Subsidies, Information, and the Timing of Children's Health Care in Mali

We study how healthcare subsidies and improved information affect over- and under-use of primary healthcare in a randomized control trial of 1544 children in Mali. In a dynamic model of healthcare demand, misuse relative to policymaker preferences (here given by WHO care-seeking standards) arises from seeking care too early or too late during an illness spell. Using nine weeks of daily data, we show that the barrier to optimal care seeking is cost, not information: subsidies increase demand by over 250%, but overuse is rare with or without the subsidy. Information, contrary to intent, appears to increase underuse, as our model predicts

Subsidies, information, and the timing of children's health care in Mali

We study the impact of subsidies (which remove cost barriers) and healthworker visits (which remove informational barriers) on over- and underuse of primary care, using a randomized control trial across 1532 children in Mali. Providing children with access to primary healthcare is an important development goal. Yet the subsidies needed to achieve this may lead to inefficient overuse, particularly if parents have difficulty assessing their child's need for care. For the treatment of acute illness, price elasticities cannot be used to determine welfare effects, because they do not provide information on whether care is used effectively, which in turn depends on when it is sought. We propose a dynamic model of healthcare timing and define over- and underuse as seeking care too early or too late during an illness spell. We then use nine weeks of daily health records to identify misuse in our sample relative to WHO standards of care. Hazard estimates of care seeking show substantial underuse, but almost no overuse in our population. The primary barrier to the optimal timing of care seeking is cost, not information: subsidies increase care seeking by about 250%, and only 18% of this increase constitutes overuse. In contrast, healthworkers do little to reduce (already minimal) overuse, and may increase underuse when not paired with free care, as we predict in our dynamic model. Free care increases the value of care consumed without crowding out private spending, and it reduces mothers' concern and average illness duration

Cash transfer programs with income multipliers

Cash transfer programs induce multiplier effects when recipients put the money they receive to work to generate additional income. The ultimate income effects are multiples of the amounts transferred. This paper analyzes the PROCAMPO program in Mexico, which was introduced to compensate farmers for the anticipated negative effect of the North American Free Trade Agreement (NAFTA) on the price of basic crops. The transfer rules and the timing of the panel data collected allow unique control of biases in this impact analysis. We find that the multiplier among ejido sector recipients is in the range of 1.5 to 2.6. Multipliers are higher for medium and large farm households, low numbers of adults in the household, nonindigenous backgrounds, and households located in the Center and Gulf regions. High multipliers reflect marginal income opportunities that were unrealized due to liquidity constraints that the transfers eased. Opportunities came from the asset endowments that these households have, particularly irrigated land, and these opportunities were enhanced by access to technical assistance.Subsidies Mexico ,income ,

Targeting Assistance to the Poor and Food Insecure: A Review of the Literature

Targeting involves the identification and selection of certain groups or households or even individuals, and the distribution of benefits (or costs) to them. Targeting is required because governments face resource constraints, and because households have different needs: some are poorer and more food insecure than others. In general, the managerial costs of targeting increase with its narrowness or intended accuracy, and these costs may exceed the savings achieved by targeting. The benefits of targeting arise precisely because it reduces the size of the target population, and the cost of narrower targeting includes the unintentional exclusion of some of the target population. The literature highlights several factors common to successful public works programs, such as the need for flexibility in design and the need to pay attention to the local cultural, geographic, and economic environment in which the projects are to be implemented.food security, food policy, Food Security and Poverty, Downloads June 2008-July 2009: 21, Q18,

A cost-effectiveness analysis of demand- and supply-side education interventions

This paper is concerned with the issue of the most cost-effective way of improving access to education for poor households in developing countries. We consider two alternatives: (1) extensive expansion of the school system (i.e., bringing education to the poor) and (2) subsidizing investment in education by the poor (i.e., bringing the poor to the education system). To this end, we evaluate the Programa Nacional de Educación, Salud y Alimentación (PROGRESA), a large poverty alleviation program recently introduced in Mexico that subsidizes education. Using double-difference regression estimators on data collected before and after the program for randomly selected control and treatment households, we estimate the relative impacts of the demand- and supply-side program components. Combining these estimates with cost information, we find that the demand-side subsidies are substantially more cost-effective than supply-side expansions.Progresa. ,Education Mexico. ,Investments. ,Poverty alleviation Mexico. ,Subsidies Mexico. ,

Promoting Handwashing and Sanitation Behaviour Change in Low- and Middle-Income Countries: A Mixed-Method Systematic Review

This systematic review shows which promotional approaches are effective in changing handwashing and sanitation behaviour and which implementation factors affect the success or failure of such interventions. The authors find that promotional approaches can be effective in terms of handwashing with soap, latrine use, safe faeces disposal and open defecation. No one specific approach is most effective. However, several promotional elements do induce behaviour change. Different barriers and facilitators that influence implementing promotional approaches should be carefully considered when developing new policy, programming, practice, or research in this area

What role for safety net transfers in very low income countries?

