Person:
Evans, David K.
Author Name Variants
Fields of Specialization
Education,
Social Development
Degrees
ORCID
Departments
Africa Chief Economist’s Office
Externally Hosted Work
Contact Information
Last updated
July 27, 2023
Biography
Bio: David is a Lead Economist in the Chief Economist's Office for the Africa Region of the World Bank. He coordinates impact evaluation work across sectors for the Africa Region. In the past, he worked as Senior Economist in the Human Development Department in the Latin America and the Caribbean Region of the World Bank, and as an economist designing and implementing impact evaluations in Africa. He has designed and implemented impact evaluations in agriculture, education, health, and social protection, in Brazil, the Gambia, Kenya, Mexico, Sierra Leone, and Tanzania. He has taught economic development at the Pardee RAND Graduate School of Public Policy, and he holds a Ph.D. in economics from Harvard University.
Publication Search Results
1 - 7 of 7
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Publication
Community-Based Conditional Cash Transfers in Tanzania : Results from a Randomized Trial
(Washington, DC: World Bank, 2014-03-04)Given the success of conditional cash transfer (CCT) programs elsewhere, in 2010 the Government of Tanzania rolled out a pilot CCT program in three districts. Its aim was to see if, using a model relying on communities to target beneficiaries and deliver payments, the program could improve outcomes for the poor the way centrally-run CCT programs have in other contexts. The program provided cash payments to poor households, but conditioned payments on complying with certain health and education requirements. Given scarce resources, the Government randomly selected 40 out of 80 eligible villages to receive the pilot program. Households in participating and comparison villages were broadly comparable at baseline. This report describes the program and the results of a rigorous, mixed methods impact evaluation. Two and a half years into the program, participating households were healthier and more educated. Health improvements due to the CCT program were greatest for the poorest half of households—the poorest of the poor. They experienced a half a day per month reduction in sick days on average, and poor children age 0-4 in particular had a full day per month reduction in sick days. In education, the program showed clear positive impacts on whether children had ever attended school and on whether they completed Standard 7. Households were also more likely to buy shoes for children, which can promote both health and school attendance. In response to the program, households also made investments to reduce risk: Participating households were much more likely to finance medical care with insurance and much more likely to purchase health insurance than were their comparison counterparts. The program did not significantly affect savings on aeverage, although it did increase non-bank savings amongst the poorest half of households. Participating households also invested in more livestock assets, which they used to create small enterprises. The program did not, however, have significant impacts on food consumption. On the whole, the results suggest that households focused on reducing risk and on improving their livelihoods rather than principally on increasing consumption. There is also evidence that the project had positive effects on community cohesion. -
Publication
An Analysis of Clinical Knowledge, Absenteeism, and Availability of Resources for Maternal and Child Health: A Cross-Sectional Quality of Care Study in 10 African Countries
(World Bank, Washington, DC, 2020-10)This paper assesses the quality of health care across African countries based on health providers' clinical knowledge, their clinic attendance, and drug availability, with a focus on seven conditions accounting for a large share of child and maternal mortality: malaria, tuberculosis, diarrhea, pneumonia, diabetes, neonatal asphyxia, and postpartum hemorrhage. With nationally representative, cross-sectional data from 10 countries in Sub-Saharan Africa, collected using clinical vignettes, unannounced visits, and visual inspections of facilities, this study assesses whether health providers are available and have sufficient knowledge and means to diagnose and treat patients suffering from common conditions amenable to primary health care. The study draws on data from 8,061 primary and secondary care facilities in Kenya, Madagascar, Mozambique, Nigeria, Niger, Senegal, Sierra Leone, Tanzania, Togo, and Uganda, and 22,746 health workers. These data were gathered under the Service Delivery Indicators program. Across all conditions and countries, health care providers were able to correctly diagnose 64 percent of the clinical vignette cases, and in 45 percent of the cases, the treatment plan was aligned with the correct diagnosis. For diarrhea and pneumonia, two common causes of under-five deaths, 27 percent of the providers correctly diagnosed and prescribed the appropriate treatment for both conditions. On average, 70 percent of health workers were present in the facilities to provide care during facility hours when those workers were scheduled to be on duty. Taken together, the estimated likelihood that a facility has at least one staff present with competency and the key inputs required to provide child, neonatal, and maternity care that meets minimum quality standards is 14 percent. Poor clinical knowledge is a greater constraint in care readiness than drug availability or health workers' absenteeism in the 10 countries. However, the paper documents substantial heterogeneity across countries. -
Publication
Cash Transfers and Health: Evidence from Tanzania
(Published by Oxford University Press on behalf of the World Bank, 2019-06)How do cash transfers conditioned on health clinic visits and school attendance impact health-related outcomes? Examining the 2010 randomized introduction of a program in Tanzania, this paper finds nuanced impacts. An initial surge in clinic visits after 1.5 years—due to more visits by those already complying with program health conditions and by non-compliers—disappeared after 2.5 years, largely due to compliers reducing above-minimal visits. The study finds significant increases in take-up of health insurance and the likelihood of seeking treatment when ill. Health improvements were concentrated among children ages 0–5 years rather than the elderly, and took time to materialize; the study finds no improvements after 1.5 years, but 0.76 fewer sick days per month after 2.5 years, suggesting the importance of looking beyond short-term impacts. Reductions in sick days were largest in villages with more baseline health workers per capita, consistent with improvements being sensitive to capacity constraints. These results are robust to adjustments for multiple hypothesis testing. -
Publication
Property Tax Compliance in Tanzania: Can Nudges Help?
