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 52

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.
Socioeconomic Determinants of Stigmatization and HIV Testing in Lesotho

(Taylor and Francis, 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.
Risking Your Health : Causes, Consequences, and Interventions to Prevent Risky Behaviors

(Washington, DC: World Bank, 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.
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.
Race, Immigration, and the U.S. Labor Market : Contrasting the Outcomes of Foreign Born and Native Blacks

(World Bank, Washington, DC, 2008-10) de Walque, Damien

It is generally expected that immigrants do not fare as well as the native-born in the U.S. labor market. The literature also documents that Blacks experience lower labor market outcomes than Whites. This paper innovates by studying the interaction between race and immigration. The study compares the labor market outcomes of four racial groups in the United States (Whites, Blacks, Asians, and Hispanics) interacted with their foreign born status, using the Integrated Public Use Micro Data Series data for the 2000 Census. Among women and for labor market outcomes such as labor force participation, employment, and personal income, the foreign born are doing worse than the native born from the same racial background, with the exception of Blacks. Among men, for labor force participation and employment, foreign-born Blacks are doing better than native Blacks. The paper tests different possible explanations for this "reversal" of the advantage of natives over immigrants among Blacks. It considers citizenship, ability in English, age at and time since arrival in the United States, as well as neighborhood effects, but concludes that none of these channels explains or modifies the observed reversal.
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.
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.