Person:
Gertler, Paul Jerome
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Impact evaluation,
Health economics
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Last updated
January 31, 2023
Biography
Paul Gertler is the Li Ka Shing Professor of Economics at the University of California, Berkeley where he holds appointments in the Haas School of Business and the School of Public Health. He is also the Scientific Director of the UC Center for Effective Global Action.
Dr. Gertler is an internationally recognized expert in impact evaluation. Dr. Gertler was Chief Economist of the Human Development Network of the World Bank from 2004-2007 and the Founding Chair of the Board of Directors of the International Initiative for Impact Evaluation (3ie) from 2009-2012. At the World Bank he led an effort to institutionalize and scale up impact evaluation for learning what works in human development. He is the author of the bestselling textbook Applied Impact Evaluation published by the World Bank Press. He has been a Principal Investigator on a large number of at-scale multi-site impact evaluations including Mexico’s CCT program, PROGRESA/OPORTUNIDADES, and Rwanda’s Health Care Pay-for-Performance scheme. He holds a PhD in economics from the University of Wisconsin and prior to UC Berkeley has held academic appointments at Harvard, RAND, and SUNY Stony Brook.
Publication Search Results
1 - 9 of 9
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Publication
Labor Market Returns to Early Childhood Stimulation : A 20-year Followup to an Experimental Intervention in Jamaica
(World Bank, Washington, DC, 2013-07)This paper finds large effects on the earnings of participants from a randomized intervention that gave psychosocial stimulation to stunted Jamaican toddlers living in poverty. The intervention consisted of one-hour weekly visits from community Jamaican health workers over a 2-year period that taught parenting skills and encouraged mothers to interact and play with their children in ways that would develop their children's cognitive and personality skills. The authors re-interviewed the study participants 20 years after the intervention. Stimulation increased the average earnings of participants by 42 percent. Treatment group earnings caught up to the earnings of a matched non-stunted comparison group. These findings show that psychosocial stimulation early in childhood in disadvantaged settings can have substantial effects on labor market outcomes and reduce later life inequality. -
Publication
A Randomized, Controlled Study of a Rural Sanitation Behavior Change Program in Madhya Pradesh, India
(World Bank, Washington, DC, 2013-11)Poor sanitation and open defecation are thought to be a major cause of diarrhea and intestinal parasite infections among young children. In 1999, India launched the Total Sanitation Campaign with the goal of achieving universal toilet coverage in rural India by 2012. This paper reports on a cluster-randomized, controlled trial that was conducted in 80 rural villages in Madhya Pradesh to measure the effect of the program on toilet access, sanitation behavior, and child health outcomes. The study analyzed a random sample of 3,039 households and 5,206 children under five years of age. Field staff collected baseline measures of sanitation conditions, behavior, and child health, and re-visited households 21 months later. The analysis finds that implementation of the program activities was slower than the original timeline (only 35 percent of villages were triggered more than six months before the follow-up survey). Nevertheless, the Total Sanitation Campaign successfully increased toilet coverage by 19 percent in intervention villages compared with control villages (41 percent v. 22 percent), while reported open defecation decreased by 10 percent among adults (74 percent v. 84 percent). The intervention also led to some improvements in water quality and protozoan infection, but consistent improvements were not observed across multiple child health outcomes (diarrhea, helminth infections, child growth). However, the exposure period was likely to have been too short to result in any benefit of the sanitation interventions on child health. Given the large improvements in toilet construction documented, an additional follow-up survey with a longer period of exposure would yield valuable information on the effects of improved sanitation conditions on health outcomes. -
Publication
Housing, Health, and Happiness
(World Bank, Washington, DC, 2007-04)Despite the importance of housing for people's well-being, there has been little work done to assess the causal impact of housing and housing improvement programs on health and welfare. In this paper the authors help fill this gap by investigating the impact of a large-scale effort by the Mexican government to replace dirt floors with cement floors on child health and adult happiness. They find that replacing dirt floors with cement floors significantly reduces parasitic infestations in young children, reduces diarrhea, reduces anemia, and improves cognitive development. Finally, they also find that this program leave adults substantially better off, as measured by satisfaction with their housing and quality of life and by their significantly lower rates of depression and perceived stress. -
Publication
Using Performance Incentives to Improve Health Outcomes
(World Bank, Washington, DC, 2012-06)This study examines the effect of performance incentives for health care providers to provide more and higher quality care in Rwanda on child health outcomes. The authors find that the incentives had a large and significant effect on the weight-for-age of children 0-11 months and on the height-for-age of children 24-49 months. They attribute this improvement to increases in the use and quality of prenatal and postnatal care. Consistent with theory, They find larger effects of incentives on services where monetary rewards and the marginal return to effort are higher. The also find that incentives reduced the gap between provider knowledge and practice of appropriate clinical procedures by 20 percent, implying a large gain in efficiency. Finally, they find evidence of a strong complementarity between performance incentives and provider skill. -