(World Bank, Washington, DC, 2022-08)Low tax compliance in low- and middle-income countries around the world limits the ability of governments to offer effective public services. This paper reports the results of a randomly rolled out text message campaign aimed at promoting tax compliance among landowners in Dar es Salaam, Tanzania. Landowners were randomly assigned to one of four groups designed to test different aspects of tax morale. They received a simple text message reminder to pay their tax (a test of salience), a message highlighting the connection between taxes and public services (reciprocity), a message communicating that people who did not pay were not contributing to local or national development (social pressure), or no message (control). Recipients of any message were 18 percent (or 2 percentage points) more likely to pay any property tax by the end of the study period. Each type of message resulted in gains in payment rates, although social pressure messages delivered the lowest gains. Total payment amounts were highest for those who received reciprocity messages. Nudges were most effective in areas with lower initial rates of tax compliance. The average estimated benefit-cost ratio across treatments is 36:1 due to the low cost of the intervention, with higher cost-effectiveness for reciprocity messages. -
Publication
Cash Transfers and Health: Evidence from Tanzania
(World Bank, Washington, DC, 2016-11)How do conditional cash transfers impact health-related outcomes? This paper examines the 2010 randomized introduction of a program in Tanzania and finds nuanced impacts. An initial surge in clinic visits after 1.5 years -- due to more visits by those already complying with program health conditions and by non-compliers -- disappeared after 2.5 years, largely due to compliers reducing above-minimal visits. The study finds significant increases in take-up of health insurance and the likelihood of seeking treatment when ill. Health improvements were concentrated among children ages 0–5 years rather than the elderly, and took time to materialize; the study finds no improvements after 1.5 years, but 0.76 fewer sick days per month after 2.5 years, suggesting the importance of looking beyond short-term impacts. Reductions in sick days were largest in villages with more baseline health workers per capita, consistent with improvements being sensitive to capacity constraints. These results are robust to adjustments for multiple hypothesis testing. -
Publication
Cash Transfers Increase Trust in Local Government
(World Bank, Washington, DC, 2018-02)How does a locally-managed conditional cash transfer program impact trust in government? On the one hand, delivering monetary benefits and increasing interactions with government officials (elected and appointed) may increase trust. On the other hand, imposing paternalistic conditions, leading some to experience feelings of social stigma or guilt, and potentially permitting capture by local elites could reduce trust. This paper answers this question by exploiting the randomized introduction of a locally-managed transfer program in Tanzania in 2010, which included popular election of community management committees to run the program. The analysis reveals that cash transfers can significantly increase trust in leaders. This effect is driven by large increases in trust in elected leaders as opposed to appointed bureaucrats. Perceptions of government responsiveness to citizens' concerns and honesty of leaders also rise; these improvements are largest where there are more village meetings at baseline. One of the central roles of village meetings is to receive and share information with village residents. One indicator that governance may have improved is that records from school and health committees are more readily available in treatment villages. Notably, while the stated willingness of citizens to participate in community development projects rises, actual participation in projects and the likelihood of voting does not. Concerns that local management of a cash transfer program will destroy trust in government or reduce the quality of governance appear unfounded—especially in high-information contexts. -
Publication
Building State Capacity: What Is the Impact of Development Projects?
(World Bank, Washington, DC, 2021-12)Although research has established the importance of state capacity in economic development, less is known about how to build that capacity and the role of external partners in the process. This paper estimates the impact of a typical development project designed to build state capacity in a low-income country. Specifically, it evaluates a multilateral development bank project in Tanzania, which incentivized investments in local state capacity by offering grants conditional on institutional performance scores. The paper uses a difference-in-differences methodology to estimate the project impact, comparing outcomes between 18 project and 22 non-project local governments over 2016–18. Outcomes were measured through two rounds of primary surveys of nearly 500 local government officials and nearly 3,000 households. Over the course of the project, measured state capacity improved in project areas, but due to comparable gains in non-project areas, the project’s value-added to change in state capacity is estimated to be zero across all the dozens of relevant variables in the surveys. The data suggest that state capacity is evolving in Tanzania through endogenous changes in trust and legitimacy in the country rather than from financial incentives offered by external partners.