Publication: Almost Random: Evaluating a Large-Scale Randomized Nutrition Program in the Presence of Crossover
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Published
2011
ISSN
03043878
Date
2012-03-30
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Large-scale randomized interventions have the potential to uncover the causal effect of programs applying to a large population, thereby improving on the insights gained from currently dominant smaller randomized studies. However, the external validity gained through larger interventions typically risks deviation from the randomization protocol. This paper investigates the impact of the Nutrition Enhancement Program, which aims to improve child nutrition in Senegal. The analysis deals with deviation from the planned treatment and suggests approaches for combining ex-post adjustments such as propensity score matching with the randomized treatment plan. The authors do not detect a strong overall program impact on the outcome measure of weight-for-age based on planned treatment status, but do find an impact on the youngest children. Moreover, the project impact is clearer when the analysis considers treatment crossover using alternative estimators of two-stage least-squares and propensity score matching. The findings underscore the importance of addressing the shortcomings of large-scale randomization interventions in a systematic manner to guide further implementation of such projects, as well as to expose the true causal effect of such programs.
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Publication Almost Random : Evaluating a Large-scale Randomized Nutrition Program in the Presence of Crossover(Washington, DC: World Bank, 2008-11)Large-scale randomized interventions have the potential to uncover the causal effect of programs applying to a large population, thereby improving on the insights gained from currently dominant smaller randomized studies. However, the external validity gained through larger interventions typically implies less supervision and often comes at the cost of some deviation from the randomization plan. This paper investigates the impact of the Nutrition Enhancement Program, which aims to improve child nutrition in Senegal based on a large-scale randomized community intervention. The analysis explicitly deals with deviation from the planned treatment and suggests approaches for combining ex-post adjustments such as propensity score matching with the randomized treatment plan. The authors do not detect a strong overall program impact on the outcome measure of weight-for-age based on planned treatment status, but do find an impact on the youngest children. Moreover, the project impact is clearer when the analysis considers treatment crossover using alternative estimators of two-stage least-squares and propensity score matching. The findings underscore the importance of addressing the shortcomings of large-scale randomization interventions in a systematic manner in order to understand the selection process that can guide further implementation of such projects, as well as to expose the true, causal effect of such programs.Publication Determinants of Malnutrition in Senegal : Individual, Household, Community Variables, and Their Interaction(2008)The relationship between poverty and nutrition is a two-sided one: on the one hand, economic growth (which is generally associated with an eradication of poverty) leads to reduced malnutrition. On the other hand, nutrition is one of the key ingredients for human capital formation, which in turn represents one of the fundamental factors of growth. There are numerous studies that show the correlates of malnutrition using both household- and community-level variables. However, few of these studies allow for the potential endogeneity of community infrastructure or indicate their interplay with characteristics of the mother. The current study considers the socio-economic determinants of child malnutrition and investigates how programs compensate for the increased risks facing young mothers and their children or substitute for a low social status of the mother in the household. The empirical results show that children of mothers giving birth at a young age are disadvantaged in terms of their anthropometric status. Interaction effects of the presence of a non-governmental organization (NGO) or a health post in the village with characteristics of the mother stress the important role played by these institutions in helping disadvantaged mothers overcome their difficulties. These findings have implications for efficient program design and represent a further step towards gaining an improved understanding of the complex determinants of child (mal)nutrition.Publication Promoting Handwashing and Sanitation : Evidence from a Large-Scale Randomized Trial in Rural Tanzania(World Bank Group, Washington, DC, 2015-01)The association between hygiene, sanitation, and health is well documented, yet thousands of children die each year from exposure to contaminated fecal matter. At the same time, evidence on the effectiveness of at-scale behavior change interventions to improve sanitation and hygiene practices is limited. This paper presents the results of two large-scale, government-led handwashing and sanitation promotion campaigns in rural Tanzania. For the campaign, 181 wards were randomly assigned to receive sanitation promotion, handwashing promotion, both interventions together, or neither. One year after the end of the program, sanitation wards increased latrine construction rates from 38.6 to 51 percent and reduced regular open defecation from 23.1 to 11.1 percent. Households in handwashing wards show marginal improvements in handwashing behavior related to food preparation, but not at other critical junctures. Limited interaction is observed between handwashing and sanitation on intermediate outcomes: wards that received both handwashing and sanitation promotion are less likely to have feces visible around their latrine and more likely to have a handwashing station close to their latrine facility relative to individual treatment groups. Final health effects on child health measured through diarrhea, anemia, stunting, and wasting are absent in the single-intervention groups. The combined-treatment group produces statistically detectable, but biologically insignificant and inconsistent, health impacts. The results highlight the importance of focusing on intermediate outcomes of take-up and behavior change as a critical first step in large-scale programs before realizing the changes in health that sanitation and hygiene interventions aim to deliver.Publication Mining Together : Large-Scale Mining Meets Artisanal Mining, A Guide for Action(Washington, DC, 2009-03)The present guide mining together-when large-scale mining meets artisanal mining is an important step to better understanding the conflict dynamics and underlying issues between large-scale and small-scale mining. This guide for action not only points to some of the challenges that both parties need to deal with in order to build a more constructive relationship, but most importantly it sheds more light on some potential interventions for conflict prevention, management, and even transformation. This guide, then, represents a step in the right direction to start transforming the relationship between large-scale and artisanal miners through win-win solutions that emerge out of the genuine interaction and dialogue of all stakeholders involved: governments, companies, communities, miners and development organizations. Large-Scale Mining (LSM) companies increasingly come across Artisanal and Small-scale Mining (ASM) workers during their exploration or production activities in the developing world. The ASM-LSM relationship is often conflictual because both types of miners compete for the same resource or because they perceive each other as a threat. However the ASM-LSM relationship is now also undergoing a largely positive evolution in part thanks to new Corporate Social Responsibility (CSR) commitments. This guide is the result of this collaboration and provides an informative overview of the growing experiences of the most typical ASM-LSM issues and guidance for appropriate interventions.Publication Decentralized Beneficiary Targeting in Large-Scale Development Programs : Insights from the Malawi Farm Input Subsidy Program(World Bank, Washington, DC, 2013-11)This paper contributes to the long-standing debate on the merits of decentralized beneficiary targeting in the administration of development programs, focusing on the large-scale Malawi Farm Input Subsidy Program. Nationally-representative household survey data are used to systematically analyze the decentralized targeting performance of the program during the 2009-2010 agricultural season. The analysis begins with a standard targeting assessment based on the rates of program participation and the benefit amounts among the eligible and non-eligible populations, and provides decompositions of the national targeting performance into the inter-district, intra-district inter-community, and intra-district intra-community components. This approach identifies the relative contributions of targeting at each level. The results show that the Farm Input Subsidy Program is not poverty targeted and that the national government, districts, and communities are nearly uniform in their failure to target the poor, with any minimal targeting (or mis-targeting) overwhelmingly materializing at the community level. The findings are robust to the choice of the eligibility indicator and the decomposition method. The multivariate analysis of household program participation reinforces these results and reveals that the relatively well-off, rather than the poor or the wealthiest, and the locally well-connected have a higher likelihood of program participation and, on average, receive a greater number of input coupons. Since a key program objective is to increase food security and income among resource-poor farmers, the lack of targeting is a concern and should underlie considerations of alternative targeting approaches that, in part or completely, rely on proxy means tests at the local level.
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