03. Journals
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These are journal articles published in World Bank journals as well as externally by World Bank authors.
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Publication
The use of video vignettes to measure health worker knowledge: Evidence from Burkina Faso
(Elsevier, 2018-09)The quality of care is a crucial determinant of good health outcomes, but is difficult to measure. Survey vignettes are a standard approach to measuring medical knowledge among health care providers. Given that written vignettes or knowledge tests may be too removed from clinical practice, particularly where “learning by doing” may be an important form of training, we developed a new type of provider vignette. It uses videos presenting a patient visiting the clinic with maternal/early childhood symptoms. We tested these video vignettes with current and future (students) health professionals in Burkina Faso. Participants indicated that the cases used were interesting, understandable and common. Their performance was consistent with expectations. Participants with greater training (medical doctors vs. nurses and midwives) and experience (health professionals vs. students) performed better. The video vignettes can easily be embedded in computers, tablets and smart phones; they are a convenient tool to measure provider knowledge; and they are cost-effective instruction and testing tools. -
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Playing Broken Telephone : Assessing Faith-inspired Health Care Provision in Africa
(Taylor and Francis, 2012-07-05)In the literature on the religious contribution to health and development, it is commonly stated that faith-inspired institutions (FIIs) provide from 30 to 70 per cent of all health care provision in Africa. This article tracks the sources of such statements back to the 1960s, highlighting a process of ‘broken telephone’ whereby estimates are passed on and frequently distorted by policy- and advocacy-oriented influences at both the national and international levels. This demonstrates how estimates are being wielded bluntly, often resulting in poorly substantiated claims to the detriment of more careful research, thereby weakening the empirical knowledge-base and improved practice. -
Publication
Conditional Cash Transfers and HIV/AIDS Prevention : Unconditionally Promising?
(Washington, DC: Oxford University on behalf of the World Bank, 2012-06-01)Conditional cash transfers (CCTs) have recently received considerable attention as a potentially innovative and effective approach to the prevention of HIV/AIDS. We evaluate a conditional cash transfer program in rural Malawi which offered financial incentives to men and women to maintain their HIV status for approximately one year. The amounts of the reward ranged from zero to approximately 3–4 months wage. We find no effect of the offered incentives on HIV status or on reported sexual behavior. However, shortly after receiving the reward, men who received the cash transfer were 9 percentage points more likely and women were 6.7 percentage points less likely to engage in risky sex. Our analyses therefore question the “unconditional effectiveness” of CCT program for HIV prevention: CCT Programs that aim to motivate safe sexual behavior in Africa should take into account that money given in the present may have much stronger effects than rewards offered in the future, and any effect of these programs may be fairly sensitive to the specific design of the program, the local and/or cultural context, and the degree of agency an individual has with respect to sexual behaviors. -
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Inequality of Opportunity in Egypt
(Oxford University Press on behalf of the World Bank, 2012-06-01)The article evaluates the contribution of inequality of opportunity to earnings inequality in Egypt and analyzes its evolution across three time periods and different population groups. It provides parametric and nonparametric estimates of a lower bound for the degree of inequality of opportunity for wage and salary workers. On average, the contribution of opportunity-shaping circumstances to earnings inequality declined from 22 percent in 1988 to 15 percent in 2006. Levels of inequality of opportunity were fairly stable while earnings differentials widened markedly, leading to a decline in the share of inequality attributable to opportunities. Father's background and geographic origins had the largest effect on earnings, although the impact of mother's education has risen in recent years. The degree of inequality of opportunity did not differ significantly by gender or rural–urban area, although the incidence was lower for men and for rural areas. The results indicate an increase in inequality of opportunity across age groups, but there is some evidence that opportunity differentials have been declining for the oldest generation. -
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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)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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Mashup Indices of Development