Publication
Rewarding Provider Performance to Enable a Healthy Start to Life : Evidence from Argentina's Plan Nacer
(World Bank, Washington, DC, 2014-05)Argentina's Plan Nacer provides insurance for maternal and child health care to uninsured families. The program allocates funding to provinces based on enrollment of beneficiaries and adds performance incentives based on indicators of the use and quality of maternal and child health care services and health outcomes. The provinces use these resources to pay health facilities to provide maternal and child health care services to beneficiaries. This paper analyzes the impact of Plan Nacer on birth outcomes. The analysis uses data from the universe of birth records in seven Argentine provinces for 2004 to 2008 and exploits the geographic phasing in of Plan Nacer over time. The paper finds that the program increases the use and quality of prenatal care as measured by the number of visits and the probability of receiving a tetanus vaccine. Beneficiaries' probability of low birth-weight is estimated to be reduced by 19 percent. Beneficiaries have a 74 percent lower chance of in-hospital neonatal mortality in larger facilities and approximately half this reduction comes from preventing low birth weight and half from better postnatal care. The analysis finds that the cost of saving a disability-adjusted life year through the program was $814, which is highly cost-effective compared with Argentina's $6,075 gross domestic product per capita over this period. Although there are small negative spillover effects on prenatal care utilization of non-beneficiary populations in clinics covered by Plan Nacer, no spillover is found on their birth outcomes. -
Publication
Paying Primary Health Care Centers for Performance in Rwanda
(World Bank, Washington, DC, 2010-01)Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery of services. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. Treatment facilities were enrolled in the P4P scheme in 2006 and comparison facilities were enrolled two years later. The incentive effect is isolated from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments to the treatment facilities. The data were collected from 166 facilities and a random sample of 2158 households. P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children, and improved quality of prenatal care. The authors find no effect on the number of prenatal care visits or on immunization rates. P4P had the greatest effect on those services that had the highest payment rates and needed the lowest provider effort. P4P financial performance incentives can improve both the use of and the quality of health services. Because the analysis isolates the incentive effect from the resource effect in P4P, the results indicate that an equal amount of financial resources without the incentives would not have achieved the same gain in outcomes. -
Publication
Promoting Handwashing Behavior in Peru : The Effect of Large-Scale Mass-Media and Community Level Interventions
(World Bank, Washington, DC, 2012-11)This paper analyzes a randomized experiment that uses novel strategies to promote handwashing with soap at critical times in Peru. It evaluates a large-scale intervention that includes a mass media provincial campaign and a district-level community component. The analysis finds that the mass media intervention alone had no significant effect on exposure to the handwashing promotion campaign messages, and therefore no effect on handwashing knowledge or handwashing behavior. In contrast, the community-level intervention, a more comprehensive intervention that included several community and school activities in addition to the communications campaign, was successful in reaching the target audience with handwashing promotion messages and in improving the knowledge of the treated population on appropriate handwashing behavior. Those improvements translated into higher self-reported and observed handwashing with soap at critical junctures. However, no significant improvements in the health of children under the age of five were observed. The results are consistent with earlier literature, which indicates that substantively changing behavior to improve health is a complex task requiring intensive and more personalized interventions. -
Publication
Long-Run Effects of Temporary Incentives on Medical Care Productivity
(World Bank, Washington, DC, 2015-06)The adoption of new clinical practice patterns by medical care providers is often challenging, even when the patterns are believed to be efficacious and profitable. This paper uses a randomized field experiment to examine the effects of temporary financial incentives paid to medical care clinics for the initiation of prenatal care in the first trimester of pregnancy. The rate of early initiation of prenatal care was 34 percent higher in the treatment group than in the control group while the incentives were being paid, and this effect persisted at least 15 months and likely 24 months or more after the incentives ended. These results are consistent with a model where the incentives enable providers to address the fixed costs of overcoming organizational inertia in innovation, and suggest that temporary incentives may be effective at motivating improvements in long-run provider performance at a substantially lower cost than permanent incentives. -
Publication
Impact Evaluation in Practice, First Edition
(World Bank, 2011)The Impact Evaluation in Practice handbook is a comprehensive and accessible introduction to impact evaluation for policymakers and development practitioners. The book incorporates real-world examples to present practical guidelines for designing and implementing evaluations. Readers will gain an understanding of the uses of impact evaluation and the best ways to use evaluations to design policies and programs that are based on evidence of what works most effectively. The handbook is divided into three sections: Part One discusses what to evaluate and why; Part Two outlines the theoretical underpinnings of impact evaluation; and Part Three examines how to implement an evaluation. Case studies illustrate different methods for carrying out impact evaluations.