Person:
de Walque, Damien
Author Name Variants
Fields of Specialization
Education,
Macroeconomic and Structural Policies,
Health
Degrees
ORCID
External Links
Departments
Development Research Group
Externally Hosted Work
Contact Information
Last updated
January 31, 2023
Biography
Damien de Walque 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.
Publication Search Results
1 - 10 of 14
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Publication
Cash Transfers and Child Schooling : Evidence from a Randomized Evaluation of the Role of Conditionality
(World Bank, Washington, DC, 2013-01)The authors conduct a randomized experiment in rural Burkina Faso to estimate the impact of alternative cash transfer delivery mechanisms on education. The two-year pilot program randomly distributed cash transfers that were either conditional or unconditional. Families under the conditional schemes were required to have their children ages 7-15 enrolled in school and attending classes regularly. There were no such requirements under the unconditional programs. The results indicate that unconditional and conditional cash transfer programs have a similar impact increasing the enrollment of children who are traditionally favored by parents for school participation, including boys, older children, and higher ability children. However, the conditional transfers are significantly more effective than the unconditional transfers in improving the enrollment of "marginal children" who are initially less likely to go to school, such as girls, younger children, and lower ability children. Thus, conditionality plays a critical role in benefiting children who are less likely to receive investments from their parents. -
Publication
Using Provider Performance Incentives to Increase HIV Testing and Counseling Services in Rwanda
(World Bank, Washington, DC, 2013-02)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. -
Publication
Armed Conflict and Schooling : Evidence from the 1994 Rwandan Genocide
(World Bank, Washington, DC, 2008-04)Civil war, and genocide in particular, are among the most destructive of social phenomena, especially for children of school-going age. In Rwanda school enrollment trends suggest that the school system recovered quickly after 1994, but these numbers do not tell the full story. Two cross-sectional household surveys collected before and after the genocide are used to compare children in the same age group who were and were not exposed to the genocide - and their educational outcomes are substantially different. Children exposed to the genocide experienced a drop in educational achievement of almost one-half year of completed schooling, and are 15 percentage points less likely to complete third or fourth grade. Sustained effort is needed to reinforce educational institutions and offer a "second chance" to those youth most affected by the conflict. -
Publication
Parental Education and Children’s Schooling Outcomes : Is the Effect Nature, Nurture, or Both? Evidence from Recomposed Families in Rwanda
(World Bank, Washington, DC, 2005-01)Educated parents tend to have educated children. But is intergenerational transmission of human capital more nature, more nurture, or both? The author uses household survey data from Rwanda that contains a large proportion of children living in households without their biological parents. The data allows him to separate genetic from environmental parental influences. The nonrandom placement of children is controlled by including the educational attainment of the absent biological parents and the type of relationship that links the children to their "adoptive" families. The results of the analysis suggest that the nurture component of the intergenerational transmission of human capital is important for both parents, contrary to recent evidence proposed by Behrman and Rosenzweig (2002) and Plug (2004). The author concludes that mothers education had no environmental impact on children s schooling. Interestingly, mothers education matters more for girls, while fathers education is more important for boys. Finally, an important policy recommendation in the African context emerges from the analysis: the risk for orphans or abandoned children to lose ground in their schooling achievements is minimized if they are placed with relatives. -
Publication
Evidence from a Randomized Evaluation of the Household Welfare Impacts of Conditional and Unconditional Cash Transfers Given to Mothers or Fathers
(World Bank, Washington, DC, 2016-06)This study conducted a randomized control trial in rural Burkina Faso to estimate the impact of alternative cash transfer delivery mechanisms on education, health, and household welfare outcomes. The two-year pilot program randomly distributed cash transfers that were either conditional or unconditional and were given to either mothers or fathers. Conditionality was linked to older children enrolling in school and attending regularly and younger children receiving preventive health check-ups. Compared with the control group, cash transfers improve children's education and health and household socioeconomic conditions. For school enrollment and most child health outcomes, conditional cash transfers outperform unconditional cash transfers. Giving cash to mothers does not lead to significantly better child health or education outcomes, and there is evidence that money given to fathers improves young children's health, particularly during years of poor rainfall. Cash transfers to fathers also yield relatively more household investment in livestock, cash crops, and improved housing. -
Publication
Love the Job... or the Patient?: Task vs. Mission-Based Motivations in Health Care
