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 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.

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Now showing 1 - 10 of 17

Education, Information, and Smoking Decisions : Evidence from Smoking Histories, 1940-2000

(World Bank, Washington, DC, 2004-07) de Walque, Damien

The author tests the hypothesis that education improves health and increases people's life expectancy. Smoking histories-reconstructed from retrospective data in the National Health Interview Surveys in the United States-show that after 1950, when information about the dangers associated with tobacco consumption started to diffuse, the prevalence of smoking declined earlier and most dramatically for college graduates. More educated individuals are also more likely to quit smoking: incidence analysis of smoking cessation shows a strong education effect. The instrumental variable approach, which relies on the fact that during the Vietnam War college attendance provided a strategy to avoid the draft, indicates that education does affect decisions about whether to smoke or stop smoking.
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.
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.
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.
Trends and Socio-Economic Gradients in Adult Mortality around the Developing World

(Washington, DC: World Bank, 2012) de Walque, Damien ; Filmer, Deon

The authors combine data from 84 Demographic and Health Surveys from 46 countries to analyze trends and socioeconomic differences in adult mortality, calculating mortality based on the sibling mortality reports collected from female respondents aged 15-49. The analysis yields four main findings. First, adult mortality is different from child mortality: while under-5 mortality shows a definite improving trend over time, adult mortality does not, especially in Sub-Saharan Africa. The second main finding is the increase in adult mortality in Sub-Saharan African countries. The increase is dramatic among those most affected by the HIV/AIDS pandemic. Mortality rates in the highest HIV-prevalence countries of southern Africa exceed those in countries that experienced episodes of civil war. Third, even in Sub-Saharan countries where HIV-prevalence is not as high, mortality rates appear to be at best stagnating, and even increasing in several cases. Finally, the main socioeconomic dimension along which mortality appears to differ in the aggregate is gender. Adult mortality rates in Sub-Saharan Africa have risen substantially higher for men than for women--especially so in the high HIV-prevalence countries. On the whole, the data do not show large gaps by urban/rural residence or by school attainment.
Does Education Affect HIV Status? Evidence from five African Countries

(World Bank, 2009-06-30) de Walque, Damien

Data from the first five Demographic and Health Surveys to include HIV testing for a representative sample of the adult population are used to analyze the socioeconomic correlates of HIV infection and associated sexual behavior. Emerging from a wealth of country relevant results, some important findings can be generalized. First, successive marriages are a significant risk factor. Second, contrary to prima facie evidence, education is not positively associated with HIV status. However, schooling is one of the most consistent predictors of behavior and knowledge: education level predicts protective behaviors such as condom use, use of counseling and testing, discussion of AIDS between spouses, and knowledge about HIV/AIDS, but it also predicts a higher level of infidelity and a lower level of abstinence.
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.
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) Akresh, Richard ; de Walque, Damien ; Kazianga, Harounan

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.
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) Packel, Laura ; Dow, William H. ; de Walque, Damien ; Isdahl, Zachary ; Majura, Albert

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.