C. Journal articles published externally
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Incentivising Safe Sex : A Randomised Trial of Conditional Cash Transfers for HIV and Sexually Transmitted Infection Prevention in Rural Tanzania
( 2012-02-08) de Walque, Damien ; Dow, William H. ; Nathan, Rose ; Abdul, Ramadhani ; Abilahi, Faraji ; Gong, Erick ; Isdahl, Zachary ; Jamison, Julian ; Jullu, Boniphace ; Krishnan, Suneeta ; Majura, Albert ; Migue, Edward ; Moncada, Jeanne ; Mtenga, Sally ; Mwanyangala, Mathew Alexander ; Packel, Laura ; Schachter, Julius ; Shirima, Kizito ; Medlin, Carol A.Objective The authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex. Design An unblinded, individually randomised and controlled trial. Setting 10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania. Participants The authors enrolled 2399 participants, aged 18–30 years, including adult spouses. Interventions Participants were randomly assigned to either a control arm (n=1124) or one of two intervention arms: low-value conditional cash transfer (eligible for $10 per testing round, n=660) and high-value conditional cash transfer (eligible for $20 per testing round, n=615). The authors tested participants every 4 months over a 12-month period for the presence of common sexually transmitted infections. In the intervention arms, conditional cash transfer payments were tied to negative sexually transmitted infection test results. Anyone testing positive for a sexually transmitted infection was offered free treatment, and all received counselling. Main outcome measures The primary study end point was combined prevalence of the four sexually transmitted infections, which were tested and reported to subjects every 4 months: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium. The authors also tested for HIV, herpes simplex virus 2 and syphilis at baseline and month 12. Results At the end of the 12-month period, for the combined prevalence of any of the four sexually transmitted infections, which were tested and reported every 4 months (C trachomatis, N gonorrhoeae, T vaginalis and M genitalium), unadjusted RR for the high-value conditional cash transfer arm compared to controls was 0.80 (95% CI 0.54 to 1.06) and the adjusted RR was 0.73 (95% CI 0.47 to 0.99). Unadjusted RR for the high-value conditional cash transfer arm compared to the low-value conditional cash transfer arm was 0.76 (95% CI 0.49 to 1.03) and the adjusted RR was 0.69 (95% CI 0.45 to 0.92). No harm was reported. Conclusions Conditional cash transfers used to incentivise safer sexual practices are a potentially promising new tool in HIV and sexually transmitted infections prevention. Additional larger study would be useful to clarify the effect size, to calibrate the size of the incentive and to determine whether the intervention can be delivered cost effectively. Trial registration number NCT00922038 ClinicalTrials.gov. -
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Leishmaniasis Chemotherapy-Challenges and Opportunities
( 2011-10) Croft, S. L. ; Olliaro, P.Clin Microbiol Infect 2011; 17: 1478-1483 ABSTRACT: Although there have been significant advances in the treatment of visceral leishmaniasis (VL), there remain challenges to ensure that treatments effective in India are also effective in other regions of the world and to identify treatment for post kala-azar dermal leishmaniasis as well as the opportunity to develop a safe oral short-course treatment. At the same time, there have been few advances for the treatment of simple or complex forms of cutaneous leishmaniasis (CL), other than topical paromomycin formulations. The main challenge for CL is to ensure that this disease is on the research and development agenda, so that new drugs are evaluated or compounds are screened in appropriate models, and that the standardization of quality of clinical trials is guaranteed. Problems also remain in the treatment of HIV/leishmaniasis co-infected patients. We are some way from having the ideal treatments for VL and CL and drug research and development for these diseases must remain focused. -
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Second Conference of the African Health Economics and Policy Association: towards universal healthcare coverage in Africa
( 2011-06) Atim, C.This report discusses the key messages coming out of the papers presented at the second African Health Economics and Policy Association conference, with a particular focus on innovative and recent research results of interest to a wider audience. It also covers the scientific structure and organization of the conference, including the various sessions and key note speeches. The 3-day conference discussed the definition and scope as well as the key issues concerned, the challenges involved, and the role of leadership and country ownership in achieving universal health coverage in low-income countries. A special effort was also made to link the research outputs of the conference to policy-making in the region, through the participation of high-level decision-makers from countries as well as the production of policy briefs targeting policy-makers and based on the conference outputs and relevant research. Sub-themes of the conference included user fee removal and exemptions, covering those outside the formal sector, improved domestic funding of healthcare, purchasing of services and policy processes. The conference was attended by approximately 230 participants drawn from over 30 African countries as well as abroad, mostly from academia, research institutions, Ministries of Health and other relevant Government agencies, as well as donor and technical partners. -
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Intergenerational Occupational Mobility in Rural Economy : Evidence from Nepal and Vietnam
( 2011-04) Emran, M. Shahe ; Shilpi, ForhadThis paper presents evidence on intergenerational occupational mobility from agriculture to the nonfarm sector using survey data from Nepal and Vietnam. In the absence of credible instruments, the degree of selection on observables is used as a guide to the degree of selection on unobservables, a la Altonji et al. (2005) to address the unobserved genetic correlations. The results show that intergenerational occupational mobility is lower among women in both countries, and is lower in Nepal compared with Vietnam. In the case of Nepal, strong evidence favors a causal role played by the mother's nonfarm participation in the daughter's occupation choice, possibly because of cultural inheritance in a traditional society. -