The authors consider the question of what role safety net transfers should play in very low income countries where a large population live in absolute poverty, and the state has limited resources to fund transfers. The number of people living below minimum acceptable consumption levels will remain so high that some form of safety net intervention is justified. For pure transfers, governments should be selective of very specific groups such as orphans, to limit costs and engender political support. To improve the impact per dollar spent on transfers, programs should be selected to have a multiplier effect on incomes such as vouchers for small fertilizers packs for the poor, or to leverage by using small amounts of cash to help households reduce risk or diversify economic activity. Selection of programs that are self-targeting, such as public works at a low wage rate or subsidized food goods. The judicious timing of transfers is important. Programs should also be kept as simple as possible to fit with the limited administrative capacity, avoiding multiple overlapping donor programs in favor of one or two simple nationwide programs that are easily implemented, cost-effective, and fiscally sustainable.Safety Nets and Transfers,Services&Transfers to Poor,Rural Poverty Reduction,Poverty Assessment,Achieving Shared Growth

Poverty, inequality, and geographic targeting: Evidence from Small-Area Estimates in Mozambique

"Typical living standards surveys can provide a wealth of information about welfare levels, poverty, and other household and individual characteristics. However, these estimates are necessarily at a high level of aggregation, because such surveys usually include only a few thousand households, with coarse spatial stratification. Larger databases, such as national censuses, provide sufficient observations for more disaggregated analysis, but typically collect very little socioeconomic information. This paper combines data from the 1996–97 Mozambique National Household Survey of Living Conditions with the 1997 National Population and Housing Census to generate small-area (subdistrict) estimates of welfare, poverty, and inequality, with the associated standard errors. These small-area estimates are then used to explore several dimensions of poverty and inequality in Mozambique, particularly with regard to geographical targeting of antipoverty efforts. Reliably identifying and targeting the poor can be administratively costly, especially in rural Africa, where low population density and weak administrative capacity are common. Geographical targeting, or targeting poor areas, is sometimes proposed as a feasible alternative to targeting poor people, and poverty maps may serve as a valuable tool in this regard. Unfortunately, the notion of poor areas might not always be especially useful, as appears to be the case in Mozambique. The poverty maps do not reveal a particularly strong spatial concentration of poverty; the differences in poverty levels between areas tend to be subtle. This pattern is also observed in the decomposition of small-area inequality estimates, which shows that only about 20 percent of consumption inequality is accounted for by inequality between districts or between administrative posts. The picture that emerges of the poor living alongside the nonpoor indicates that targeting poor areas is likely to result in leakage to the nonpoor in that area, and considerable under-coverage of the significant numbers of poor households in areas that are less poor.”" Authors' AbstractInequality ,Geographic targeting ,Small area estimation ,Poverty mapping ,

Is there persistence in the impact of emergency food aid? Evidence on consumption, food security, and assets in rural Ethiopia

"The primary goal of emergency food aid after an economic shock is often to bolster short-term food and nutrition security. However, these transfers also act as insurance against other shock effects, such as destruction of assets and changes in economic activity, which can have lasting deleterious consequences. Although existing research provides some evidence of small positive impacts of timely food aid disbursements after a shock on current food consumption and aggregate consumption, little is known about whether these transfers play a safety net role by reducing vulnerability and protecting assets into the future. We investigate this issue by exploring the presence of persistent impacts of two major food aid programs following the 2002 drought in Ethiopia: a food-for-work program known as the Employment Generation Schemes (EGS) and a program of free food distribution (FFD). Using rural longitudinal household survey data collected in 1999 and 2004, we estimate the impact of these programs on consumption growth, food security, and growth in asset holdings 18 months after the peak of the drought, when food aid transfers had substantially or entirely ceased in most program villages... Overall, these results suggest that emergency food aid played an important role in improving welfare, access to food, and food security for many households following the drought in 2002. However, improved targeting, especially in EGS, and larger, sustained transfers may be required to increase benefits, particularly to the poorest households. The impacts of food aid identified here indicate some persistence or accumulated effects of transfers on consumption growth over time. Although the time lag between receipt of transfers and observed consumption is not more than one year in most cases, the estimated impact on consumption growth relative to the size and timing of transfers suggests possible savings or multiplier effects of emergency food aid." -- Authors' AbstractFood aid, Treatment effects, Propensity score matching, Ethiopia, africa, East Africa, food security, Nutrition security

Assessing care

The objective of this report is to summarize progress towards measurement of selected childcare and feeding practices, and to discuss the feasibility and usefulness of these measurements in research and program contexts. This is the third in a series of reports documenting insights regarding care and measurement of care gained from the Accra Urban Food and Nutrition Study (AUFNS). This last report complements the previous two by providing an extensive review of the published literature on experience with the measurement of selected dimensions of care.FCND ,Child Feeding. ,Child care. ,