there have been no increases in the volumes being produced, the observed changes in poverty are vulnerable to reversals if commodity prices were to decline significantly. Finally, although private transfers (domestic and foreign) helped to reduce poverty over the period, public transfers were not as effective. In particular, the reduction in the real value of transfers of the Samurdhi program during 2002 to 2012/13 slowed down poverty reduction.

Several government and development partner programs employ different approaches to ensure the inclusion of poor and vulnerable areas and people in Myanmar’s development. Buildingon this experience, this note aims to identify feasible options to effectively reach these groups, as government programs expand. Depending on program-specific choices about geographic focus andindividual, household eligibility, identifying poor and vulnerable areas and people in Myanmar can become more evidence-based, effective, and systematic, as better data become available and administrative systems develop. While targeting is currently done by individual programs, there can be important economies of scale in sharing and developing these systems in a coordinated manner so as to support multiple programs.

Measuring poverty and tracking it over time is an important prerequisite to national economic planning. Absence of official data on household expenditure or poverty line hampered the ability of Iraqi policymakers to understand the extent of the problem, analyze their causes, and devise appropriate policies. Iraq household socioeconomic survey (IHSES) 2006-07 was the first survey of its kind since 1988 to cover all 18 governorates. The survey collected rich information on income, expenditure, employment, housing, education, health, and other socioeconomic indicators. Building on the experience of the first IHSES survey and using international best practice on sampling and questionnaire design and survey implementation, the second round of IHSES was fielded in 201-/13. To fill the data gap, a larger survey was designed to collect information on correlates of household welfare like demographic characteristics, education, occupation, housing, and assets and estimate small-area poverty rates using projection methods. This report presents results from the exercise, the first of its kind for Iraq. Poverty mapping not only provides a visual representation of poverty at subnational levels, it also reveals pockets of poverty and islands of prosperity where they exist. This knowledge is useful to inform decisions on policy design and targeting of development projects and programs.

Maternal and child undernutrition is a pervasive and detrimental condition in Papua New Guinea. Despite rapid economic growth during the past decade, the stunting rate for children under 5, one of the primary indicators for child undernutrition, was estimated at 46 percent in Papua New Guinea in 2010, stagnant from 44 percent in 2005. This paper analyzes the association between the demographic, socioeconomic, environmental, and health-related factors on nutritional status for children under age 5 years, using the 2009–10 Papua New Guinea Household Income and Expenditure Survey. Stunting and underweight rates sharply rise in the first 24 months. Even in the better-off quintiles, children suffer from suboptimal breastfeeding and complementary food in the first 24 months. In general, the regression results showed that household wealth and geographic location are crucial factors that contribute to children’s malnutrition. More importantly, food quality, measured by protein intake, has significant predicting power on child malnutrition. Broadly increasing socioeconomic status and improving the quantity and quality of caloric intake are general steps to improving health outcomes in Papua New Guinea. In addition, three key areas were identified as critical to alleviating the persistent and detrimental stunting rate in the country: (1) exclusive breastfeeding and complementary food; (2) interventions by health workers; and (3) nutrition education.

This paper provides new empirical insights on the joint distribution of consumption, income, and wealth in three of the poorest countries in the world — Malawi, Tanzania, and Uganda — all located in Sub-Saharan Africa (SSA). The first finding is that while income inequality is similar to that of the United States (US), wealth inequality is barely one-third that of the US. Similarly, while the top of the income distribution (1 and 10 percent) earns a similar share of total income in SSA as in the US, the share of total wealth accumulated by the income-rich in SSA is one-fifth of its US counterpart. The main contributions of the paper are to document: (i) this dwarfed transmission from income to wealth, which suggests that SSA households face a larger inability to save and accumulate wealth compared with US households; and (ii) a lower transmission from income to consumption inequality, which suggests the presence of powerful institutions that favor consumption insurance to the detriment of saving. These features are more relevant for rural areas, which represent roughly four-fifths of the total population. The paper identifies the few successful pockets of the SSA population that are able to accumulate wealth by exploring sources of inequality such as age, education, migration, borrowing ability, and societal systems.

Since 1991 the national poverty rate of Ghana has more than halved. The estimated national headcount poverty ratio fell by 31.2 percentage points from 52.6 percent in 1991 to 21.41 percent in 2012. Heterogeneity of poverty outcomes is, however, high both across urban and rural areas and across regions. The robustness of these poverty trends is checked with trends of five correlates: urbanization and rural-urban migration, remittances, asset growth, labor market transformations, and agricultural productivity growth. Urbanization turns out to be highly correlated with poverty reduction. Poverty trends and asset index trends turn out to follow a similar pattern in both urban and rural areas and by regions: asset index increase where poverty decreases. In the report the authors try to understand the drivers of recent decrease in poverty in northern regions. The attention is focused on two different aspects, the agricultural productivity growth and the inflation patterns. In northern regions, there is a generalized increase in production of main food crops and an increase in productivity. To test the contribution of most of these drivers to poverty reduction, the authors estimated unconditional quintile regressions over the 20th, 40th, and 60th percentiles and decomposed the results using the Oaxaca Blinder method. To further strengthen the spatial analysis of poverty the authors constructed a new poverty map based on sixth Ghana living standard survey (GLSS 6) (conducted in 2012-13) in combination with the 2010 census, which was then compared with the 2000 map. This profile focuses on inequalities seen from three different perspectives: consumption inequality, inequalities of opportunities, and polarization.

