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Do Informed Citizens Receive More, or Pay More?

Philip Keefer's picture

One widely-accepted political economy research finding is that informed citizens receive greater benefits from government transfer programs. The evidence for the impact of information comes from particular contexts—disaster relief in India and welfare payments in the USA during the Great Depression.  Do other contexts yield similar results?  New research on the distribution of anti-malaria bed nets in Benin suggests:  “No.”  Instead, local health officials charged more informed households for bed nets that they could have given them for free.

The Benin context differs in three ways.  First, the policy is not the distribution of cash, but of health benefits.  Households’ access to information then influences not only their knowledge of government programs to distribute such benefits, but also the value they place on them. 

Second, the political context also differs.  In younger democracies, like Benin’s, citizens are more likely to confront additional obstacles, besides a lack of information, in their efforts to extract promised benefits from government.

Are the Knowledge Bank’s assets actually being used? The case of the World Bank’s Human Development sector

Adam Wagstaff's picture

According to its first-ever Knowledge Report, published earlier this year, the World Bank spends over $600 million a year on “core knowledge services” – research, economic and sector work, technical assistance, “knowledge management”, training, and the like. Yet as the authors of report concede, precious little is known about the impact of this spending.

In a post on this blog last year, I reported on some work that Martin Ravallion and I did on a subset of the Bank’s knowledge portfolio – formal publications. We found the publications portfolio is larger than typically thought: the Bank’s Documents and Reports (D&R) database excludes the vast majority of journal articles authored by Bank staff, and there are as many of these as there are books and other formal publications published by the Bank. We also tried to look at the impact of the Bank’s publications on development thinking, which we measured using citations in Google Scholar. We found that, despite a view by some that the Bank is more a proselytizer than a producer of new knowledge, a lot of Bank publications do get cited a lot, suggesting that these publications contain new knowledge that’s considered useful by others.

Food Prices, Nutrition and the Millennium Development Goals

Jos Verbeek's picture

How are communities around the world coping with the higher and more volatile food prices? What is the impact on poverty, or on nutritional outcomes? And, how should policymakers respond to such price spikes that can eat away at already-tight budgetary resources?

These are only some of the questions that a key World Bank-IMF report is delving into as it provides an annual assessment on progress towards the Millennium Development Goals (MDGs) as well as the challenges which developing countries face in achieving them. 

Seasonal Hunger: A Forgotten Reality

Shahid Khandker's picture

Harvesting crops. Bangladesh. Photo: Thomas Sennett / World BankThe seasonality of poverty and food deprivation is a common feature of rural livelihood in Bangladesh, but it is more marked in the northwest region of Rangpur.  The recently launched policy interventions in the region provide a test case of what works and what does not in combating seasonal hunger.

Key messages
The analysis of Bangladesh’s experience with seasonal hunger vis-à-vis year-round poverty shows a clear distinction between what is observed and what is excluded from placement and evaluation of poverty-mitigation policies, based on official poverty statistics. The key recommendations from this analysis are as follows: 

Health System Innovation in India Part III

Adam Wagstaff's picture

Taking high-quality affordable primary care to the rural poor with the help of handheld computers, telemedicine, and P4P.

In our first post in this series, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In our last post, we outlined the Aarogyasri scheme—a novel government-sponsored health insurance program in the state of Andhra Pradesh that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care. In this post, we discuss an innovative private-sector approach to delivering and financing primary health care in rural Andhra Pradesh.

Health System Innovation in India Part II: Aarogyasri

Adam Wagstaff's picture

More than health insurance for the poor

In our last post, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In this post, we outline a novel government-sponsored health insurance program in the state of Andhra Pradesh (AP)—a program that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care.

a) “Actors”, and their rights and responsibilities

Initiated by the then chief minister of AP, the medical doctor YSR Reddy, the Rajiv Aarogyasri scheme started in 2007 and is targeted at the below-poverty line (BPL) population. The scheme focuses on life-saving procedures that aren’t covered elsewhere in India’s patchwork of health programs, for which treatment protocols are available, and for which specialist doctors and equipment are required. Currently 938 tertiary care procedures are covered. The scheme revolves around five key “actors”, one unique to Aarogyasri and all with interesting rights and responsibilities.

Health System Innovation in India Part I: India’s health system challenges

Adam Wagstaff's picture

India’s health system faces some major challenges. In some respects, the hill India’s health system has to climb is steeper than that facing other developing countries. The good news is that the innovation that India is famous for in other sectors, as well as in health technology, is now starting to make itself felt in the health system. Not only may these ideas benefit India’s poor; they may also provide food for thought for other countries.

In this post, we sketch out the challenges facing India’s health system. In the next two, we outline two innovative approaches—one government, one private—in the state of Andhra Pradesh.

Why Civil Registration matters in the countdown to the Millennium Development Goals

Sulekha Patel's picture

With just four years to the target date of 2015, progress on the health-related Millennium Development Goals (MDGs) has been slow. Measuring progress has been hampered by the lack of quality and timely data; this is especially true when measuring progress toward goals that rely on civil registration for their information, such as Goal 4 on reducing child mortality. Available data in the new edition of World Development Indicators show that of the 144 countries for which data are available, more than 100 countries remain off-track to reach the MDG 4 by 2015.  

Health reform: A consensus emerging in Asia?

Adam Wagstaff's picture

Amanda Glassman’s blog post on Ghana’s health insurance program and the firestorm it produced (hat tip to Mead Over) is a reminder of the passions that health reform debates still generate. This is intriguing because my sense is that while we health-reform aficionados are berating one another in the blogosphere, policymakers in Asia are quietly iterating toward something of a consensus on a whole swathe of key issues on health reform. The process isn’t always driven by hard evidence, but that’s because there isn’t much hard evidence either way. I certainly don’t see compelling evidence against the emerging consensus—if that’s what it is. And what’s emerging is rather interesting.

Could easier access to AIDS treatment increase risky sexual behaviors?

Damien de Walque's picture
 Photo: istockphoto.com

By the end of 2009, an estimated 5.2 million people in low- and middle-income countries received antiretroviral therapy (ART). In sub-Saharan Africa, nearly 37% [34%–40%] of people eligible for treatment had access to those life-saving medicines (UNAIDS 2010). This is an extraordinary achievement, considering that as recently as 2003, relatively few people living with HIV/AIDS had access to ART in Africa. The scaling-up of ART in Africa and other regions has saved the lives of countless people and we hope will continue to do so.

 At the same time, access to HIV/AIDS treatment might have transformed the perception of AIDS from a death sentence to a manageable, chronic condition, not necessarily different from any other chronic disease. Such a change in perception could lead to change in sexual behaviors. If AIDS is not perceived as a killer disease anymore, it might induce complacency and increase risky behaviors and the mixing between higher- and lower-risk groups in the population. That’s what has been described as the “disinhibition” hypothesis.

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