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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Measuring Human Capital in Middle Income Countries
(Elsevier, 2022-12)This paper develops an indicator that measures the level of human capital to address the specific education and health challenges faced by middle income countries. We apply this indicator to countries in Europe and Central Asia, where productive employment requires skills that are more prevalent among higher education graduates, and where good health is associated to low levels of adult health risk factors. The Europe and Central Asia Human Capital Index (ECA-HCI) extends the World Bank's Human Capital Index by adding a measure of quality-adjusted years of higher education to the original education component, and it includes the prevalence of three adult health risk factors—obesity, smoking, and heavy drinking—as an additional proxy for latent health status. The results show that children born today in the average country in Europe and Central Asia will be almost half as productive as they would have had they reached the benchmark of complete education and full health. Countries with good basic education outcomes do not necessarily have good higher education outcomes, and high prevalence of adult health risk factors can offset good education indicators. This extension of the Human Capital Index could also be useful for assessing the state of human capital in middle-income countries in general. -
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Can cities bounce back better from COVID-19? Reflections from emerging post-pandemic recovery plans and trade-offs
(SAGE, 2022-10-01)As cities plan for post-COVID recovery, many questions preoccupy mayors, policymakers, planners, and developers. This article examines COVID-19’s impact on cities, drawing on local governments’ developing policies and responses to identify some of the emerging trends and trade-offs. Overall, city recovery will likely involve some transformation to land uses and real estate markets, with increasing demand for urban amenities and nature, and with policies in support of affordable housing, slum upgrading and informal sector employment, to achieve more liveable and inclusive cities. This in turn will depend on the policies, planning, finance, digital infrastructure, and governance systems in place. While many city challenges predate COVID-19, they were exacerbated by the pandemic. The extent to which cities, and especially cities in the global South, will overcome such challenges will depend on political will and the implementation of targeted policies and low-cost investments in sustainability, liveability and inclusion. -
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Child mortality after the Ebola virus disease outbreak across Guinea, Liberia, and Sierra Leone
(Elsevier, 2022-09-01)The Ebola virus disease outbreak in 2014-2016 had a substantial impact on population health in Guinea, Liberia, and Sierra Leone. This study aimed to assess whether the impact continued after the outbreak ended regarding child mortality. Cross-sectional logistic regressions were run using data from the Demographic and Health Surveys in the three countries. The average child mortality rate was significantly lower for children born after the outbreak than for those born before. However, the association of the child mortality rate with an increase in the number of Ebola cases per 100,000 people was significantly stronger for children born after the outbreak ended. Also, the change in the utilization of maternal health services after the outbreak varied across health services. Restoring disrupted child health services to pre-Ebola levels may be more difficult in areas that suffered a higher number of Ebola cases. The recovery of maternal health services after the outbreak might be affected by factors such as the resilience of health systems at the subnational level. This study suggests that strengthening the health system is crucial to fully recover from the Ebola outbreak and cope with future epidemics. -
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Behavioral Change Promotion, Cash Transfers and Early Childhood Development: Experimental Evidence from a Government Program in a Low-Income Setting
(Elsevier, 2022-06-26)Signs of development delays and malnutrition are widespread among young children in low-income settings. Social protection programs such as cash transfers are increasingly combined with behavioral change promotion or parenting interventions to improve early childhood development. This paper disentangles the effects of behavioral change promotion from cash transfers to poor households through an experiment embedded in a government program in Niger. The study is also designed to identify within-community spillovers from the behavioral change intervention. The findings show that behavioral change promotion affects a range of practices related to nutrition, health, stimulation, and child protection. Moderate gains in children’s socio-emotional development are observed, but there is no improvement in anthropometrics or cognitive development. Cash transfers alone do not alter parenting practices or improve early childhood development. Cash transfers raise food security and consumption at the household level, including the purchase of non-food items privately consumed by adults. The behavioral intervention offsets these changes and instead improves children’s food security, pointing to some intra-household reallocations toward children. Local spillovers on parenting practices are found, which further highlights that cash alone is not the main driver of changes in parenting behaviors. -
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Estimating the impact of trained midwives and upgraded health facilities on institutional delivery rates in Nigeria using a quasi-experimental study design
(BMJ Publishing Group Ltd, 2022-05-24)Studies have shown that demand-side interventions, such as conditional cash transfers and vouchers, can increase the proportion of women giving birth in a health facility in low-income and middle-income countries, but there is limited evidence of the effectiveness of supply-side interventions. We evaluated the impact of the Subsidy Reinvestment and Empowerment Program Maternal and Child Health Project (SURE-PMCH) on rates of institutional delivery and antenatal care. The authors used a differences-in-differences study design that compared changes in rates of institutional delivery and antenatal care in areas that had received additional support through the SURE-PMCH program relative to areas that did not. Data on outcomes were obtained from the 2013 Nigerian Demographic and Health Survey. The authors found that the program significantly increased the proportion of women giving birth in a health facility by approximately 7 percentage points (p=0.069) or approximately 10 percent relative to the baseline after 9 months of implementation. The program, however, did not significantly increase the use of antenatal care. The findings of this study suggest there could be important improvements in institutional delivery rates through greater investment in supply-side interventions. -
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How much does reducing inequality matter for global poverty?
