Publication: A Study of Fragility, Entrepreneurship and Mental Health: Investing in Better Cognitive and Behavioral Skills for Small Medium Enterprise Entrepreneurs to Thrive in Conflict-Affected Areas of Pakistan
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2019-05
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2019-05
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Mental health, well-being and lasting economic outcomes are intimately connected. However, in geographies marked by fragility, conflict and violence (FCV), entrepreneurs of small and medium size enterprises (SMEs) experience chronic stress and poor mental health on a regular basis. These issues can hamper performance and quality of life for the entrepreneurs, and can dampen the benefits of existing financial and business assistance programs. Few proven rigorous interventions are known. This study tests the hypothesis that a five-week group Cognitive Behavioral Therapy (CBT) training called Problem Management Plus for Entrepreneurs (PM+E) in combination with financial assistance could be more effective at reducing psychological stressors of SME entrepreneurs in FCV contexts than financial assistance alone. Meaningful and statistically significant improvements in mental health were achieved, with improvements persisting and increasing beyond the immediate post-intervention period. Three months after the intervention, based on analysis of pooled data across two follow-up rounds (at five weeks and three months post intervention), entrepreneurs in the treatment group experienced statistically significant reduction in the intensity and prevalence of depression and anxiety symptoms (measured by the Patient Health Questionnaire Anxiety and Depression Scale) and higher levels of well-being (measured by the WHO-5 Well-Being Index) compared with the control group. The effect was marked for those experiencing mild/moderate levels of depression and anxiety, indicating the clinical value of such low-touch early interventions. Overall, the study demonstrates that empirical research through Randomized Control Trials (RCTs) can be conducted in challenging, FCV settings through appropriate rapid training of local researchers and non-specialist providers (NSPs) at a low cost yielding scalable programmatic and policy level lessons.
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“Saraf, Priyam. 2019. A Study of Fragility, Entrepreneurship and Mental Health: Investing in Better Cognitive and Behavioral Skills for Small Medium Enterprise Entrepreneurs to Thrive in Conflict-Affected Areas of Pakistan. © World Bank. http://hdl.handle.net/10986/32145 License: CC BY 3.0 IGO.”
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Publication Group-Based Cognitive Behavioral Therapy Training Improves Mental Health of SME Entrepreneurs(World Bank, Washington, DC, 2019-06)Mental health, well-being, and lasting economic outcomes are intimately connected. However, in geographies marked by fragility, conflict, and violence (FCV), entrepreneurs of small and medium size enterprises (SMEs) experience chronic stress and poor mental health on a regular basis. These issues can hamper performance and quality of life for the entrepreneurs, and can dampen the benefits of existing financial and business assistance programs. Few proven rigorous interventions are known. This study tests the hypothesis that a five-week group Cognitive Behavioral Therapy (CBT) training called Problem Management Plus for Entrepreneurs (PM+E), in combination with financial assistance, could be more effective at reducing psychological stressors of SME entrepreneurs in FCV contexts than financial assistance alone. Meaningful and statistically significant improvements in mental health were achieved, with improvements persisting and increasing beyond the immediate post-intervention period. Based on analysis of pooled data across two follow-up rounds (at five weeks and three months post-intervention), entrepreneurs in the treatment group experienced statistically significant reduction in the intensity and prevalence of depression and anxiety symptoms (measured by the Patient Health Questionnaire Anxiety and Depression Scale) and higher levels of well-being (measured by the World Health Organization Well-Being Index) compared with the control group. The effect was marked for those experiencing mild/moderate levels of depression and anxiety, suggesting the clinical value of such low touch interventions. Overall, the study demonstrates that empirical research through Randomized Control Trials (RCTs) can be conducted in challenging, FCV settings through appropriate rapid training of local researchers and non-specialist providers (NSPs) at a low cost, yielding scalable programmatic and policy level lessons.Publication Improving Mental Well-Being and Productivity of Small-Medium Entrepreneurs in Fragile, Conflict and Violence Affected Areas(World Bank, Washington, DC, 2018-06)This literature review summarizes the link between psychological well-being and entrepreneurial outcomes for small and medium-size enterprises in fragile, conflict, and violence–affected contexts. It identifies potentially promising, scalable