Person:
Friedman, Jed
Author Name Variants
Fields of Specialization
Poverty, POV,
Health, HEA
Degrees
ORCID
Departments
Development Research Group
Development Economics, DEC
Development Economics, DEC
Externally Hosted Work
sites.google.com/site/decrgjedfriedman
Contact Information
Last updated
August 15, 2023
Publication Search Results
1 - 10 of 10
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Publication
The Challenge of Measuring Hunger
(World Bank, Washington, DC, 2014-01)There is widespread interest in the number of hungry people in the world and trends in hunger. Current global counts rely on combining each country's total food balance with information on distribution patterns from household consumption expenditure surveys. Recent research has advocated for calculating hunger numbers directly from these same surveys. For either approach, embedded in this effort are a number of important details about how household surveys are designed and how these data are then used. Using a survey experiment in Tanzania, this study finds great fragility in hunger counts stemming from alternative survey designs. As a consequence, comparable and valid hunger numbers will be lacking until more effort is made to either harmonize survey designs or better understand the consequences of survey design variation. -
Publication
Health Information, Treatment, and Worker Productivity : Experimental Evidence from Malaria Testing and Treatment among Nigerian Sugarcane Cutters
(World Bank Group, Washington, DC, 2014-11)Agricultural and other physically demanding sectors are important sources of growth in developing countries but prevalent diseases such as malaria adversely impact the productivity, labor supply, and choice of job tasks among workers by reducing physical capacity. This study identifies the impact of malaria on worker earnings, labor supply, and daily productivity by randomizing the temporal order at which piece-rate workers at a large sugarcane plantation in Nigeria are offered malaria testing and treatment. The results indicate a significant and substantial intent to treat effect of the intervention -- the offer of a workplace-based malaria testing and treatment program increases worker earnings by approximately 10 percent over the weeks following the offer. The study further investigates the effect of health information by contrasting program effects by workers' revealed health status. For workers who test positive for malaria, the treatment of illness increases labor supply, leading to higher earnings. For workers who test negative, and especially for those workers most likely to be surprised by the healthy diagnosis, the health information also leads to increased earnings via increased productivity. Possible mechanisms for this response include selection into higher return tasks within the plantation as a result of changes in the perceived cost of effort. A model of the worker labor decision that allows health expectations partly to determine the supply of effort suggests that, in endemic settings with poor quality health services, inaccurate health perceptions may lead workers to suboptimal labor allocation decisions. The results underline the importance of medical treatment, but also of access to improved information about one's health status, as the absence of either may lead workers to deliver lower effort in lower return jobs. -
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Linking Results to Performance: Evidence from a Results Based Financing Pre-Pilot Project in Katete District, Zambia
(World Bank, Washington, DC, 2015-04) -
Publication
Disruptions in Maternal and Child Health Service Utilization during COVID-19: Analysis from Eight Sub-Saharan African Countries
(Oxford University Press, 2021-06-19)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. -
Publication
How Many More Infants Are Likely to Die in Africa as a Result of the Global Financial Crisis?
( 2009-08-01)The human consequences of the current global financial crisis for the developing world are presumed to be severe yet few studies have quantified such impact. The authors estimate the additional number of infant deaths in sub-Saharan Africa likely due to the crisis and discuss possible mitigation strategies. They pool birth-level data as reported in female adult retrospective birth histories from all Demographic and Health Surveys collected in sub-Saharan Africa nations. This results in a data set of 639,000 births to 264,000 women in 30 countries. The authors use regression models with flexible controls for temporal trends to assess an infant s likelihood of death as a function of fluctuations in national income. They then apply this estimated likelihood to expected growth shortfalls as a result of the crisis. At current growth projections, their estimates suggest there will be 30,000 - 50,000 excess infant deaths in sub-Saharan Africa. Most of these additional deaths are likely to be poorer children (born to women in rural areas and lower education levels) and are overwhelmingly female. If the crisis continues to worsen the number of deaths may grow much larger, especially those to girls. Policies that protect the income of poor households and that maintain critical health services during times of economic contraction should be considered. Interventions targeted at female infants and young girls may be particularly beneficial. -
Publication
Methods of Household Consumption Measurement Through Surveys : Experimental Results from Tanzania
( 2010-12-01)Consumption expenditure has long been the preferred measure of household living standards. However, accurate measurement is a challenge and household expenditure surveys vary widely across many dimensions, including the level of reporting, the length of the reference period, and the degree of commodity detail. These variations occur both across countries and also over time within countries. There is little current understanding of the implications of such changes for spatially and temporally consistent measurement of household consumption and poverty. A field experiment in Tanzania tests eight alternative methods to measure household consumption on a sample of 4,000 households. There are significant differences between consumption reported by the benchmark personal diary and other diary and recall formats. Under-reporting is particularly relevant in illiterate households and for urban respondents completing household diaries; recall modules measure lower consumption than a personal diary, with larger gaps among poorer households and households with more adult members. Variations in reporting accuracy by household characteristics are also discussed and differences in measured poverty as a result of survey design are explored. The study concludes with recommendations for methods of survey based consumption measurement in low-income countries. -
