Person:
Kandpal, Eeshani

Development Research Group

Fields of Specialization

Health economics, Gender, Social protection

ORCID

0000-0001-9055-6296

Departments

Development Research Group

Externally Hosted Work

https://sites.google.com/view/eeshanikandpal/home

Last updated: October 24, 2023

Biography

Eeshani Kandpal is a Senior Economist in the Development Research Group of the World Bank. Her research examines two types of financial incentives: (1) cash transfers to poor households and (2) pay-for-performance contracts with health workers and facilities to improve the provision of primary health care. She is particularly interested in design elements like the targeting mechanisms of cash transfers and optimal pricing regimes for health service delivery as well as spillovers from incomplete contracts or targeting methods. She is an associate editor for the American Journal of Agricultural Economics and a lead author of the forthcoming World Bank Policy Research Report titled Financial Incentives for Effective Coverage in Health. Her work has been covered by NPR and VoxDev as well as several media outlets in India and the Philippines. Eeshani was born and raised in India and has a PhD from the University of Illinois and a BA from Macalester College. Eeshani Kandpal is currently on leave from the World Bank.

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Publication Search Results

Now showing 1 - 10 of 14

Improving Effective Coverage in Health: Do Financial Incentives Work?
(Washington, DC: World Bank, 2022-05-11) de Walque, Damien; Kandpal, Eeshani; Wagstaff, Adam; Friedman, Jed; Neelsen, Sven; Piatti-Fünfkirchen, Moritz; Sautmann, Anja; Shapira, Gil; Van de Poel, Ellen
In many low- and middle-income countries, health coverage has improved dramatically in the last two decades, but health outcomes have not. As such, effective coverage -- a measure of service delivery that meets a minimum standard of quality -- remains unacceptably low. This Policy Research Report examines one specific policy approach to improving effective coverage: financial incentives in the form of performance-based financing (PBF) or financial incentives to health workers on the front lines. The report draws on a rich set of rigorous studies and new analysis. When compared to business-as-usual, in low-income settings with centralized health systems PBF can result in substantial gains in effective coverage. However, the relative benefits of PBF are less clear when it is compared to two alternative approaches, decentralized facility financing which provides operating budget to frontline health services with facility autonomy on allocation, and demand-side financial support for health services (i.e., conditional cash transfers and vouchers). While PBF often results in improvements on the margins, closing the substantial gaps in effective health coverage is not yet within reach for many countries. Nonetheless, there are important lessons learned and experiences from the roll-out of PBF over the last decade which can guide health policies into the future.
Unequal Households or Communities?: Decomposing the Inequality in Nutritional Status in South Asia
(World Bank, Washington, DC:, 2022-04) Brown, Caitlin; Kandpal, Eeshani; Lee, Jean; Williams, Anaise
Half of all undernourished women and children in South Asia are not found in the bottom 40 percent of wealth-poor households. This paper quantifies the extent to which this inequality in nutritional status arises within households versus between households. In contrast to previous literature, it shows that between-household inequality explains 3.5 times as much of the variation as does inequality within households. Within the household, gender, age, and birth order are key correlates of nutritional outcomes. At the household level and accounting for community-level factors, both an index of sanitation infrastructure and the presence of an improved toilet matter independently to household wealth for nutritional outcomes. The paper concludes with a comparison of the effectiveness of targeting undernourishment using household wealth, a community sanitation infrastructure index, and, separately, the proportion of improved toilets in a community. The findings show that access to improved toilets, despite its relative simplicity, performs almost as well as household wealth and better than the community sanitation index. These findings highlight that (a) inequality between households within the same communities is an overlooked but important driver of inequality in nutritional status, and (b) community-level sanitation infrastructure may be a better indicator of nutritional status than more complicated household-level targeting measures.
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) Fink, Gunther; Kandpal, Eeshani; Shapira, Gil
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.
Disruptions in Maternal and Child Health Service Utilization during COVID-19: Analysis from Eight Sub-Saharan African Countries
(Oxford University Press, 2021-06-19) Shapira, Gil; Drouard, Salome Henriette Paulette; Fernandez, Pablo Amor; Kandpal, Eeshani; Sanford Wesseh, Chea; Mohamud, Nur Ali; Smart, Francis; Mwansambo, Charles; Baye, Martina L; Diabate, Mamatou; Yuma, Sylvain; Ogunlayi, Munirat; De Dieu Rusatira, Rwema Jean; Hashemi, Tawab; Vergeer, Petra; Friedman, Jed
