Development Research Group
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Health economics, Education, Gender, Health, Microeconomics, Cultural economics, India, Pakistan, Kenya, Zambia, Macroeconomic and Structural Policies
Development Research Group
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Last updated January 31, 2023
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
Now showing 1 - 10 of 18
Publication(World Bank, Washington, D.C., 2004-05) Das, Jishnu ; Hammer, JeffreyThe authors develop a method in which vignettes-a battery of questions for hypothetical cases-are evaluated with item response theory to create a metric for doctor quality. The method allows a simultaneous estimation of quality and validation of the test instrument that can be used for further refinements. The authors apply the method to a sample of medical practitioners in Delhi, India. The method gives plausible results, rationalizes different perceptions of quality in the public and private sectors, and pinpoints several serious problems with health care delivery in urban India. The findings confirm, for instance, that the quality of private providers located in poorer areas of the city is significantly lower than those in richer neighborhoods. Surprisingly, similar results hold for providers in the public sector, with important implications for inequities in the availability of health care.
Publication(World Bank, Washington, D.C., 2004-03) Das, Jishnu ; Hammer, Jeffrey S.The quality of medical care is a potentially important determinant of health outcomes. Nevertheless, it remains an understudied area. The limited research that exists defines quality either on the basis of drug availability or facility characteristics, but little is known about how provider quality affects the provision of health care. The authors address this gap through a survey in Delhi with two related components. They evaluate "competence" (what providers know) through vignettes and practice (what providers do) through direct clinical observation. Overall quality as measured by the competence necessary to recognize and handle common and dangerous conditions is quite low, albeit with tremendous variation. While there is some correlation with simple observed characteristics, there is still an enormous amount of variation within such categories. Further, even when providers know what to do they often do not do it in practice. This appears to be true in both the public and private sectors though for very different, and systematic, reasons. In the public sector providers are more likely to commit errors of omission-they are less likely to exert effort compared with their private counterparts. In the private sector, providers are prone to errors of commission-they are more likely to behave according to the patient's expectations, resulting in the inappropriate use of medications, the overuse of antibiotics, and increased expenditures. This has important policy implications for our understanding of how market failures and failures of regulation in the health sector affect the poor.
Publication(World Bank, Washington, DC, 2003-02) Das, Jishnu ; Sánchez-Páramo, CarolinaIndia spends 6 percent of its GDP on health-three times the amount spent by Indonesia and twice that of China-and spending on non-chronic morbidities is three times that of chronic illnesses. It is normally assumed that the high spending on non-chronic illnesses reflects the prevalence of morbidities with high case-fatality or case-disability ratios. But there is little data that can be used to separate out spending by type of illness. The authors address this issue with a unique dataset where 1,621 individuals in Delhi were observed for 16 weeks through detailed weekly interviews on morbidity and health-seeking behavior. The authors' findings are surprising and contrary to the normal view of health spending. They define a new class of illnesses as "short duration morbidities" if they are classified as non-chronic in the international classification of disease and are medically expected to last less than two weeks. The authors show that short duration morbidities are important in terms of prevalence, practitioner visits, and household health expenditure: Individuals report a short duration morbidity in one out of every five weeks. Moreover, one out of every three weeks reported with a short duration morbidity results in a doctor visit, and each week sick with such a morbidity increases health expenditure by 25 percent. Further, the absolute spending on short duration morbidities is similar across poor and rich income households. The authors discuss the implications of these findings in understanding household health behavior in an urban context, with special emphasis on the role of information in health-seeking behavior.
Publication(World Bank, Washington, DC, 2006-12) Das, Jishnu ; Sohnesen, Thomas PaveTo examine the relationship between patient satisfaction and doctor performance, the authors observed 2,271 interactions between 292 doctors and their patients in 98 clinics and hospitals in Paraguay and conducted an exit-survey with the same patients as they left the clinic. For a subsample of 64 facilities they also interviewed patients who visited the facility within the last week. There are three patterns in the data: (1) Patient satisfaction is positively correlated with doctor effort, measured as a combination of time spent, questions asked, and examinations performed after controlling for observed doctor and patient characteristics; (2) However, accounting for unobserved doctor characteristics dramatically reduces the level of significance and size of correlation between effort and satisfaction, showing that much of the positive relationship is driven by these unobserved doctor-specific factors; and (3) Reported satisfaction is significantly lower for patients interviewed at home compared with those interviewed at the clinic. This leads the authors to conclude that even if patient satisfaction reflects some aspects of the doctor's performance, unobserved heterogeneity combined with survey biases limit the widespread applicability of patient satisfaction as an indicator of doctor performance.
