Person:
de Walque, Damien

Development Research Group
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Education, Macroeconomic and Structural Policies, Health
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Last updated: October 24, 2023
Biography
Damien de Walque is a Lead Economist in the Development Research Group (Human Development Team) at the World Bank. He received his Ph.D.in Economics from the University of Chicago in 2003. His research interests include health and education and the interactions between them. His current work is focused on evaluating the impact of financial incentives on health and education outcomes. He is currently evaluating the education and health outcomes of conditional cash transfers linked to school attendance and health center visits in Burkina Faso. He is also working on evaluating the impact of HIV/AIDS interventions and policies in several African countries. He is leading two evaluations of the impact of short-term financial incentives on the prevention of HIV/AIDS and other sexually transmitted infections (STIs): individuals who test negatively for a set of STIs receive regular cash payment in Tanzania, while in Lesotho they receive lottery tickets. On the supply side of health services, he is managing a large portfolio of impact evaluations of results-based financing in the health sector. He has also edited a book on risky behaviors for health (smoking, drugs, alcohol, obesity, risky sex) in the developing world.
Citations 594 Scopus

Publication Search Results

Now showing 1 - 10 of 69
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Socioeconomic Determinants of Stigmatization and HIV Testing in Lesotho

2013-06-09, Corno, Lucia, de Walque, Damien

HIV/AIDS stigmatizing attitudes and their consequences on preventative behaviors are among the most poorly understood aspects of the AIDS epidemic. This paper analyzes the socioeconomic determinants of discriminating attitudes toward people living with HIV and their implications on the likelihood of HIV testing. These effects are tested using the 2004 and 2009 Demographic and Health Surveys conducted in Lesotho, where HIV/AIDS is a pervasive problem. We find that HIV/AIDS stigmatizing attitudes are negatively associated with education and wealth and positively correlated with Catholic religion for women and traditional circumcision for men. The analysis also shows a negative association between stigmatizing beliefs and the probability of being tested for HIV.

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Incentivising Safe Sex: A Randomised Trial of Conditional Cash Transfers for HIV and Sexually Transmitted Infection Prevention in Rural Tanzania

2012-02-08, de Walque, Damien, Nathan, Rose, Abdul, Ramadhani, Abilahi, Faraji, Gong, Erick, Isdahl, Zachary, Jamison, Julian, Jullu, Boniphace, Krishnan, Suneeta, Majura, Albert, Miguel, Edward, Moncada, Jeanne, Mtenga, Sally, Mwanyangala, Mathew Alexander, Packel, Laura, Schachter, Julius, Shirima, Kizito, Medlin, Carol A.

The authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex. Conditional cash transfers used to incentivise safer sexual practices are a potentially promising new tool in HIV and sexually transmitted infections prevention.

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Risking Your Health : Causes, Consequences, and Interventions to Prevent Risky Behaviors

2014, de Walque, Damien, de Walque, Damien

Behaviors that pose risks for an individual’s health and that also represent important threats for public health, such as drug use, smoking, alcohol, unhealthy eating causing obesity, and unsafe sex, are highly prevalent in low income countries, even though they are traditionally associated with richer countries. Individual choices are an important part of the risky behaviors. Risking Your Health: Causes, Consequences, and Interventions to Prevent Risky Behaviors explore how those choices are formed and what are their consequences. Why do people engage in risky behaviors? Many different explanations have been proposed by psychology, sociology, economics or public health. One trait common to all these behaviors is that there is a disconnect – a function of both delay and uncertainty - between the pleasure or satisfaction provided by them and their consequences. Another characteristic of risky behaviors is that they rarely occur in isolation. Peer-pressure, parental influences, networks and social norms often play an important role in initiating, continuing, or quitting those behaviors. Even if they might often be the first to suffer, the consequences of risky behaviors are also rarely limited to the individuals engaging in them. In certain cases, such as second-hand smoking or HIV transmission, the link is direct. In other cases, the link is less direct but not necessarily less real: the long term health consequences of many of these behaviors are costly to treat and could stretch households’ finances and worsen poverty. Finally, these risky behaviors have consequences for society as a whole since they often trigger a non-trivial amount of public health expenditures and lead to declines in aggregate productivity through premature death and morbidity. Changing behaviors is tricky -- public health interventions via legislation with strong enforcement mechanisms can be more effective than simple communication campaigns informing consumers about the risks associated with certain behaviors, since translating knowledge into concrete changes in behavior seems to be hard to achieve. Economic mechanisms such as taxes (especially on alcohol and tobacco products), subsidies (such as free condoms), and conditional/unconditional cash transfers are also used to reduce risky behaviors (for example in HIV prevention). Of great interest to policy makers, academics and practitioners, this book assesses the efficiency of those interventions designed to reduce the prevalence of behaviors that endanger health.