The coronavirus-19 pandemic and its secondary effects threaten the continuity of essential health services delivery, which may lead to worsened population health and a protracted public health crisis. We quantify such disruptions, focusing on maternal and child health, in eight sub-Saharan countries. Service volumes are extracted from administrative systems for 63 954 facilities in eight countries: Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone and Somalia. Using an interrupted time series design and an ordinary least squares regression model with facility-level fixed effects, we analyze data from January 2018 to February 2020 to predict what service utilization levels would have been in March–July 2020 in the absence of the pandemic, accounting for both secular trends and seasonality. Estimates of disruption are derived by comparing the predicted and observed service utilization levels during the pandemic period. All countries experienced service disruptions for at least 1 month, but the magnitude and duration of the disruptions vary. Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. We estimate a cumulative shortfall of 5 149 491 outpatient consultations and 328 961 third-dose pentavalent vaccinations during the 5 months in these eight countries. Decreases in maternal health service utilization are less generalized, although significant declines in institutional deliveries, antenatal care and postnatal care were detected in some countries. There is a need to better understand the factors determining the magnitude and duration of such disruptions in order to design interventions that would respond to the shortfall in care. Service delivery modifications need to be both highly contextualized and integrated as a core component of future epidemic response and planning.
Information, Loss Framing, and Spillovers in Pay-for-Performance Contracts
(World Bank, Washington, DC, 2021-06) Bauhoff, Sebastian; Kandpal, Eeshani
Do incentives matter beyond the information conveyed by pay-for-performance contracts? Does loss framing matter? And do incomplete contracts generate spillovers on unincentivized tasks? This study reports on a framed field experiment with 1,363 maternity care workers in 691 primary health facilities in Nigeria to answer these questions. Participants were randomized into three study arms—(1) information with a flat participation fee, (2) performance-based rewards, and (3) performance-based penalties. In each arm, participants had to identify correct clinical actions based on the records of hypothetical patients receiving maternity care. Five of fifteen possible actions were incentivized but performance was measured on all fifteen. Compared to information alone, both rewards and penalties increase time on task by 11 percent, correct overall performance by 6 to 8 percent, and directly incentivized performance by 20 percent. Incentives also generate positive spillovers of 14 percent on unincentivized tasks. Loss framing does not affect performance. Results suggest that improving health worker effort by 8 percent would have an impact on neonatal mortality at par with the short run effect of adding a physician to a health facility. Finally, findings show that a small incentive captures most of the impact, implying that incentives work by making information more effective and that pay-for-performance contracts can be made significantly more cost-effective.
The Social Lives of Married Women: Peer Effects in Female Autonomy and Investments in Children
(World Bank, Washington, DC, 2019-04) Baylis, Kathy; Kandpal, Eeshani
In patriarchal societies, sticky norms affect married women's social circles, their autonomy, and the outcomes of intra-household bargaining. This paper uses primary data on women's social networks in Uttarakhand, India; the modal woman has only three friends, and over 80 percent do not have any friends of another caste. This paper examines the effect of a shock to friends' empowerment on a woman's autonomy, specifically physical mobility, access to social safety nets, and employment outside the household; perceived social norms; and an outcome of household bargaining: investments in her children. The analysis instruments for endogenous network formation using a woman's age and her caste network in the village. The key peer effect is the impact of having a friend who received an empowerment shock on a woman who did not receive that shock. The results show significant peer effects on only a few of the examined measures of women's autonomy. In contrast, peer effects exist on all considered outcomes of a daughters’ diet and time spent on chores. The findings suggest a large decay rate between effects on own empowerment and peer effects. Interventions targeting child welfare through women's empowerment may generate second-order effects on intra-household decision-making, albeit with substantial decay rates, and thus benefit from targeted rather than randomized rollout. In contract, interventions on gender roles and women's autonomy may be limited by the stickiness of social norms.
Inequality in the Quality of Health Services: Wealth, Content of Care, and Price of Antenatal Consultations in the Democratic Republic of Congo
(World Bank, Washington, DC, 2019-04) Fink, Gunther; Kandpal, Eeshani; Shapira, Gil
