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
Impacts of Performance‑Based Financing on Health System Performance: Evidence From The Democratic Republic of Congo (Published: 04 October 2023)
(BMC Medicine, 2023-10-10)Health systems’ weakness remains one of the primary obstacles towards achieving universal access to quality healthcare in low-income settings. Performance-based financing (PBF) programs have been increasingly used to increase access to quality care in LMICs. However, evidence on the impacts of these programs remains fragmented and inconclusive. We analyze the health system impacts of the PBF program in the Democratic Republic of the Congo (DRC), one of the largest such programs introduced in LMICs to date. We used a health systems perspective to analyze the benefits of PBF relative to unconditional financing of health facilities. Fifty-eight health zones in six provinces were randomly assigned to either a control group (28 zones) in which facilities received unconditional transfers or to a PBF program (30 zones) that started at the end of 2016. Follow-up data collection took place in 2021–2022 and included health facility assessments, health worker interviews, direct observations of consultations and deliveries, patient exit interviews, and household surveys. Using multivariate regression models, we estimated the impact of the program on 55 outcomes in seven health system domains: structural quality, technical process quality, non-technical process quality, service fees, facility management, providers’ satisfaction, and service coverage. We used random-effects meta-analysis to generate pooled average estimates within each domain. The PBF program improved the structural quality of health facilities by 4 percentage points (ppts) (95% CI 0.01–0.08), technical process quality by 5 ppts (0.03–0.07), and non-technical process by 2 ppts (0–0.04). PBF also increased coverage of priority health services by 3 ppts (0.02–0.04). Improvements were also observed for facility management (9 ppts, 0.04–0.15), service fee policies, and users’ satisfaction with service affordability (14 ppts, 0.07–0.20). Service fees and health workers’ satisfaction were not affected by the program. The results suggest that well-designed PBF programs can lead to improvements in most health systems domains relative to comparable unconditional financing. However, the large persisting gaps suggest that additional changes, such as allocating more resources to the health system and reforming the human resources for health management, will be necessary in DRC to achieve the ambitious global universal health coverage and mortality goals. -
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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. -
Publication
Centring Rights-Based Access to Self-Care Interventions
(Taylor and Francis, 2022-11-11)Ensuring sexual and reproductive health and rights (SRHR) is fundamental to the success of the Sustainable Development Goals and a range of other global commitments. As such, innovations that can help promote SRHR, including self-care interventions, offer exciting opportunities to improve health and rights simultaneously. While self-care is not new conceptually, the growing number of evidence-based technologies, medicines and products that can be accessed outside of the formal health sector point to the role lay people play as active participants in their own health care. -
Publication
Improving the Well-Being of Adolescent Girls in Developing Countries
(Published by Oxford University Press on behalf of the World Bank, 2022-10-13)This paper conducts a large, narrative review of interventions that might plausibly (a) increase educational attainment, (b) delay childbearing, and/or (c) delay marriage for adolescent girls in low- and middle-income countries (LMICs). Using 108 interventions from 78 studies, predominantly in LMICs, the paper summarizes the performance of 15 categories of interventions in improving these outcomes. Transfer programs emerge as broadly effective in increasing educational attainment but their effects on delaying fertility and marriage remain mixed and dependent on context. Construction of schools in underserved areas and the provision of information on returns to schooling and academic performance also increase schooling. No category of interventions is found to be categorically effective in delaying pregnancies and reducing child marriages among adolescent girls. While targeted provision of sexual and reproductive health services, including vouchers and subsidies for family planning, and increasing job opportunities for women seem promising, more research is needed to evaluate the longer-term effects of such interventions. We propose that future studies should aim to measure short-term outcomes that can form good surrogates for long-term welfare gains and should collect detailed cost information. -
Publication
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. -
Publication
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. -
Publication
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. -
Publication
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. -
Publication
Tackling psychosocial and capital constraints to alleviate poverty
(Springer Nature, 2022-04-27)Many policies attempt to help extremely poor households build sustainable sources of income. Although economic interventions have predominated historically 1,2, psychosocial support has attracted substantial interest 3,4,5, particularly for its potential cost-effectiveness. Recent evidence has shown that multi-faceted ‘graduation’ programs can succeed in generating sustained changes 6,7. Here we show that a multi-faceted intervention can open pathways out of extreme poverty by relaxing capital and psychosocial constraints. We conducted a four-arm randomized evaluation among extremely poor female beneficiaries already enrolled in a national cash transfer government program in Niger. The three treatment arms included group savings promotion, coaching and entrepreneurship training, and then added either a lump-sum cash grant, psychosocial interventions, or both the cash grant and psychosocial interventions. All three arms generated positive effects on economic outcomes and psychosocial well-being, but there were notable differences in the pathways and the timing of effects. Overall, the arms with psychosocial interventions were the most cost-effective, highlighting the value of including well-designed psychosocial components in government-led multi-faceted interventions for the extreme poor. -
Publication
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.