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 11

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

(World Bank, Washington, D.C., 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.
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.
Potential Applications of Conditional Cash Transfers for Prevention of Sexually Transmitted Infections and HIV in Sub-Saharan Africa

(World Bank, Washington, DC, 2008-07) Medlin, Carol ; de Walque, Damien

A growing number of developing countries have introduced conditional cash transfer programs that provide money to poor families with certain contingencies attached - such as requiring school attendance or regular immunization and health check-ups. As the popularity of conditional cash transfer programs has grown, experimentation with potential applications in other areas of health, such as sexual and reproductive health, and HIV prevention, in particular, has also increased. Evaluations of conditional cash transfer programs have focused almost exclusively on uptake of health and educational services, which make relatively low demands of participants compared with more complex interventions, which require the cessation of risky behaviors, such as smoking, obesity, and substance abuse. The literature on contingency management - based on the principle that behavioral change occurs when appropriate behaviors are reinforced and rewarded - provides a richer picture of the complexity of the use of conditionality to encourage healthy behavioral change. This paper examines developing countries' experiences with conditional cash transfer programs and the results of trials in clinical settings on the efficacy of contingency management, and addresses their relevance for designing conditional cash transfer programs to address risky sexual behavior and promote the prevention of sexually transmitted infections and HIV in Sub-Saharan Africa.
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.
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.
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.
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.