(Springer Nature, 2022-03-02)The goals of ending extreme poverty by 2030 and working towards a more equal distribution of incomes are part of the United Nations’ Sustainable Development Goals. Using data from 166 countries comprising 97.5 percent of the world’s population, we simulate scenarios for global poverty from 2019 to 2030 under various assumptions about growth and inequality. We use different assumptions about growth incidence curves to model changes in inequality and rely on a machine-learning algorithm called model-based recursive partitioning to model how growth in GDP is passed through to growth as observed in household surveys. When holding within-country inequality unchanged and letting GDP per capita grow according to World Bank forecasts and historically observed growth rates, our simulations suggest that the number of extreme poor (living on less than 1.90 dollars/day) will remain above 600 million in 2030, resulting in a global extreme poverty rate of 7.4 percent. If the Gini index in each country decreases by 1 percent per year, the global poverty rate could reduce to around 6.3 percent in 2030, equivalent to 89 million fewer people living in extreme poverty. Reducing each country’s Gini index by 1 percent per year has a larger impact on global poverty than increasing each country’s annual growth 1 percentage point above forecasts. We also study the impact of COVID-19 on poverty and find that the pandemic may have driven around 60 million people into extreme poverty in 2020. If the pandemic increased the Gini index by 2 percent in all countries, then more than 90 million may have been driven into extreme poverty in 2020. -
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Invitations, Incentives, and Conditions: A Randomized Evaluation of Demand-Side Interventions for Health Screenings
(Elsevier, 2022-03)This randomized controlled trial investigates the impact of four demand-side interventions on health screening for diabetes and hypertension among Armenian adults. The interventions are 1) personalized invitations from a physician, 2) personalized invitations with information about peer screening behavior, 3) personalized invitations with a labeled but unconditional financial incentive, and 4) personal invitations with a conditional financial incentive. Compared with the control group, interventions 1 to 3 led to a significant increase in the screening rate of about 15 percentage points for diabetes and hypertension. The highest impact was measured for intervention 4 leading to a 31.2 percentage point increase in both screenings. -
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Inequality in the Quality of Health Services: Wealth, Content of Care, and the Price of Antenatal Consultations in the Democratic Republic of Congo
(The University of Chicago Press, 2022-02-14)We use unique data on direct observations of patient-provider interactions linked to detailed patient exit interviews and household surveys to study the relationship between patients’ socioeconomic status and the quality of antenatal care in the Democratic Republic of Congo. We find a significant wealth-quality gradient: a 1 standard deviation in household wealth is associated with a 1.6–3.2 percentage point increase in protocol compliance, depending on the data source and the definition of the compliance index. A large part of the overall wealth-quality gradient is driven by generally lower facility quality in poorer areas. However, we also find a statistically significant within-village wealth-quality relationship that is primarily driven by wealthier women seeking care at higher-quality facilities even if they are more distant. Finally, we find some evidence that even within the same facilities, poorer women tend to receive worse care but, on average, also pay less for care of a given quality. -
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HIV, Risk, and Time Preferences: Evidence from a General Population Sample in Lesotho
(Wiley, 2022-02-11)Identifying individuals most at risk of HIV infection is a priority for policymakers. Apart from specific groups, however, little is known about how to identify those at high risk in the population. Research suggests that attitudes toward risk and time preferences may influence risky sexual behavior, but no studies have so far investigated the interplay between risk attitudes, time preference, and HIV infection. We collect data on risk and time preferences using hypothetical games (multiple price list method) at baseline and data on HIV status at baseline (2010) and endline (2012) allowing us to calculate incidence rate over a 2-year period among 675 participants, males and females 18–32 years old in Lesotho. We find robust evidence of a statistically significant positive associations between HIV incidence and prevalence and risk-loving attitudes, while the associations with risky behaviors and time preferences are not statistically significant. A measure of attitude toward risk, relatively easy to administer to individuals in a survey, is thus associated with future HIV status. This is an important finding for policymakers and suggests the importance of targeting HIV prevention programs to risk-loving individuals and therefore improving program efficiency. -
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Incentivizing Quantity and Quality of Care: Evidence from an Impact Evaluation of Performance-Based Financing in the Health Sector in Tajikistan
(University of Chicago Press, 2022-02)To improve utilization and quality of health services, a growing number of low- and middle-income countries have been experimenting with financial incentives tied to providers’ performance. Relying on a difference-in-differences approach, we estimate the impacts of the performance-based financing pilot in Tajikistan. Primary care facilities were given financial incentives conditional on the quality and quantity of selected services. Significant improvements are found on quality indicators, including elements of the content of care. While the communities in the pilot districts reported higher satisfaction with the local primary care facilities, and despite the improvements in quality, the impact on utilization was limited.
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