The Determinants of Child Weight and Height in Sri Lanka: A Quantile Regression Approach

Reducing child malnutrition is a key goal of most developing countries. To combat child malnutrition with the right set of interventions, policymakers need to have a better understanding of its economic, social and policy determinants. While there is a large literature that investigates the determinants of child malnutrition, it focuses almost exclusively on mean effects of these determinants. However, socioeconomic background variables and policy interventions may affect child nutrition differently at different points of the conditional nutritional distribution. Using quantile regressions, this paper explores the effects of variables such as a child?s age, sex and birth order; household expenditure per capita; parental schooling; and infrastructure on child weight and height at different points of the conditional distributions of weight and height using data from Sri Lanka?s Demographic and Health Survey. Results indicate that OLS estimates can be misleading in predicting the effects of determinants at the lower end of the distributions of weight and height. For example, even though on average Sri Lankan girls are not nutritionally-disadvantaged relative to boys, among children at the highest risk of malnutrition girls are disadvantaged relative to boys. Likewise, although expenditure per capita is associated with strong nutritional improvement on average, it is not a significant determinant of child height or weight at the lower end of the distribution. Similarly, parental education, electricity access, and the availability of piped water have larger effects on child weight and height at the upper quantiles than at the lower quantiles. The policy implication is that general interventions?parental schooling, infrastructure and income growth?are not as effective for children in the lower tail of the conditional weight and height distributions. These children, who are at the highest risk of malnutrition, are likely to need specialized nutritional interventions.child health, child nutrition, malnutrition, child weight, child height, quantile regression, Sri Lanka

India's Health Initiative: Financing Issues and Options

In response to the challenge of sustaining the health gains achieved in the better-performing states and ensuring that the lagging states catch up with the rest of the country, the Indian government has launched the National Rural Health Mission. A central goal of the effort is to increase public spending on health from the current 1.1 percent of GDP to roughly 2–3 percent of GDP within the next five years. In this paper, we examine the current status of health financing in India, as well as alternatives for realizing maximal health gains for the incremental expenditures.health financing, public spending, India, cost-effectiveness

Working Toward a Healthy Vietnam: Key Policy Messages From the VASS-SSRC Project

This brief provides key policy messages based on a large-scale longitudinal study from 2008 to 2016 in twelve communes in three Vietnamese provinces by the Vietnam Academy of Social Sciences (VASS) and the Social Science Research Council (SSRC).The project's objective was to understand household health practices and health-seeking behavior in Viet Nam, especially among economically and socially disadvantaged groups.Key findings highlight the main areas where donors and the government will need to focus in the coming years in order to improve and reduce disparities in health outcomes.These recommendations include:Increasing the use and effectiveness of commune health centers (CHCs)Improving antenatal care and utilizationHelping CHCs implement preventive health care and essential disease control program

The determinants of child weight and height in Sri Lanka: A quantile regression approach

Reducing child malnutrition is a key goal of most developing countries. To combat child malnutrition with the right set of interventions, policymakers need to have a better understanding of its economic, social and policy determinants. While there is a large literature that investigates the determinants of child malnutrition, it focuses almost exclusively on mean effects of these determinants. However, socioeconomic background variables and policy interventions may affect child nutrition differently at different points of the conditional nutritional distribution

Promoting Effective Schooling through Education Decentralization in Bangladesh, Indonesia, and Philippines

"Among developing member countries (DMCs), Indonesia and the Philippines rank fairly high in the distribution of real GDP per capita in PPP dollars while Bangladesh ranks much lower. In terms of aggregate schooling, the Philippines has secondary and tertiary enrollment rates that are substantially higher, while Indonesia has rates that are substantially lower, than that predicted based on all DMCs and their respective real products per capita. The Philippines also has expected grades for synthetic cohorts that are substantially above the overall mean for DMCs. In terms of public expenditures on education, all three countries have about the same percentage of GNP invested in education, a little over 2 percent, which is significantly below the level predicted by the experience of all DMCs given their respective real products per capita. There has been considerable public pressure for decentralization of education in DMCs in recent years. This pressure has been driven largely by fiscal constraints but has also been motivated by concerns over the effectiveness of a centralized system for delivering education services. The three country studies provide a rich characterization of the evolving - and in certain respects, rapidly changing - education systems in these DMCs.