psychosocial training interventions, based on cognitive-behavioral therapy approaches, that can be adapted and implemented to improve psychological health at the individual level, that could lead to better business performance at the firm level. The findings from the literature of cognitive psychology and small business economics suggest that small and medium-size enterprise entrepreneurs, without diversified capital, stable sources of income, or delegation opportunities, tend to suffer from more stress and anxiety compared with their peers in salaried jobs or in larger firms. Chronic stress is found to deplete their psychological resources, erode their motivating role within the firm, and result in counterproductive work behavior. The combination of regular business-related entrepreneurial stressors with the uncertainties of a fragile, conflict, and violence–specific environment—natural disasters, conflict, migration, and/or exposure to trauma—can amplify poorer psychological outcomes and hamper business performance. Utilization of cognitive-behavioral therapy approaches to mitigate stress and build psychological capital appears promising. Although such curricula have been tried and tested for other target groups at scale, such an intervention has not yet been applied for at-risk entrepreneurs. Given that small and medium-size enterprises are important drivers of income in fragile, conflict, and violence–affected contexts, future research might benefit from evaluating whether the effects of cognitive-behavioral therapy–based training interventions can be replicated for these new target groups and, importantly, whether the interventions can lead to better behavioral outcomes and business performance over time.Publication Social Protection in Fragile and Conflict-Affected Countries(World Bank, Washington, DC, 2015-04)This study examines the role of social protection programming, and programming design and implementation features, that are prominent in fragile and conflict-affected states. The main objective is to build on existing, available information from a sample of fragile and conflict-affected countries and develop operational guidance that addresses policy, design, and implementation issues and offers operational solutions for social protection programming and policy making in different fragile settings. The analysis showcases the universe of social protection objectives that are evident in these countries as well as the programming trends, types, coverage, and expenditure patterns. The paper also examines dimensions specific to fragile and conflict-affected settings in implementing social protection and labor programs, such as social cohesion, the role of community-driven development, and postwar benefits. Finally, the study highlights social protection and labor program delivery in seven different country contexts, and discusses the country-specific programming options chosen to achieve the objectives and overcome capacity and operational constraints.Publication Entrepreneurship Programs in Developing Countries : A Meta Regression Analysis(2013-04)Fostering entrepreneurship is widely perceived to be a critical policy agenda to expand employment and earning opportunities and to reduce poverty. Sound macroeconomic conditions and business environment including infrastructure, regulation, and legal environment have typically been emphasized to increase entrepreneurial activities and create jobs. While these remain relevant, in developing countries, increasing attention is being paid to the role of labor policies that aim to reduce constraints and enhance productivity among the self-employed and small-scale entrepreneurs. The next section describes the procedure for constructing data and discusses main features of the entrepreneurship programs in our sample studies. Section three presents a standardization and estimation strategy using Meta regressions and discusses methodology. Section four then discusses the main findings of the Meta analysis. Finally, Section five concludes the study.Publication Entrepreneurship Programs in Developing Countries : A Meta Regression Analysis(World Bank, Washington, DC, 2013-04)This paper provides a synthetic and systematic review on the effectiveness of various entrepreneurship programs in developing countries. It adopts a meta-regression analysis using 37 impact evaluation studies that were in the public domain by March 2012, and draws out several lessons on the design of the programs. The paper observes wide variation in program effectiveness across different interventions depending on outcomes, types of beneficiaries, and country context. Overall, entrepreneurship programs have a positive and large impact for youth and on business knowledge and practice, but no immediate translation into business set-up and expansion or increased income. At a disaggregate level by outcome groups, providing a package of training and financing is more effective for labor activities. In addition, financing support appears more effective for women and business training for existing entrepreneurs than other interventions to improve business performance.
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