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
Effectiveness of Fertiliser Policy Reforms to Enhance Food Security in Kenya: A Macro-Microsimulation Analysis
(Taylor and Francis, 2022-02)Food security represents a key challenge in most Sub-Saharan African countries and in Kenya in particular where still a relevant share of the population lives below a minimum dietary energy consumption. Kenya addresses this concern with a noteworthy policy mix, aiming at giving to the agricultural sector a leading task in improving food security. This paper evaluates the impacts on food security of expanding fertilizer capacities in Kenya, combined with a set of additional policy changes targeting fertilizer use. In a top-down analysis, a specific Computable General Equilibrium (CGE) model is linked with a microsimulation approach. Scenarios present overall positive effects on key food security aggregates. The same is true for welfare. Nevertheless, the heterogeneity of households across and within regions suggests that improving input productivity through better market access and service extension are critical to reducing possible discrepancies across farmers, households and regions. The paper concludes on the need for a sound policy mix since increasing fertilizer production alone is not enough to enhance food security evenly. Among accompanying measures, intensifying extension services are essential especially for smallholders in their acquisition of better knowledge on the use of agricultural inputs. -
Publication
Disrupted Service Delivery? The Impact of Conflict on Antenatal Care Quality in Kenya
(Frontiers Media, 2021-02-28)African countries facing conflict have higher levels of maternal mortality. Understanding the gaps in the utilization of high-quality maternal health care is essential to improving maternal survival in these states. Few studies have estimated the impact of conflict on the quality of health care. In this study, we estimated the impact of conflict on the quality of health care in Kenya, a country with multiple overlapping conflicts and significant disparities in maternal survival. Our study demonstrates the importance of designing maternal health policy based on the context-specific evidence on the mechanisms through which conflict affects health care. In Kenya, deterioration of equipment and infrastructure does not appear to be the main mechanism through which conflict has affected ANC quality. Further research should focus on better understanding the determinants of the gaps in process quality in conflict-affected settings, including provider motivation, competence, and incentives. -
Publication
Is There a Cost-Effective Means of Training Microenterprises?
(Published by Oxford University Press on behalf of the World Bank, 2020-02)Despite billions of dollars spent by policy institutions and academics, very few programs designed to increase managerial skills among microenterprises are cost-effective. This short paper highlights a mentorship program designed to provide managerial skills to Kenyan microenterprises, and it provides a detailed cost-benefit analysis. For each dollar spent on a treated firm, average profit increases by 1.63 USD; the result stems from both a higher program impact and lower cost relative to existing training programs. Motivated by this increased cost-effectiveness, the study then compares the program to the large literature focusing on “supply-side” interventions designed to increase managerial capacity in small firms, and it highlights particular margins on which mentorship improves on classroom training and also where training should focus. -
Publication
Enhancing Young Children’s Language Acquisition through Parent–Child Book-Sharing: A Randomized Trial in Rural Kenya
(Elsevier, 2020-01)Worldwide, 250 million children under five (43%) are not meeting their developmental potential because they lack adequate nutrition and cognitive stimulation in early childhood. Several parent support programs have shown significant benefits for children’s development, but the programs are often expensive and resource intensive. The objective of this study was to test several variants of a potentially scalable, cost-effective intervention to increase cognitive stimulation by parents and improve emergent literacy skills in children. The intervention was a modified dialogic reading training program that used culturally and linguistically appropriate books adapted for a low-literacy population. We used a cluster randomized controlled trial with four intervention arms and one control arm in a sample of caregivers (n?=?357) and their 24- to 83-month-old children (n?=?510) in rural Kenya. The first treatment group received storybooks, while the other treatment arms received storybooks paired with varying quantities of modified dialogic reading training for parents. Main effects of each arm of the trial were examined, and tests of heterogeneity were conducted to examine differential effects among children of illiterate vs. literate caregivers. Parent training paired with the provision of culturally appropriate children’s books increased reading frequency and improved the quality of caregiver-child reading interactions among preschool-aged children. Treatments involving training improved storybook-specific expressive vocabulary. The children of illiterate caregivers benefited at least as much as the children of literate caregivers. For some outcomes, effects were comparable; for other outcomes, there were differentially larger effects for children of illiterate caregivers. -
Publication
Redistribution and Group Participation: Experimental Evidence from Africa and the UK
(Published by Oxford University Press on behalf of the World Bank, 2019-10)We investigate whether the prospect of redistribution hinders the formation of efficiency-enhancing groups. We conduct an experiment in a Kenyan slum, Ugandan villages, and a UK university town. We test, in an anonymous setting with no feedback, whether subjects join a group that increases their endowment but exposes them to one of three redistributive actions: stealing, giving, or burning. We find that exposure to redistributive options among group members operates as a disincentive to join a group. This finding obtains under all three treatments—including when the pressure to redistribute is intrinsic. However the nature of the redistribution affects the magnitude of the impact. Giving has the least impact on the decision to join a group, while forced redistribution through stealing or burning acts as a much larger deterrent to group membership. These findings are common across all three subject pools, but African subjects are particularly reluctant to join a group in the burning treatment, indicating strong reluctance to expose themselves to destruction by others. -
Publication
What Drives Local Food Prices? Evidence from the Tanzanian Maize Market