Using unique direct observations of patient-provider interactions linked to patient exit interviews and detailed household surveys, this paper assesses the relationship between patient wealth and the quality and price of antenatal care in the Democratic Republic of Congo. Overall, the analysis finds a significant wealth-quality gradient, with a standard deviation increase in wealth being associated with an increase of 4 percentage points in protocol compliance. This increase in compliance represents 8 percent of the average quality of care received by women in the lowest wealth quintile. Over half of the wealth-quality gradient is driven by lower facility quality in poorer areas. However, the analysis also finds statistically significant within-village and even within-facility wealth-quality relationships. Within villages, wealth-quality gradients are primarily driven by wealthier women seeking care at higher-quality even if more distant facilities. Within the same facilities, poorer women tend to receive worse care, but on average they also pay less for the same quality of care compared with wealthier women. The price gap increases in the local ratio of wealthy to poor households, suggesting that providers do not charge different prices only for redistributive reasons.
Cash Transfers, Food Prices, and Nutrition Impacts on Nonbeneficiary Children
(World Bank, Washington, DC, 2018-03) Onishi, Junko; Filmer, Deon; Friedman, Jed; Kandpal, Eeshani
Cash transfer programs may generate significant general equilibrium effects that can detract from the anti-poverty goals of the program. Data from a randomized evaluation of a Philippine cash transfer program targeted to poor households show that a 9 percent increase in village income significantly raised the prices of perishable protein-rich foods while leaving other food prices unaffected. The price changes are largest in areas with the highest program saturation, where the shock to village income is on the order of 15 percent and persists more than 2.5 years after program introduction. Although significantly improving nutrition related outcomes among beneficiary children, the cash transfer worsened those same indicators among non-beneficiary children. The stunting rate of young non-beneficiary children increased by eleven percentage points, with even greater increases in the most saturated areas. Another potentially related spillover arises in local health markets: formal health care utilization by mothers and children also declined among non-beneficiary households. Failing to consider such local general equilibrium effects can overstate the net benefit of targeted cash transfers. In areas where individual targeting of social programs covers the majority of households, offering the program on a universal basis should avoid such negative impacts at little additional cost.
Safety Nets and Natural Disaster Mitigation: Evidence from Cyclone Phailin in Odisha
(World Bank, Washington, DC, 2018-03) Christian, Paul; Kandpal, Eeshani; Palaniswamy, Nethra; Rao, Vijayendra
To what degree can vulnerability to extreme weather events be mitigated by access to a rural livelihoods program, particularly with regard to the impacts on women? This paper addresses this question through a natural experiment arising from two independent but overlapping sources of variation: exposure to a devastating cyclone that occurred in the Bay of Bengal region of India and the staggered rollout of a rural livelihoods intervention. Comparisons from household surveys across communities more or less exposed to the storm before and after the introduction of the program reveal that the storm led to significant reductions in overall household expenditure, and that these reductions were indeed the largest for women, adding to the emerging evidence for the frequently-posed hypothesis that women bear the brunt of the effects of disasters on overall household consumption. Participation in the livelihoods program mitigated some of the reductions in household nonfood expenditure and women's consumption, but not on food expenditure. These results from a densely populated region whose topography makes it particularly vulnerable to storms can inform future policy approaches and aid in modeling the impact of these policies on the effects of climate change.
Child Schooling and Child Work in the Presence of a Partial Education Subsidy
(World Bank, Washington, DC, 2017-09) de Hoop, Jacobus; Friedman, Jed; Kandpal, Eeshani; Rosati, Furio
Could a partial subsidy for child education increase children's participation in paid work? In contrast to much of the theoretical and empirical child labor literature, this paper shows that child work and school participation can be complements under certain conditions. Using data from the randomized evaluation of a conditional cash transfer program in the Philippines, the analysis finds that some children, who were in neither school nor work before the program, increased participation in school and work-for-pay after the program. Earlier cash transfer programs, notably those in Mexico, Brazil, and Ecuador, increased school attendance while reducing child labor. Those programs fully offset schooling costs, while the transfers under the Philippine transfers fall short of the full costs of schooling for a typical child. As a result, some beneficiary children from poor Philippine households increased work to support their schooling. The additional earnings from this work represent a substantive share of the shortfall in the schooling costs net of transfer. The paper rules out several potential alternative explanations for the increase in child labor, including changes in household productive activities, adult labor supply, and household expenditure patterns that, in principle, can arise after a cash transfer and may also affect the supply of or demand for child labor.