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Child Labor, Schooling, and Child Ability

2012-02-01, Akresh, Richard, Bagby, Emilie, de Walque, Damien, Kazianga, Harounan

Using data collected in rural Burkina Faso, this paper examines how children's cognitive abilities influence households' decisions to invest in their education. To address the endogeneity of child ability measures, the analysis uses rainfall shocks experienced in utero or early childhood to instrument for ability. Negative shocks in utero lead to 0.24 standard deviations lower ability z-scores, corresponding with a 38 percent enrollment drop and a 49 percent increase in child labor hours compared with their siblings. Negative education impacts are largest for in utero shocks, diminished for shocks before age two, and have no impact for shocks after age two. The paper links the fetal origins hypothesis and sibling rivalry literatures by showing that shocks experienced in utero not only have direct negative impacts on the child's cognitive ability (fetal origins hypothesis), but also negatively impact the child through the effects on sibling rivalry resulting from the cognitive differences.

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Demographic and Socioeconomic Patterns of HIV/AIDS Prevalence in Africa

2009-10-01, Beegle, Kathleen, de Walque, Damien

Understanding the demographic and socioeconomic patterns of the prevalence and incidence of HIV/AIDS in Sub-Saharan Africa is crucial for developing programs and policies to combat HIV/AIDS. This paper looks critically at the methods and analytical challenges to study the links between socioeconomic and demographic status and HIV/AIDS. Some of the misconceptions about the HIV/AIDS epidemic are discussed and unusual empirical evidence from the existing body of work is presented. Several important messages emerge from the results. First, the study of the link between socioeconomic status and HIV faces a range of challenges related to definitions, samples, and empirical methods. Second, given the large gaps in evidence and the changing nature of the epidemic, there is a need to continue to improve the evidence base on the link between demographic and socioeconomic status and the prevalence and incidence of HIV/AIDS. Finally, it is difficult to generalize results across countries. As the results presented here and in other studies based on Demographic and Health Survey datasets show, few consistent and significant patterns of prevalence by socioeconomic and demographic status are evident.

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How Two Tests Can Help Contain COVID-19 and Revive the Economy

2020-04-08, de Walque, Damien, Friedman, Jed, Gatti, Roberta, Mattoo, Aaditya

Faced with COVID-19 (Coronavirus), countries are taking drastic action based on little information. Two tests can help governments shorten and soften economically costly suppression measures while still containing the novel coronavirus (COVID-19) pandemic. The first—a PCR assay—identifies people currently infected by testing for the presence of live virus in the subject. The second—an antibody test—identifies those rendered immune after being infected by searching for COVID-19-specific antibodies. The first test can help contain the disease because it facilitates the identification of infected persons, the tracing of their contacts, and isolation in the very early stages of an epidemic—or after a period of suppression, in case of a resurgent epidemic. The second can help us assess the extent of immunity in the general population or subgroups, to finetune social isolation and to manage health care resources. Wide application of the two tests could transform the battle against COVID-19 (Coronavirus), but implementing either on a large scale in developing countries presents challenges. The first test is generally available, but needs to be processed in adequately equipped laboratories with trained staff. The second test is easy to perform and can be processed quickly on the spot, but at this stage it is produced and available only on a limited basis in a few countries. This policy brief reviews the use of both tests, suggests strategies to target their use, and discusses the benefits and costs of such strategies. If PCR assay testing, together with tracing and isolation, helps reduce the duration of suppression measures by two weeks, and antibody testing allows one-fifth of the immune return to work early, the gain could be about 2 percent of national income, or about $8 billion for a country like the Philippines. Because the estimated economic benefits of the tests are likely to far outweigh the cost, the international community must help countries develop the capacity to process the first test and procure the second.