(Oxford University Press on behalf of the World Bank, 2012-02-01)Countries are increasingly being ranked by some new “mashup index of development,” defined as a composite index for which existing theory and practice provides little or no guidance for its design. Thus the index has an unusually large number of moving parts, which the producer is essentially free to set. The parsimony of these indices is often appealing—collapsing multiple dimensions into just one, yielding seemingly unambiguous country rankings, and possibly reducing concerns about measurement errors in the component series. But the meaning, interpretation, and robustness of these indices and their implied country rankings are often unclear. If they are to be properly understood and used, more attention needs to be given to their conceptual foundations, the tradeoffs they embody, the contextual factors relevant to country performance, and the sensitivity of the implied rankings to the changing of the data and weights. In short, clearer warning signs are needed for users. But even then, nagging doubts remain about the value-added of mashup indices, and their policy relevance, relative to the “dashboard” alternative of monitoring the components separately. Future progress in devising useful new composite indices of development will require that theory catches up with measurement practice. -
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Coping with Crises : Policies to Protect Employment and Earnings
(Oxford University Press on behalf of the World Bank, 2012-02-01)The continuing failure of many countries to adequately mitigate the adverse labor market impacts of economic downturns is of concern, since labor market volatility can exacerbate poverty and stunt growth. This article aims to identify potentially effective policies responses to crises by navigating the potential tradeoffs between offsetting adverse short-term impacts of economic downturns on the quantity and quality of jobs, and preserving incentives for economic recovery. The authors propose a taxonomy that categorizes interventions depending on whether they mitigate the negative short-term impact of crises or whether they stimulate recovery. The taxonomy helps policymakers to identify “win–win” policies that avoid potential tradeoffs between these objectives by simultaneously serving both. Common elements of effective interventions are feasibility, flexibility (for example the capacity for scaling up and down), and incentive compatibility—and there is no substitute for being prepared. Having sound safety nets in place before a crisis is superior to haphazardly implementing responses after a crisis hits. -
Publication
How to Deal with Covert Child Labor and Give Children an Effective Education, in a Poor Developing Country
(World Bank, 2012-01-18)Because credit and insurance markets are imperfect and intrafamily transfers and how children use their time outside school hours are private information, the second-best policy makes school enrollment compulsory, forces overt child labor below its efficient level (if positive), and uses a combination of need- and merit-based grants, financed by earmarked taxes, to relax credit constraints, redistribute, and insure. Existing conditional cash transfer schemes can be made to approximate the second-best policy by incorporating these principles in some measure. -
Publication
Impact Evaluation of School Feeding Programs in Lao PDR
(Taylor and Francis, 2011-11-25)Despite the popularity and widespread implementation of school feeding programmes, evidence of their impact on school participation and nutritional status is mixed. In this study we evaluate feeding programmes in three districts of the Lao People's Democratic Republic. Feeding modalities included on-site feeding, take-home rations, and a combined modality. District-level implementation of the intervention sites and selective take-up presented considerable evaluation challenges. To address these, we use difference-in-difference estimators with propensity-score weighting to construct plausible counterfactuals. We find minimal evidence that school feeding increased enrolment or improved nutritional status. Several robustness checks and possible explanations for null findings are presented. -
Publication
Do Labor Statistics Depend on How and to Whom the Questions Are Asked? Results from a Survey Experiment in Tanzania
(World Bank, 2011-10-18)Labor market statistics are critical for assessing and understanding economic development. However, widespread variation exists in how labor statistics are collected in household surveys. This paper analyzes the effects of alternative survey design on employment statistics by implementing a randomized survey experiment in Tanzania. Two features of the survey design are assessed – the level of detail of the employment questions and the type of respondent. It turns out that both features have relevant and statistically significant effects on employment statistics. Using a short labor module without screening questions induces many individuals to adopt a broad definition of employment, incorrectly including domestic duties. But after reclassifying those in domestic work as ‘not working’ in order to obtain the correct ILO classification, the short module turns out to generate lower female employment rates, higher working hours for both men and women who are employed, and lower rates of wage employment than the detailed module. Response by proxy rather than self-report has no effect on female labor statistics but yields substantially lower male employment rates, mostly due to underreporting of agricultural activity. The large impacts of proxy responses on male employment rates are attenuated when proxy informants are spouses and individuals with some schooling.