(Published by Oxford University Press on behalf of the World Bank, 2019-02)We examine the drivers of monthly changes in maize prices across 18 Tanzanian markets. Local prices respond three to four times faster to the main regional market (Nairobi) than to the international benchmark (US Gulf). More importantly, shocks from Nairobi account for only one third of the explained variation in domestic prices; the remaining two-thirds is accounted for by domestic influences (including harvest cycles, weather shocks, and trade policies). Further, we show that remoteness and the local agroecology systematically influence the behavior of food prices. -
Publication
Accessibility Across Transport Modes and Residential Developments in Nairobi
(Elsevier, 2019-01)A key goal of urban transportation planning is to provide people with access to a greater number of opportunities for interaction with people and places. Measures of accessibility are gaining attention globally for use in planning, yet few studies measure accessibility in cities in low-income countries, and even fewer incorporate semi-formal bus systems, also called paratransit. Drawing on rich datasets available for Nairobi, Kenya this analysis quantifies place-based accessibility for walking, paratransit, and driving using three different measures: a mobility measure quantifying how many other locations in Nairobi can be reached in 60 min, a contour measure quantifying the number of health facilities that can be reached in 60 min, and a gravity measure quantifying the number of health facilities weighted by a time-decay function. Health facilities are used because they are an essential service that people need physical access to and as a representation of the spatial distribution of activities more broadly. The findings show that place-based accessibility is highest for driving, then paratransit, then walking, and that there are high levels of access to health facilities near the Central Business District (CBD) for all modes. Additionally, paratransit accessibility is comparatively better in the contour and gravity measures, which may mean that paratransit is efficiently providing access based on the spatial distribution of services. The contour measure results are also compared across different residential levels, which are grouped based on neighborhood characteristics and ordered by income. Counterintuitively, the wealthiest areas have very low levels of place-based accessibility for all modes, while poor areas have comparatively better walking access to health facilities. Interestingly, the medium low residential level, characterized in part by tenement apartment buildings, has significantly higher accessibility than other residential types. One way to reduce inequality in access across income groups is to increase spatial accessibility for the modes used by low- and middle-income households, for example with policies that prioritize public transport and non-motorized travel, integrate paratransit with land use development, and provide safe, efficient, and affordable options. -
Publication
Kenya National Hospital Insurance Fund Reforms: Implications and Lessons for Universal Health Coverage
(Taylor and Francis, 2018-11-06)This article identifies and describes the reforms undertaken by the National Hospital Insurance Fund (NHIF) and examines their implications for Kenya’s quest to achieve universal health coverage (UHC). We undertook a review of published and grey literature to identify key reforms that had been implemented by the NHIF since 2010. We examined the reforms undertaken by the NHIF using a health financing evaluation framework that considers the feasibility, equity, efficiency, and sustainability of health financing mechanisms. We found the following NHIF reforms: (1) the introduction of the Civil Servants Scheme (CSS), (2) the introduction of a stepwise quality improvement system, (3) the health insurance subsidy for the poor (HISP), (4) revision of monthly contribution rates and expansion of the benefit package, and (5) the upward revision of provider reimbursement rates. Though there are improvements in several areas, these reforms raise equity, efficiency, feasibility, and sustainability concerns. The article concludes that though NHIF reforms in Kenya are well intentioned and there has been improvement in several areas, design attributes could compromise the extent to which they achieve their intended goal of providing universal financing risk protection to the Kenyan population. -
Publication
Effects of Exposure to an Intensive HIV-prevention Programme on Behavioural Changes among Female Sex Workers in Nairobi, Kenya
(Taylor and Francis, 2018-03-08)While Kenya has had a long-standing national HIV-prevention program, evidence on the level of exposure to its interventions and related effects on behavioral changes among female sex workers (FSWs) is limited. Using cross-sectional behavioral data collected in 2013 from 1 357 FSWs aged 18 years and above in Nairobi, Kenya, this study explores the relationship between FSW program exposure levels and behavioral outcomes including condom use, sexually transmitted infection (STI)-treatment, and empowerment measures like disclosure of self-identity and violence reporting. We categorized program exposure levels as none, moderate and intensive. Multivariate logistic regression was used for analysis. Overall, 35% of the FSWs were not exposed to any HIV prevention program, whereas about 24% had moderate and 41% had intensive exposure. FSWs having intensive program exposure had a higher likelihood of using condoms consistently with occasional clients (AOR: 1.57; 95% CI: 1.08–2.31) and seeking treatment for STIs (AOR: 3.37; 95% CI: 1.63–7.02) compared to FSWs with no or moderate exposure. Intensive program exposure was also associated with higher self-disclosure of sex-work identity (AOR: 1.63; 95% CI: 1.19–2.24), reporting of violence to police (AOR: 2.45; 95% CI: 1.03–5.84), and negotiation of condom use at last sex when the client was under the influence of alcohol (AOR: 1.63; 95% CI: 0.94–2.82). Although HIV prevention programs in Kenya have been underway for over a decade, program efforts were largely focused on saturating the coverage (intervention breadth). Strategies should now focus on ensuring improved quality of contacts through intensified program exposure (intervention depth) to enhance gains in behavioral change among FSWs and preventing the burden of HIV infection among them. -
Publication
Do Refugee Camps Help or Hurt Hosts?: The Case of Kakuma, Kenya
(Elsevier, 2018-01)We combine nighttime lights data, official statistics, and new household survey data from northern Kenya in order to assess the impact of long-term refugee camps on host populations. The nighttime lights estimates show that refugee inflows increase economic activity in areas very close to Kakuma refugee camp: the elasticity of the luminosity index to refugee population is 0.36 within a 10 km distance from the camp center. In addition, household consumption within the same proximity to the camp is 25% higher than in areas farther away. Price, household survey, and official statistics suggest that the mechanisms driving this positive effect are increased availability of new employment and price changes in agricultural and livestock markets that are favorable to local producers.