Person: Yi Chang, Andres
Human Development Chief Economist Office
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Yi Chang, Andres, Chang, Andres Y., Chang, Andres, Yi, Andres, Chang, A.Y.
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Economics of Education, Health Economics, Service Delivery, Social Development
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Human Development Chief Economist Office
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Last updated:January 24, 2025
Biography
Andres Yi Chang is an economist in the Human Development Chief Economist’s Office, where he also serves as the SDI program manager. He began working at the World Bank in 2015, first at the World Bank Research Development Group and then moving to the HDCEO in 2019. Before joining the World Bank, he worked at Yale University, the Organization of American States, the Pan American Health Organization, and Leibniz University of Hannover. His research and projects are related to education, health, and social development in low- and middle-income countries, particularly in Africa, Latin America, and Southeast Asia.
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Publication Caseloads and Competence in Sub-Saharan Africa: A Fundamental Reassessment of the Human Resources Crisis in Primary Health Care(Washington, DC: World Bank, 2025-01-24) Daniels, Benjamin; Das, Jishnu; Gatti, Roberta; Yi Chang, AndresThis paper presents a fundamental reassessment of the global human resources crisis in primary health care, using nationally representative survey data from 7,915 health facilities across 10 Sub-Saharan African countries. The reassessment consists of three main parts. First, in contrast to a literature that posits pervasive health workforce shortages, the paper estimates that the median primary health care provider sees 10.9 patients each day and spends under two hours doing so. However, variation in patient loads across facilities implies that most patients visit busier facilities, and therefore the median patient experiences long wait times. Second, by combining caseload data with measures of medical competence for 14,367 individual providers, the paper demonstrates that provider caseload is very weakly correlated with medical competence. As a result, the most competent doctors in each system are nearly as likely to be underutilized as the least competent. Third, the paper assesses how much productivity is lost due to the low observed correlation between caseload and competence, by calculating potential quality improvements from matching the most competent providers to the busiest postings. Such transfers could increase the likelihood that a patient sees a provider who can correctly manage simple cases by 4.5 percentage points, or 12 percent, but with substantial variation across countries. The paper concludes that in half of the countries in the sample, there are substantial numbers of competent but underutilized providers; but in the other half, quality improvements will require a full overhaul of the training infrastructure and spatial distribution of facilities.Publication Infrastructure Matters: Complementarities with the Quality of Health Service Delivery in Kenya(World Bank, Washington, DC, 2022-11) Luna, Laura Becerra; Lebrand, Mathilde; Pkhikidze, Nino; Yi Chang, AndresIn many low- and middle-income countries, the lack of access to essential infrastructure such as roads, electricity, and information and communications technology may hinder the provision of many critical services such as health care. For instance, scarce and deficient roads might limit the patients’ access to health facilities, restrict the supply of qualified staff, and constrict access to key inputs such as medicines and vaccines. Likewise, lack of reliable electricity and internet connection may limit the ability of health facilities to power essential equipment, have better access to information, potentially serve more patients, and manage their supply chain efficiently. This paper combines exhaustive health facility surveys with geospatial data to study the extent to which better access to infrastructure in Kenya might improve the functioning of health care facilities and the quality of their services. First, the paper documents the gap in access to infrastructure in the health care sector in Kenya and reviews the literature on this topic. Then, using a novel data set, it finds that access to electricity and good quality roads is associated with more accurate provider diagnostics for both general illnesses and those primarily affecting children and pregnant women. Additionally, access to electricity is associated with (i) higher availability of vaccines for children—mostly by making it possible to have a working fridge, which is essential to store most vaccines; and (ii) higher availability of essential and priority medicines, by facilitating the use of information and communications technology for supply chain management. Finally, access to good quality roads, electricity and use of information and communications technology for supply management are positively related to the availability of antenatal care tests for pregnant women. Overall, the results suggest that increased investment in infrastructure and communications technologies may improve health service provision in Kenya.Publication The Quality of Health and Education Systems Across Africa: Evidence from a Decade of Service Delivery Indicators Surveys(Washington, DC: World Bank, 2021-11-18) Conner, Ruben; Gatti, Roberta; Andrews, Kathryn; Avitabile, Ciro; Sharma, Jigyasa; Yi Chang, AndresHave teachers mastered the subject matter they are teaching? Can doctors accurately diagnose and treat critical health conditions? Are schools and health facilities sufficiently stocked with needed equipment and supplies? Are they sufficiently supported and staffed to optimize learning and health care outcomes? For the past decade, the World Bank’s Service Delivery Indicators (SDI) surveys have collected nationally representative data in countries across Africa to answer these questions. The surveys aim to measure the quality of services where they meet citizens: in schools and health facilities. The Quality of Health and Education Systems Across Africa: Evidence from a Decade of Service Delivery Indicators Surveys identifies areas of achievement and constraint in service delivery, shedding light on how service delivery may foster or stunt human capital accumulation. SDI surveys show that schools and health clinics across Africa are still falling short in some critical areas. The delivery of primary care services is very heterogenous between and within countries. Many health facilities lack the basic necessities to provide proper care, such as essential medicines, basic diagnostic equipment, and adequate water and sanitation. Moreover, health care providers’ ability to diagnose and treat common health conditions correctly is low and distributed unevenly. Health personnel’s absence from health facilities remains a concern across the surveyed countries. Learning is low, and, not unlike health care, levels of student learning vary significantly across countries: less than half of grade 4 students can recite a simple sentence or perform basic mathematical operations. This deficient learning is correlated with teachers’ low levels of content knowledge and sub-par pedagogy skills. Some schools are also missing crucial inputs, such as blackboards or private and gendered toilets, and struggle with high pupil-teacher ratios. Despite these challenges, success stories in both sectors illustrate the quality of service delivery that could be achieved and showcase the dedication of teachers and medical staff across Africa. By studying data from thousands of facilities, considering the local context, and drawing insights from the literature, this book offers important insights for how countries can strengthen health and education systems and build back better in the wake of the massive disruptions brought about by the COVID-19 pandemic.