This paper is motivated by two stylized facts about poverty in Africa: female-headed households tend to be poorer, and poverty has been falling in the aggregate since the 1990s. These facts raise two questions: How have female-headed households fared? And what role have they played in Africas impressive recent aggregate growth and poverty reduction? Using data covering the entire region, the paper reexamines the current prevalence and characteristics of female-headed households, and asks whether their prevalence has been rising over time, what factors have been associated with such changes since the mid-1990s, and whether poverty has fallen equi-proportionately for male- and female-headed households. Rising gross domestic product has dampened rising female headship. However, other subtle transformations occurring across Africa—changes in marriage behavior, family formation, health, and education—have put upward pressure on female headship, with the result that the share of female-headed households has been growing. This has been happening alongside declining aggregate poverty incidence. However, rather than being left behind, female-headed households have generally seen faster poverty reduction. As a whole, this group has contributed almost as much to the reduction in poverty as male-headed households, despite the smaller share of female-headed households in the population.

Between 2008 and 2012 the urban/rural poverty divide substantially narrowed down, which was the result of relatively stable rural and rising urban poverty rates. Over the same period, food inflation spiked, whereby strong links between domestic and global price movements were observed owed to major import dependence on food. The high shares of consumption that households dedicate to food, especially among the poor, leave limited scope to deal with food price surges by economizing on non-food expenditure. Food price increases of 5, 10, and 15 percent are estimated to increase poverty rates between 2 and 5 percentage points in the baseline scenario.

Recent National Sample Surveys point to significant poverty reduction in India since 2004/05, with a marked acceleration between 2009/10 and 2011/12. This paper enquires into important aspects of income mobility between 2004/05 and 2011/12, based on new statistical methods to convert the three pertinent National Sample Survey rounds into synthetic panels. The analysis draws on the synthetic panels to derive a vulnerability line for India that can be used to separate out a population subgroup comprising non-poor households facing a heightened risk of falling into poverty. The paper documents a strong pattern of upward mobility out of poverty and vulnerability into the middle class, with a noticeable acceleration between 2009/10 and 2011/12. The paper further undertakes a careful investigation into the comparability of the survey rounds, prompted by the observation that fairly significant modifications had been made to survey questionnaires. The findings suggest that changes in questionnaire design have not compromised the comparability of the data.

The paper investigates the structure and dynamics of consumption inequality and inequality of opportunity in Tanzania. The analysis covers the period 2001 to 2012. It reveals moderate and declining levels of consumption inequality at the national level, but increasing inequalities between geographic regions. Spatial inequalities are mainly driven by the disparities of households’ characteristics and endowments across geographic locations. An important part of these endowments results from intergenerational transmission of parental background. Father’s education appears as the most important background variable affecting consumption and income in Tanzania. Without appropriate policy actions, there are few chances for the next generations to spring out of the poverty and inequality lived by their parents, engendering risks of poverty and inequality traps in the country.

Accurately measuring poverty and assessing trends in its incidence and severity are among the most fundamental challenges in economic development. The issue of effective poverty measurement has been the subject of renewed interest since the United Nations adopted the millennium development goals (MDGs) in 2000. In Niger, as in many comparable countries worldwide, poverty data are collected through household surveys of consumption patterns and living conditions. A number of methodological factors can affect the accuracy of consumption data during the collection phase, especially the number of survey visits, the time of year during which the questionnaire is administered, the recall period, and the composition of the consumption basket defined in the survey. The purpose of this paper is to produce a robust analysis of poverty trends in Niger from 2005 to 2011 by using the 2011 survey as the basis for monitoring poverty and correcting for methodological differences in earlier surveys. The decision to use the 2011 survey as the basis for establishing methodological consistency is rooted in two factors. First, the large variations in poverty estimates obtained in different survey periods are suspected to be due in part to changes in the survey methodology. Second, the 2011 survey coincided with the adoption of Niger’s current growth and poverty reduction strategy, programme de développement economique et social (PDES). The report describes the 2011 survey methodology and the techniques used to make the previous figures compatible with this methodology. It presents the revised poverty figures and discusses their implications. It also offers conclusions and recommendations.

This note presents 9 stylized facts that emerge related to the evolution of poverty and inequality over the 2002 to 2012 period, especially from 2008 to 2012, as well as some insights into the drivers of poverty changes. It complements existing work on monitoring and understanding shared prosperity – the second corporate goal of the World Bank along with reducing poverty - in Albania and the Western Balkans. Albania poverty estimates are based on the Living Standards Measurement Survey (LSMS). The LSMS is conducted by the Albania Statistics Office (INSTAT) with donor funding and has been carried out in 2002, 2005, 2008 and recently in 2012.