(World Bank, Washington, DC, 2018-02)A booming literature has argued that mission-based motives are a central feature of mission-oriented labor markets. This paper shifts the focus to task-based motivation and finds that it yields significantly more effort than mission-based motivation. Moreover, in the presence of significant task motivation, mission motivation has no additional effect on effort. The evidence emerges from experiments with nearly 250 medical and nursing students in Burkina Faso. The students exert effort in three tasks, from boring to interesting. In addition, for half of the students, mission motivation is present: their effort on the task generates benefits for a charity. Two strong results emerge. First, task motivation has an economically important effect on effort, more than doubling effort. Second, mission motivation increases effort, but only for mundane tasks and not when the task is interesting. Moreover, even for mundane tasks, the effects of mission motivation appear to be less than those of task motivation. -
Publication
The use of video vignettes to measure health worker knowledge: Evidence from Burkina Faso
(Elsevier, 2018-09)The quality of care is a crucial determinant of good health outcomes, but is difficult to measure. Survey vignettes are a standard approach to measuring medical knowledge among health care providers. Given that written vignettes or knowledge tests may be too removed from clinical practice, particularly where “learning by doing” may be an important form of training, we developed a new type of provider vignette. It uses videos presenting a patient visiting the clinic with maternal/early childhood symptoms. We tested these video vignettes with current and future (students) health professionals in Burkina Faso. Participants indicated that the cases used were interesting, understandable and common. Their performance was consistent with expectations. Participants with greater training (medical doctors vs. nurses and midwives) and experience (health professionals vs. students) performed better. The video vignettes can easily be embedded in computers, tablets and smart phones; they are a convenient tool to measure provider knowledge; and they are cost-effective instruction and testing tools. -
Publication
Sexual Behavior Change Intentions and Actions in the Context of a Randomized Trial of a Conditional Cash Transfer for HIV Prevention in Tanzania
( 2012-03-01)Information, education, communication and interventions based on behavioral-change communication have had success in increasing the awareness of HIV. But these strategies alone have been less successful in changing risky sexual behavior. This paper addresses this issue by exploring the link between action and the intention to change behaviors. In Africa, uncertainty in the lives of those at risk for HIV may affect how intentions are formed. Characterize this uncertainty by understanding the reasons for discrepancies between intentions and actions may help improve the design of HIV-prevention interventions. Based on an incentives-based HIV prevention trial in Tanzania, the longitudinal dataset in this paper allows the exploration of intended strategies for changing sexual behaviors and their results. The authors find that gender, intervention groups and new positive diagnoses of sexually transmitted infections can significantly predict the link between intent and action. The paper examines potential mediators of these relationships. -
Publication
Food Crisis, Household Welfare and HIV/AIDS Treatment : Evidence from Mozambique
( 2011-01-01)Using panel data from Mozambique collected in 2007 and 2008, the authors explore the impact of the food crisis on the welfare of households living with HIV/AIDS. The analysis finds that there has been a real deterioration of welfare in terms of income, food consumption, and nutritional status in Mozambique between 2007 and 2008, among both HIV and comparison households. However, HIV households have not suffered more from the crisis than others. Results on the evolution of labor force participation suggest that initiation of treatment and better services in health facilities have counter-balanced the effect of the crisis by improving the health of patients and their labor force participation. In addition, the authors look at the effect of the change in welfare on the frequency of visits to a health facility of patients and on their treatment outcomes. Both variables can proxy for adherence to treatment. This is a particularly crucial issue as it affects both the health of the patient and public health, because sub-optimal adherence leads to the development of resistant forms of the virus. The paper finds no effect of the change in welfare on the frequency of visits, but does find that people who experienced a negative income shock also experienced a reduction or a slower progression in treatment outcomes. -
Publication
Mines, Migration and HIV/AIDS in Southern Africa
( 2012-02-01)Swaziland and Lesotho have the highest HIV prevalence in the world. They also share another distinct feature: during the last century, they sent a large numbers of migrant workers to South African mines. This paper examines whether participation in mining in a bordering country affects HIV infection rate. A job in the mines means leaving for long periods away from their families and living in an area with an active sex industry. This creates potential incentives for multiple, concurrent partnerships. Using Demographic and Health Surveys, the analysis shows that migrant miners ages 30-44 are 15 percentage points more likely to be HIV positive, and women whose partner is a migrant miner are 8 percentage points more likely to become infected. The study also shows that miners are less likely to abstain or use condoms, and female partners of miners are more likely to engage in extramarital sex. The authors interpret these results as suggesting that miners' migration into South Africa has increased the spread of HIV/AIDS in their countries of origin. Consistent with this interpretation, the association between HIV infection and being a miner or a miner's wife are not statistically significant in Zimbabwe, a country where the mining industry is local and does not involve migrating to South Africa.