Publication(World Bank, Washington, DC, 2005-02) Andrabi, Tahir ; Das, Jishnu ; Khwaja, Asim Ijaz ; Zajonc, TristanBold assertions have been made in policy reports and popular articles on the high and increasing enrollment in Pakistani religious schools, commonly known as madrassas. Given the importance placed on the subject by policymakers in Pakistan and those internationally, it is troubling that none of the reports and articles reviewed based their analysis on publicly available data or established statistical methodologies. The authors of this paper use published data sources and a census of schooling choice to show that existing estimates are inflated by an order of magnitude. Madrassas account for less than 1 percent of all enrollment in the country and there is no evidence of a dramatic increase in recent years. The educational landscape in Pakistan has changed substantially in the past decade, but this is due to an explosion of private schools, an important fact that has been left out of the debate on Pakistani education. Moreover, when the authors look at school choice, they find that no one explanation fits the data. While most existing theories of madrassa enrollment are based on household attributes (for instance, a preference for religious schooling or the household s access to other schooling options), the data show that among households with at least one child enrolled in a madrassa, 75 percent send their second (and/or third) child to a public or private school or both. Widely promoted theories simply do not explain this substantial variation within households.
Publication(World Bank, 2009-02-28) Das, Jishnu ; Do, Quy-Toan ; Friedman, Jed ; McKenzie, DavidThe social and economic consequences of poor mental health in the developing world are presumed to be significant, yet remain underresearched. This study uses data from nationally representative surveys in Bosnia and Herzegovina, Indonesia, and Mexico and from special surveys in India and Tonga to show similar patterns of association between mental health and socioeconomic characteristics. Individuals who are older, female, widowed, and report poor physical health are more likely to report worse mental health. Individuals living with others with poor mental health are also significantly more likely to report worse mental health themselves. In contrast, there is little observed relation between mental health and consumption poverty or education, two common measures of socioeconomic status. Indeed, the results here suggest instead that economic and multidimensional shocks, such as illness or crisis, can have a greater impact on mental health than poverty. This may have important implications for social protection policy. Also significant, the associations between poor mental health and lower labor force participation (especially for women) and more frequent visits to health centers suggest that poor mental health can have economic consequences for households and the health system. Mental health modules could usefully be added to multipurpose household surveys in developing countries. Finally, measures of mental health appear distinct from general subjective measures of welfare such as happiness.
Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India(World Bank, Washington, DC, 2015-06) Das, Jishnu ; Holla, Alaka ; Mohpal, Aakash ; Muralidharan, KarthikThis 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( 2015-01) Coarasa, Jorge ; Das, JishnuMuch 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(World Bank, Washington, DC, 2013-05) Alderman, Harold ; Das, Jishnu ; Rao, VijayendraThis essay discusses practical issues confronted when conducting surveys as well as designing appropriate field trials. First, it looks at the challenge of ensuring transparency while maintaining confidentiality. Second, it explores the role of trust in light of asymmetric information held by the surveyor and by the respondents as well as the latter's expectations as to what their participation will set in motion. The authors present case studies relevant to both of these issues. Finally, they discuss the role of ethical review from the perspective of research conducted through the World Bank.
Publication( 2010-10-01) Andrabi, Tahir ; Das, JishnuWinning "hearts and minds" in the Muslim world is an explicitly acknowledged aim of U.S. foreign policy and increasingly, bilateral foreign aid is recognized as a vehicle towards this end. The authors examine the effect of aid from foreign organizations and on-the-ground presence of foreigners following the 2005 earthquake in Northern Pakistan on local attitudes. They show that four years after the earthquake, humanitarian assistance by foreigners and foreign organizations has left a lasting imprint on population attitudes. Measured in three different ways those living closer to the fault-line report more positive attitudes towards foreigners, including Europeans and Americans; trust in foreigners decreases 6 percentage points for every 10 Kilometers distance from the fault-line. In contrast, there is no association between distance to the fault-line and trust in local populations. Pre-existing differences in socioeconomic characteristics or population attitudes do not account for this finding. Instead, the relationship between trust in foreigners and proximity to the fault-line mirrors the greater provision of foreign aid and foreign presence in these villages. In villages closest to the fault-line, foreign organizations were the second largest providers of aid after the Pakistan army (despite reports to the contrary aid provision by militant organizations was extremely limited, with less than 1 percent of all respondents reporting any help from such organizations). The results provide a compelling case that trust in foreigners is malleable, responds to humanitarian actions by foreigners and is not a deep-rooted function of local preferences.