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Alternative Cash Transfer Delivery Mechanisms : Impacts on Routine Preventative Health Clinic Visits in Burkina Faso

2012-01-01, Akresh, Richard, de Walque, Damien, Kazianga, Harounan

The authors conducted a unique randomized experiment to estimate the impact of two alternative cash transfer delivery mechanisms on household demand for routine preventative health services in rural Burkina Faso. The two-year pilot program randomly distributed cash transfers that were either conditional or unconditional, and the money was given to either mothers or fathers. Families enrolled in the conditional cash transfer schemes were required to obtain quarterly child-growth monitoring at local health clinics for all children under five years old. There was not such a requirement under the unconditional programs. Compared with control group households, conditional cash transfers significantly increased the number of preventative health care visits during the previous year, while unconditional cash transfers did not have such an impact. For the conditional cash transfers, money given to mothers or fathers showed beneficial impacts of similar magnitude in increasing routine visits.

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Using Provider Performance Incentives to Increase HIV Testing and Counseling Services in Rwanda

2013-02, de Walque, Damien, Gertler, Paul J., de Dieu Bizimana, Jean, Vermeersch, Christel, Condo, Jeanine

Paying for performance provides financial rewards to medical care providers for improvements in performance measured by specific utilization and quality of care indicators. In 2006, Rwanda began a paying for performance scheme to improve health services delivery, including HIV/AIDS services. This study examines the scheme's impact on individual and couples HIV testing and counseling and using data from a prospective quasi-experimental design. The study finds a positive impact of paying for performance with an increase of 6.1 percentage points in the probability of individuals having ever been tested. This positive impact is stronger for married individuals: 10.2 percentage points. The results also indicate larger impacts of paying for performance on the likelihood that the respondent reports both partners have ever been tested, especially among discordant couples (14.7 percentage point increase) in which only one of the partners is HIV positive.

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Relative Measures of Genocide Mortality: Benefits and Methodological Considerations of Using Siblings' Survival Data

2019-12-31, de Walque, Damien

When studying events such as the 1994 Genocide in Rwanda, for many researchers the first order question seems to be to find the best available data and methods to estimate the death toll, i.e. to provide a number of deaths in absolute terms. This makes sense since the staggering number of victims over a very short period is one of the most shocking – and defining – features of such an historical event. This short note argues that while looking for an absolute death toll number is certainly an important and worthwhile research exercise, analyzing relative mortality numbers also provides valuable insights that might not be available when focusing on absolute numbers. By relative mortality I mean comparing mortality across different population segments such as by gender, by age group or socioeconomic categories (e.g. education levels, urban/rural background). Specifically, I will use the examples of the Khmer Rouge Period in Cambodia (1975-1978) and the 1994 Genocide in Rwanda to illustrate this argument and will rely on earlier studies to show how the sibling mortality schedule – a module collecting information about the date of birth, the sex and if relevant the date of death of all siblings of the respondent – contained in most of the well-known and commonly used Demographic and Health Surveys (DHS) can be exploited to obtain reasonable and useful estimates of relative mortality.

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The Long-Term Legacy of the Khmer Rouge Period in Cambodia

2004-11, de Walque, Damien

The author studies the long-term impact of genocide during the period of the Khmer Rouge (1975-79) in Cambodia and contributes to the literature on the economic analysis of conflict. Using mortality data for siblings from the Cambodia Demographic and Health Survey in 2000, he shows that excess mortality was extremely high and heavily concentrated during 1974-80. Adult males had been the most likely to die, indicating that violent death played a major role. Individuals with an urban or educated background were more likely to die. Infant mortality was also at very high levels during the period, and disability rates from landmines or other weapons were high for males who, given their birth cohort, were exposed to this risk. The very high and selective mortality had a major impact on the population structure of Cambodia. Fertility and marriage rates were very low under the Khmer Rouge but rebounded immediately after the regime's collapse. Because of the shortage of eligible males, the age and education differences between partners tended to decline. The period had a lasting impact on the educational attainment of the population. The education system collapsed during the period, so individuals-especially males-who were of schooling age during this interval had a lower educational attainment than the preceding and subsequent birth cohorts.