Reform leaders who are persuaded by the need to invest in human capital face the challenge of getting thousands of state personnel, who staff myriad government agencies, to deliver. The quintessential “delivery unit” in Africa, a region flagged by the Human Capital Index as having the greatest need for health and education investments, consists of local governments helmed by appointed bureaucrats and locally elected politicians. In new research in Uganda, we find that the quality of local politicians, elected at humble levels in a village or district, is a robust and substantial predictor of delivery of national health programs. These results suggest that for the Human Capital Project to have impact it may need to move beyond creating political space for national leaders to allocate more public resources to health and education and take-on the challenge of local politics as key to service delivery at the last mile.
African widows often face considerable disadvantage relative to married women in their first union. How much so depends on the society they live in, with pronounced hardship in some contexts, yet benefits to widows in others. In the absence of effective policies, their situation is likely to depend heavily on the social-cultural norms applying to women following widowhood. In a recent paper, Annamaria Milazzo and I investigate this issue by comparing the well-being (as measured by BMI and rates of underweight) of young (15-49) Nigerian widows and non-widows across Christian and Muslim groups using the Demographic and Health Surveys (DHS) of 2008 and 2013.
It’s not so long since the days when speaking of ‘universal health coverage’ used to provoke shockwaves. Happily, the principle that “… everyone having access to the health care they need without suffering financial hardship” is now widely recognized and documented. And although few countries have achieved this goal in practice, it is clearly within reach, including in low-income countries like Rwanda.
When I was a teenager in Belgium, my parents wanted to make sure that I wouldn’t become a smoker. At the age of 15, I had tried a few cigarettes with friends and they were worried I would pick up the habit. They could have organized a complicated system of surveillance and sanctions to monitor and prevent my smoking behavior. Instead, my dad offered me a very simple deal: “if you are not smoking by the time you graduate from high school, I will pay your trip to a destination of your choice in Europe during the summer before you start college”. My dad’s deal worked well: I took a great trip to Greece – my first flight – with a few friends and I have never smoked after those first cigarettes at 15.
The rate of change in human development outcomes varies considerably across countries over long periods of time, as reflected in the two histograms below (Figure 1). For 78 countries in the period 1980-2014, the percentage decline in child mortality was 3.39% on average, with a standard deviation of 1.36%, a smallest rate of 0.89% (Central African Republic) and a highest rate of 8.07% (Maldives). The average percentage increase in school enrollment was 3.35%, with a standard deviation 3.54%, a minimum of 0.37% (Georgia) and a maximum of 19.68% (Maldives). Similar patterns of cross-country variation are found when using alternative proxies for health and education outcomes.
How do we deliver higher-quality health services in low-capacity settings?
This is the question that we have sought to answer through a long-standing impact evaluation (IE) research collaboration with the Nigerian Ministry of Health and the Bill & Melinda Gates Foundation. The results of this collaboration will be presented at the World Bank on February 8 at Beyond the Status Quo: Using Impact Evaluation for Innovation in Health Policy. This one-day event will bring together policymakers, practitioners, and academics to discuss policy implications and ways to further promote and strengthen capacity for evidence-informed policy.
A few years ago, West Africa was gripped by the Ebola outbreak. The onset of the virus devastated communities and weakened the economies of Guinea, Liberia, and Sierra Leone.
Ebola moved quickly and an immediate response by development partners was badly needed. The governments of the three affected countries requested assistance from UN agencies and the World Bank to lead a coordinated effort to curb the epidemic. The Bank responded by restructuring ongoing health projects to free up resources for the governments to quickly contract UN agencies.
A blogpost on financial incentives in health by one of us in September 2015 generated considerable interest. The post raised several issues, one being whether demand-side financial incentives (like maternal vouchers) are more or less effective at increasing the uptake of key maternal and child health (MCH) interventions than supply-side financial incentives (variously called pay-for-performance (P4P) or performance-based financing (PBF)).
The four of us are now hard at work investigating this question — and related ones — in a much more systematic fashion. And we'd very much welcome your help.
I usually don’t wake up to hate mail in my inbox. What prompted this deluge is a recent paper that evaluates the impact of a training program for informal health care providers (providers without any formal medical training) in the state of West Bengal, India (paper summary). Training improved the ability of informal providers to correctly manage the kind of conditions they may see in their clinics, but it did not decrease their overuse of unnecessary medicines or antibiotics.