de Walque, Damien

Person:
de Walque, Damien

Development Research Group

Fields of Specialization

Education, Macroeconomic and Structural Policies, Health

ORCID

0000-0003-1592-7602

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Blog: Africa Can ... End Poverty

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Development Research Group

Last updated September 26, 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.

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Publication Search Results

Now showing 1 - 10 of 29

Cash Transfers and Child Schooling : Evidence from a Randomized Evaluation of the Role of Conditionality

(World Bank, Washington, DC, 2013-01) Akresh, Richard ; de Walque, Damien ; Kazianga, Harounan

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

(World Bank, Washington, DC, 2013-02) de Walque, Damien ; Gertler, Paul J. ; Bautista-Arredondo, Sergio ; Kwan, Ada ; Vermeersch, Christel ; de Dieu Bizimana, Jean ; Binagwaho, Agnès ; 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.
Coping with Risk : The Effects of Shocks on Reproductive Health and Transactional Sex in Rural Tanzania

(World Bank, Washington, DC, 2014-01) de Walque, Damien ; Dow, William H. ; Gong, Erick

Transactional sex is believed to be an important risk-coping mechanism for women in Sub-Saharan Africa and a leading contributor to the HIV/AIDS epidemic. This paper uses data from a panel of women in rural Tanzania whose primary occupation is agriculture. The analysis finds that following a negative shock (such as food insecurity), unmarried women are about three times more likely to have been paid for sex. Regardless of marital status, after a shock women have more unprotected sex and are 36 percent more likely to have a sexually transmitted infection. These empirical findings support the claims that transactional sex is not confined to commercial sex workers and that frequently experienced shocks, such as food insecurity, may lead women to engage in transactional sex as a risk-coping behavior.
Armed Conflict and Schooling : Evidence from the 1994 Rwandan Genocide

(World Bank, Washington, DC, 2008-04) Akresh, Richard ; de Walque, Damien

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.
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) de Walque, Damien

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.
Who Gets AIDS and How? The Determinants of HIV Infection and Sexual Behaviors in Burkina Faso, Cameroon, Ghana, Kenya and Tanzania

(World Bank, Washington, DC, 2006-02) de Walque, Damien

This paper analyzes the determinants of HIV infection and associated sexual behaviors using data from the first five Demographic and Health Surveys to include HIV testing for a representative sample of the adult population. Emerging from a wealth of country relevant results, four important findings can be generalized. First, married women who engage in extra-marital sex are less likely to use condoms than single women when doing so. Second, having been in successive marriages is a significant risk-factor, as evidenced by the results on HIV infection and on sexual behaviors. Contrary to prima facie evidence, education is not associated positively with HIV status. But schooling is one of the most consistent predictors of behavior and knowledge: education predicts protective behaviors like condom use, use of counseling and testing, discussion among spouses and knowledge, but it also predicts a higher level of infidelity and a lower level of abstinence. Finally, male circumcision and female genital mutilation are often associated with sexual behaviors, practices, and knowledge related to AIDS. This might explain why in the analysis in the five countries there is no significant negative association between male circumcision and HIV status, despite recent evidence from a randomized control trial that male circumcision has a protective effect.
Discordant Couples : HIV Infection Among Couples in Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania

(World Bank, Washington, DC, 2006-06) de Walque, Damien

Most analyses of the determinants of HIV infection are performed at the individual level. The recent Demographic and Health Surveys which include results from HIV tests allow studying HIV infection at the level of the cohabiting couple. The paper exploits this feature of the data for Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania. The analysis yields two surprising findings about the dynamics of the HIV/AIDS epidemic which have important implications for policy. First, at least two-thirds of the infected couples are discordant couples, that is, couples where only one of the two partners is infected. This implies that there is scope for prevention efforts among couples. Second, between 30 and 40 percent of the infected couples are couples where the female partner only is infected. This is at odds with levels of self-reported marital infidelity by females and with the common perception that unfaithful males are the main link between high risk groups and the general population. This study investigates and confirms the robustness of these findings. For example, even among couples where the woman has been in only one union for 10 years or more, the fraction of couples where only the female partner is infected remains high. These results suggest that extramarital sexual activity among cohabiting women, whatever its causes, is a substantial source of vulnerability to HIV that should be, as much as male infidelity, targeted by prevention efforts. Moreover, this paper uncovers several inconsistencies between the sexual behaviors reported by male and female partners, suggesting that as much as possible, prevention policies should rely on evidence including objectively measured HIV status.
The Determinants of HIV Infection and Related Sexual Behaviors : Evidence from Lesotho

(World Bank, Washington, DC, 2007-12) Corno, Lucia ; de Walque, Damien

This paper analyzes the socioeconomic determinants of HIV infection and related sexual behaviors using the 2004 Lesotho Demographic and Health Survey. The authors find that in Lesotho education appears to have a protective effect: it is negatively associated with HIV infection (although not always significantly) and it strongly predicts preventive behaviors. The findings also show that married women who have extra-marital relationships are less likely to use a condom than non-married women. This is an important source of vulnerability that should be addressed in prevention efforts. The paper also analyzes HIV infection at the level of the couple. It shows that in 41 percent of the infected couples, only one of the two partners is HIV infected. Therefore, there are still opportunities for prevention inside the couple.
Information is Power : Experimental Evidence on the Long-Run Impact of Community Based Monitoring

(World Bank Group, Washington, DC, 2014-08) Bjorkman Nyqvist, Martina ; de Walque, Damien ; Svensson, Jakob

This paper presents the results of two field experiments on local accountability in primary health care in Uganda. Efforts to stimulate beneficiary control, coupled with the provision of report cards on staff performance, resulted in significant improvements in health care delivery and health outcomes in both the short and the longer run. Efforts to stimulate beneficiary control without providing information on performance had no impact on quality of care or health outcomes. The paper shows that informed users are more likely to identify and challenge (mis)behavior by providers and as a result turn their focus to issues that they can manage locally.
Rewarding Safer Sex : Conditional Cash Transfers for HIV/STI Prevention

(World Bank Group, Washington, DC, 2014-11) de Walque, Damien ; Dow, William H. ; Nathan, Rose

Incentive-based policies have been shown to be powerful in many areas of behavior, but have rarely been tested in the sexual domain. The Rewarding Sexually Transmitted Infection Prevention and Control in Tanzania (RESPECT) study is a randomized controlled trial testing the hypothesis that a system of rapid feedback and positive reinforcement that uses cash as the primary incentive can be used to reduce risky sexual activity among young people, male and female, who are at high risk of HIV infection. The study enrolled 2,399 participants in 10 villages in rural southwest Tanzania. The intervention arm received conditional cash transfers that depended on negative results of periodic screenings for sexually transmitted infections, an objectively measured marker for risky sexual behavior. The intervention arm was further divided into two subgroups, one receiving a high value payment of up to $60 over the course of the study ($20 payments every four months) and the other receiving a lower value payment of up to $30 ($10 payments every four months). At the end of the one year of intervention, the results showed a significant reduction in sexually transmitted infections in the group that was eligible for the $20 payments every four months, but no such reduction was found for the group receiving the $10 payments. The effects were stronger among the lower socioeconomic and higher risks groups. The results of a post-intervention follow-up survey conducted one year after discontinuing the intervention indicate a sustained effect among males, but not among females.