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
The Next Wave of Deaths from Ebola?: The Impact of Health Care Worker Mortality
(World Bank, Washington, DC, 2015-07)The ongoing Ebola outbreak in West Africa has put a huge strain on already weak health systems. Ebola deaths have been disproportionately concentrated among health care workers, exacerbating existing skill shortages in Guinea, Liberia, and Sierra Leone in a way that will negatively affect the health of the populations even after Ebola has been eliminated. This paper combines data on cumulative health care worker deaths from Ebola, the stock of health care workers and mortality rates pre-Ebola, and coefficients that summarize the relationship between health care workers in a given country and rates of maternal, infant, and under-five mortality. The paper estimates how the loss of health care workers to Ebola will likely affect non-Ebola mortality even after the disease is eliminated. It then estimates the size of the resource gap that needs to be filled to avoid these deaths, and to reach the minimum thresholds of health coverage described in the Millennium Development Goals. Maternal mortality could increase by 38 percent in Guinea, 74 percent in Sierra Leone, and 111 percent in Liberia due to the reduction in health personnel caused by the epidemic. This translates to an additional 4,022 women dying per year across the three most affected countries. To avoid these deaths, 240 doctors, nurses, and midwives would need to be immediately hired across the three countries. This is a small fraction of the 43,565 doctors, nurses, and midwives that would need to be hired to achieve the adequate health coverage implied by the Millennium Development Goals. Substantial investment in health systems is urgently required not only to improve future epidemic preparedness, but also to limit the secondary health effects of the current epidemic owing to the depletion of the health workforce. -
Publication
Correspondence: Health-Care Worker Mortality and the Legacy of the Ebola Epidemic
(Elsevier, 2015-07-09)The authors modelled how the loss of health-care workers—defined here as doctors, nurses, and midwives—to Ebola might affect maternal, infant, and under-5 mortality in Guinea, Liberia, and Sierra Leone, with the aim of characterising the order of magnitude of likely effects, not providing specific predictions. The authors combined data on: (1) health-care worker deaths from Ebola; (2) the stock of health-care workers pre-Ebola; (3) maternal, infant, and under-5 mortality rates for each country, pre-Ebola; and (4) coefficients of health-care worker mortality, which capture the relation between health-care workers in a given country and different mortality rates (ie, maternal, infant, and under-5 mortality). -
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
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
Equivalent Years of Schooling: A Metric to Communicate Learning Gains in Concrete Terms
(World Bank, Washington, DC, 2019-02)In the past decade, hundreds of impact evaluation studies have measured the learning outcomes of education interventions in developing countries. The impact magnitudes are often reported in terms of "standard deviations," making them difficult to communicate to policy makers beyond education specialists. This paper proposes two approaches to demonstrate the effectiveness of learning interventions, one in "equivalent years of schooling" and another in the net present value of potential increased lifetime earnings. The results show that in a sample of low- and middle-income countries, one standard deviation gain in literacy skill is associated with between 4.7 and 6.8 additional years of schooling, depending on the estimation method. In other words, over the course of a business-as-usual school year, students learn between 0.15 and 0.21 standard deviation of literacy ability. Using that metric to translate the impact of interventions, a median structured pedagogy intervention increases learning by the equivalent of between 0.6 and 0.9 year of business-as-usual schooling. The results further show that even modest gains in standard deviations of learning -- if sustained over time -- may have sizeable impacts on individual earnings and poverty reduction, and that conversion into a non-education metric should help policy makers and non-specialists better understand the potential benefits of increased learning. -
Publication
Economic Impact of COVID-19: Implications for Health Financing in Asia and Pacific
(World Bank, Washington, DC, 2020-09)Coronavirus 2019 (COVID-19’s) impact has gone far beyond its direct effect on morbidity and mortality. In addition to adversely impacting non-COVID health care utilization, the pandemic has resulted in a deep global economic contraction due to lockdown policies and declining demand and supply of goods and services. As a result, most countries are experiencing lower levels of gross domestic product (GDP), rising unemployment, higher levels of impoverishment, and increasing income inequality. Some countries are more vulnerable to the economic contagion resulting from COVID-19, including those implementing more stringent lockdowns and those that are more globally integrated due to their dependence on trade, tourism, and remittances. In addition, countries with preexisting conditions of fiscal weakness due to higher dependence on external grant financing, low tax revenues, and large pre-crisis debt levels are struggling to implement countercyclical mitigative fiscal and monetary policies. In addition to declining economic activity, government revenues have declined, government borrowing is increasing, and public debt levels are projected to skyrocket globally. Higher debt levels will likely imply fiscal tightening for years to come. Implications for health financing are potentially dire, dependent in part on the combination of domestic government, external, and out-of-pocket financing for health that is extant across countries. Tentative projections indicate that, in the absence of reprioritization, growth in public spending for health can decline across most low- and middle-income countries in the region, including becoming negative in some cases, risking reversal of gains made toward expanding universal health coverage in recent years. To reduce the likelihood of such a scenario, and with the caveat that protecting levels of financing will not be effective if resources are not used properly to begin with, ministries of health will need to pay careful attention to planning and budgeting - demonstrating where waste can be reduced and efficiency enhanced - and prioritize within their outlays interventions that are the most cost-effective and equitable. At the same time, ministries of finance should improve the adequacy and predictability of outlays for the sector, taking a multiyear programming perspective and include potential additional resources that will be necessary to procure and deliver a COVID-19 vaccine, once an effective one becomes available. In doing so, they should consider augmenting resources via increasing the scope and breadth of health taxes and proactively seeking out debt relief opportunities, especially if these can be tied to efforts to reprioritize health within overall government budgets where this may be necessary. Whereas there is the perception that the health sector has been flooded with new resources to respond to the pandemic, it remains unclear to what extent these have been additional and not a result of reprogramming of outlays from other areas within health. To the extent COVID-19 presents an opportunity, it is one for removing any doubts that health and the economy are inextricably linked, nudging both ministries of health and finance to reevaluate their priorities, accountabilities, and performance to sustain improvements in both population health, including for ensuring pandemic preparedness, and economic performance.