Person:
Das, Jishnu
Author Name Variants
Fields of Specialization
Health economics,
Education,
Gender,
Health,
Microeconomics,
Cultural economics,
India,
Pakistan,
Kenya,
Zambia,
Macroeconomic and Structural Policies
Degrees
ORCID
External Links
Departments
Development Research Group
Externally Hosted Work
Contact Information
Last updated
January 31, 2023
Biography
Jishnu Das is a Lead Economist in the Development Research Group (Human Development Team) at the World Bank and a Visiting Fellow at the Center for Policy Research, New Delhi. Jishnu’s work focuses on the delivery of basic services, particularly health and education. He has worked on the quality of health care, mental health, information in health and education markets, child learning and test-scores and the determinants of trust. His work has been published in leading economics, health and education journals and widely covered in the media and policy forums. In 2011 he was part of the core team on the World Development Report on Gender and Development. He received the George Bereday Award from the Comparative and International Education Society and the Stockholm Challenge Award for the best ICT project in the public administration category in 2006, and the Research Academy award from the World Bank in 2013. He is currently working on long-term projects on health and education markets in India and Pakistan.
Publication Search Results
1 - 7 of 7
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Publication
Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India
(World Bank, Washington, DC, 2015-06)This paper presents direct evidence on the quality of health care in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly representative sample of rural public and private primary care providers in the Indian state of Madhya Pradesh. Three main findings are reported. First, private providers are mostly unqualified, but they spent more time with patients and completed more items on a checklist of essential history and examination items than public providers, while being no different in their diagnostic and treatment accuracy. Second, the private practices of qualified public sector doctors were identified and the same doctors exerted higher effort and were more likely to provide correct treatment in their private practices. Third, there is a strong positive correlation between provider effort and prices charged in the private sector, whereas there is no correlation between effort and wages in the public sector. The results suggest that market-based accountability in the unregulated private sector may be providing better incentives for provider effort than administrative accountability in the public sector in this setting. While the overall quality of care is low both sectors, the differences in provider effort may partly explain the dominant market share of fee-charging private providers even in the presence of a system of free public healthcare. -
Publication
Primary Care for the Poor: The Potential of Micro-Health Markets to Improve Care
( 2015-01)Much of the primary curative care provided to the poor by the private sector occurs not at large hospitals but at small, single-person clinics. While such micro-health providers increase access, questions persist about quality. Some have argued that the micro-health sector needs to be better regulated. This note cites recent studies in arguing that the micro-health sector needs to be better understood. A more evidence based approach may enable the World Bank Group to better target investments and interventions and help these providers fulfill an important role serving the poor. The following recommendations are made at the conclusion of this paper: (1) Effort, rather than hardware or training, may count the most. (2) Scaling up interventions to improve quality requires understanding and addressing market failures. (3) Changing the way impacts are measured will lead to smarter investments. -
Publication
Quality of Tuberculosis Care by Indian Pharmacies: Mystery Clients Offer New Insights
(Elsevier, 2018-01)For many patients in India, pharmacies are their first point of contact, where most drugs, including antibiotics, can be purchased over-the-counter (OTC). Recent standardized (simulated) patient studies, covering four Indian cities, provide new insights on how Indian pharmacies manage patients with suspected or known tuberculosis. Correct management of the simulated patients ranged from 13% to 62%, increasing with the certainty of the TB diagnosis. Antibiotics were frequently dispensed OTC to patients, with 16% to 37% receiving such drugs across the cases. On a positive note, these studies showed that no pharmacy dispensed first-line anti-TB drugs. Engagement of pharmacies is important to not only improve TB detection and care, but also limit the abuse of antibiotics. -
Publication
Tuberculosis Detection and the Challenges of Integrated Care in Rural China: A Cross-Sectional Standardized Patient Study
(PLoS, 2017-10-17)Despite recent reductions in prevalence, China still faces a substantial tuberculosis (TB) burden, with future progress dependent on the ability of rural providers to appropriately detect and refer TB patients for further care. This study (a) provides a baseline assessment of the ability of rural providers to correctly manage presumptive TB cases; (b) measures the gap between provider knowledge and practice and; (c) evaluates how ongoing reforms of China’s health system—characterized by a movement toward “integrated care” and promotion of initial contact with grassroots providers—will affect the care of TB patients. -
Publication
A Systematic Tale of Two Differing Reviews: Evaluating the Evidence on Public and Private Sector Quality of Primary Care in Low and Middle Income Countries
(Springer, 2017-04-12)Systematic reviews are powerful tools for summarizing vast amounts of data in controversial areas; but their utility is limited by methodological choices and assumptions. Two systematic reviews of literature on the quality of private sector primary care in low and middle income countries (LMIC), published in the same journal within a year, reached conflicting conclusions. The difference in findings reflects different review methodologies, but more importantly, a weak underlying body of literature. A detailed examination of the literature cited in both reviews shows that only one of the underlying studies met the gold standard for methodological robustness. Given the current policy momentum on universal health coverage and primary health care reform across the globe, there is an urgent need for high quality empirical evidence on the quality of private versus public sector primary health care in LMIC. -
Publication
Use of Standardised Patients to Assess Antibiotic Dispensing for Tuberculosis by Pharmacies in Urban India: A Cross-Sectional Study
(Elsevier, 2016-11)India's total antibiotic use is the highest of any country. Patients often receive prescription-only drugs directly from pharmacies. Here we aimed to assess the medical advice and drug dispensing practices of pharmacies for standardized patients with presumed and confirmed tuberculosis in India. In this cross-sectional study in the three Indian cities Delhi, Mumbai, and Patna, we developed two standardized patient cases: first, a patient presenting with 2–3 weeks of pulmonary tuberculosis symptoms (Case 1); and second, a patient with microbiologically confirmed pulmonary tuberculosis (Case 2). -
Publication
Variations in the Quality of Tuberculosis Care in Urban India: A Cross-Sectional, Standardized Patient Study in Two Cities
(PLoS, 2018-09-25)India has the highest burden of tuberculosis (TB). Although most patients with TB in India seek care from the private sector, there is limited evidence on quality of TB care or its correlates. Following our validation study on the standardized patient (SP) method for TB, we utilized SPs to examine quality of adult TB care among health providers with different qualifications in 2 Indian cities.