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Climate Variability and Child Height in Rural Mexico
( 2011) Skoufias, E. ; Vinha, K.We examine the impacts of weather shocks, defined as rainfall or growing degree days, a cumulative measure of temperature, more than a standard deviation from their respective long run mean, on the stature of children between 12 and 47 months of age in Mexico. We find that after a positive rainfall shock children are shorter regardless of their region or altitude. Negative temperature shocks have a negative impact on height in the central and southern parts of the country as well as in higher altitudes. Although on average there are no statistically significant impacts from positive temperature shocks, certain sub-populations - namely boys, children between 12 and 23 months at the time of measurement, and children of less educated mothers - in some of the regions are negatively impacted. The results also suggest that potentially both agricultural income and communicable disease prevalence contribute to the effects. -
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Export Discoveries, Diversification and Barriers to Entry
( 2011) Klinger, Bailey ; Lederman, DanielThe literature on the relationship between economic diversification and development established that diversification rises with development up to a point. Some have argued that market failures reduce private investments that are necessary to find out whether a new product can be exported profitably, thus implying that the threat of entry can reduce export discoveries and consequently hamper diversification. In parallel, the trade literature on the "extensive margin" of trade has focused on the role of fixed costs of exporting, which affects the number and types of firms that enter into exporting activities. This article presents data suggesting that export diversification and export discoveries are correlated over the course of development, and it provides an empirical test of market failures that might deter export discoveries. The findings suggest that the threat of entry by imitators reduces the number of export discoveries within countries and industries for a given rate of growth of non-discovery exports. However, this market-failure effect is less pronounced when allowing for inter-industry spillovers, whereby export discoveries in one industry lead to discoveries in another industry. The policy implication is that barriers to entry should not be used to protect innovators from the threat of imitation, but governments could consider interventions that directly focus on stimulating export discoveries. -
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The Poverty Reduction Strategy Approach Six Years On: An Examination of Principles and Practice in Uganda
( 2011) Canagarajah, Sudharshan ; van Diesen, ArthurIt is over six years since the World Bank and the IMF started promoting a PRS approach to development management in low-income countries. The 2005 review endorsed the approach, but highlighted the need for a renewed focus on the principles underpinning it: country ownership; results orientation; comprehensiveness; partnership focus; and long-term outlook. Uganda is often hailed as one of the best PRS performers. This article finds that Uganda's Poverty Eradicaton Action Plan (PEAP) has brought significant gains to development management, but that its performance against several of the PRS principles is disappointing. A return to these principles could improve the practice of the government and development partners around the PEAP--a finding likely to be applicable to many countries implementing a PRS. -
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Earthquake Propensity and the Politics of Mortality Prevention
( 2011) Keefer, Philip ; Neumayer, Eric ; Plumper, ThomasGovernments can significantly reduce earthquake mortality by enforcing quake-proof construction regulation. We examine why many governments do not. First, mortality is lower in countries with higher earthquake propensity, where the payoffs to investments in mortality prevention are greater. Second, the opportunity costs of these investments are higher in poorer countries; mortality is correspondingly less responsive to propensity in poor countries. Third, mortality is higher at any level of quake propensity when governments have fewer incentives to provide public goods, such as in autocracies with less institutionalized ruling parties or in more corrupt countries. -
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This Recession Is Wearing Me Out! Health-Related Quality of Life and Economic Downturns
( 2011) Davalos, Maria E. ; French, Michael T.Previous research on the relationships between macroeconomic conditions and health status reveal improvements in physical health during economic downturns. However, few studies have examined whether mental health status improves or declines during tough economic times. This paper estimates the effect of a key macroeconomic indicator, the state-level unemployment rate, on health-related quality of life. Analyzing recent data from Waves 1 and 2 of the NESARC and controlling for individual heterogeneity with fixed-effects models, our study suggests that health-related quality of life, both physical and mental, worsens with increases in the unemployment rate. Although the effect sizes are relatively small in magnitude for both outcomes, the impact is more pronounced for mental health. These results raise questions about the unexpected findings reported in earlier studies of a health-improving effect of economic downturns and suggest that the current worldwide economic recession may have some serious hidden costs. -
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Does More Cash in Conditional Cash Transfer Programs Always Lead to Larger Impacts on School Attendance?
( 2011) Filmer, Deon ; Schady, NorbertThere is considerable evidence that conditional cash transfer (CCT) programs can have large impacts on school enrollment, including in very poor countries. However, little is known about what features of program design account for the observed outcomes. In this paper we analyze the impact of a program in Cambodia that made payments of varying magnitude to otherwise comparable households. The identification is based on a sharp regression discontinuity design. We find that a modest cash transfer, equivalent to approximately 2% of the consumption of the median recipient household, had a substantial impact on school attendance, approximately 25 percentage points. A somewhat larger transfer did not raise attendance rates above this level.