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Mental Health Patterns and Consequences : Results from Survey Data in Five Developing Countries
(World Bank, Washington, DC, 2008-01)The social and economic consequences of poor mental health in the developing world are presumed to be significant, yet are largely under-researched. The authors argue that mental health modules can be meaningfully added to multi-purpose household surveys in developing countries, and used to investigate this relationship. Data from nationally representative surveys in Bosnia and Herzegovina, Indonesia, and Mexico, along with special surveys from India and Tonga, show similar patterns of association between mental health and socioeconomic characteristics across countries. Individuals who are older, female, widowed, and report poor physical health are more likely to report worse mental health outcomes. Individuals living with others with poor mental health are also significantly more likely to report worse mental health themselves. In contrast, there is little observed relationship between mental health and poverty or education, common measures of socio-economic status. The results instead suggest that economic and multi-dimensional shocks such as illness or crisis can have a greater impact on mental health than overall levels of poverty. This may have important implications for social protection policy. The authors also find significant associations between poor mental health and lowered labor force participation (especially for women) and higher frequency visits to health centers, suggesting that poor mental health can have significant economic consequences for households and the health system. Finally, the paper discusses how measures of mental health are distinct from general subjective welfare measures such as happiness and indicate useful directions of future research. -
Publication
Improving Supply Chain for Essential Drugs in Low-Income Countries: Results from a Large Scale Randomized Experiment in Zambia
(Taylor and Francis, 2019-03-20)Despite increased investments in procurement of essential medicines, their availability at health facilities remains extremely low in many low- and middle-income countries. The lack of a well-functioning supply chain for essential medicines is often the cause of this poor availability. Using a randomized trial conducted in 439 health facilities and 24 districts in Zambia, this study helps understand the optimal supply chain structure for essential medicines distribution in the public sector in low-income countries. It shows that a more direct distribution system where clinics order and receive medicines supply directly from the central agency through a cross-docking arrangement significantly reduces the duration and frequency of stockouts compared to a traditional three-level drug distribution system. As an example, the frequency of stockouts for first line pediatric malaria medicines reduced from 47.9% to 13.3% and the number of days of stockout in a quarter reduced from 27 days to 5 days. The direct flow of demand and order information from health facilities to the central supply agency reduces the problem of diffuse accountability that exists in multi-tiered distribution systems. It also shifts the locus of decision making for complex supply chain functions such as scarce stock allocation and adjustment of health facility order quantities to levels in the system where staff competency is aligned with what the function needs. Even when supply chain system redesign such as the one evaluated in this paper are demonstrated to be technically robust using rigorous evidence, they often require navigating a complex political economy within the overall health system and its actors. -
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The Distribution of Effort: Physical Activity, Gender Roles, and Bargaining Power in an Agrarian Setting
(World Bank, Washington, DC, 2021-04)The disutility of work, often summarily described as effort, is a primal component of economic models of worker and consumer behavior. However, empirical applications that measure effort, especially those that assess the distribution of effort across known populations, are historically scarce. This paper explores intra-household differences in physical activity in a rural agrarian setting. Physical activity is captured via wearable accelerometers that provide a proxy for physical effort expended per unit of time. In the study setting of agricultural households in Malawi, men devote significantly more time to sedentary activities than women (38 minutes per day), but also spend more time on moderate-to-vigorous activities (16 minutes). Using standardized energy expenditure as a summary measure for physical effort, women exert marginally higher levels of physical effort than men. However, gender differences in effort among married partners are strongly associated with intra-household differences in bargaining power, with significantly larger husband-wife effort gaps alongside larger differences in age and individual land ownership as well as whether the couple lives as part of a polygamous union. Physical activity -- a proxy for physical effort, an understudied dimension of wellbeing -- exhibits an unequal distribution across gender in this population. -
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Development, Modernization, and Childbearing
(World Bank, 2009-11-30)Does the sex composition of existing children in a family affect fertility behavior? An unusually large data set, covering 64 countries and some 5 million births, is used to show that fertility behavior responds to the presence—or absence—of sons in many regions of the developing world. The response to the absence of sons is particularly large in Central Asia and South Asia. Modernization does not appear to reduce this differential response. For example, in South Asia the fertility response to the absence of sons is larger for women with more education and has been increasing over time. The explanation appears to be that a latent demand for sons is more likely to manifest itself when fertility levels are low. As a result of this differential fertility behavior, girls tend to grow up with significantly more siblings than do boys, with potential implications for their well-being when quantity–quality tradeoffs result in fewer material and emotional resources allocated to children in larger families.