Conceptual Issues in the Role of Education Decentralization

"While decentralization of education in DMCs has largely been driven by fiscal constraints, it has also been motivated by concerns about the effectiveness of a centralized system in delivering education services. The statistics are revealing: while virtually all DMCs have made impressive gains in expanding the coverage of primary schooling, enrollment rates remain generally low at secondary and tertiary levels, particularly for children coming from disadvantaged backgrounds. The quality of education is also a cause for concern, judging by dropout and grade repetition rates, and international comparisons of achievement test scores. Another cause for concern is whether the curricula used are appropriate, especially for higher education. To varying degrees, DMCs have adopted some elements of decentralization in their education systems. These include devolution of authority and responsibility for schools from central to local levels, increased local financing of schools, decentralization of school functions, and reforms to the incentive structure of schools and their teachers. However, it is not often clear that the measures adopted have led to improvements in education. There is not much evidence that decentralization has been successful in improving education in DMCs, perhaps in part because decentralization measures in most countries so far have been incomplete. There is still no clear understanding of the economic and institutional conditions under which decentralization leads to more effective education

Public Goods Access and Juvenile Sex Ratios in Rural India: Evidence from the 1991 and 2001 Village Census Data

We use village level data from the 1991 and 2001 Indian Censuses to examine how the availability of health facilities and safe drinking water at the village level affect juvenile sex ratios. In addition to controlling for village fixed effects in our estimating equation of the juvenile sex ratio, we also allow villages to be heterogeneous in terms of how their juvenile sex ratios respond to the availability of health facilities and safe drinking water. A key result we obtain is that although the presence of public health facilities does not exert a positive, significant effect on juvenile sex ratios on average, they do so in villages where the problem of discrimination against girls is most acute, i.e., in villages at the 0.10 and 0.25 quantiles of the conditional juvenile sex ratio distribution. Thus public policy can be an effective tool in improving gender balance in cases where it is most needed

Re-Imagining School Feeding : A High-Return Investment in Human Capital and Local Economies

Analysis shows that a quality education, combined with a guaranteed package of health and nutrition interventions at school, such as school feeding, can contribute to child and adolescent development and build human capital. School feeding programs can help get children into school and help them stay there, increasing enrollment and reducing absenteeism. Once children are in the classroom, these programs can contribute to their learning by avoiding hunger and enhancing cognitive abilities. The benefits are especially great for the poorest and most disadvantaged children. As highlighted in the World Bank’s 2018 World Development Report (World Bank 2018), countries need to prioritize learning, not just schooling. Children must be healthy, not hungry, if they are to match learning opportunities with the ability to learn. In the most vulnerable communities, nutrition-sensitive school meals can offer children a regular source of nutrients that are essential for their mental and physical development. And for the growing number of countries with a “double burden” of undernutrition and emerging obesity problems, well-designed school meals can help set children on the path toward more healthy diets. In Latin America, for example, where there is a growing burden of noncommunicable diseases (NCDs), school feeding programs are a key intervention in reducing undernutrition and promoting healthy diet choices. Mexico’s experience reducing sugary beverages in school cafeterias, for example, was found to be beneficial in advancing a healthy lifestyle. A large trial of school-based interventions in China also found that nutritional or physical activity interventions alone are not as effective as a joint program that combines nutritional and educational interventions. In poor communities, economic benefits from school feeding programs are also evident—reducing poverty by boosting income for households and communities as a whole. For families, the value of meals in school is equivalent to about 10 percent of a household’s income. For families with several children, that can mean substantial savings. As a result, school feeding programs are often part of social safety nets in poor countries, and they can be a stable way to reliably target pro-poor investments into communities, as well as a system that can be scaled up rapidly to respond to crises. There are also direct economic benefits for smallholder farmers in the community. Buying local food creates stable markets, boosting local agriculture, impacting rural transformation, and strengthening local food systems. In Brazil, for example, 30 percent of all purchases for school feeding come from smallholder agriculture (Drake and others 2016). These farmers are oftentimes parents with schoolchildren, helping them break intergenerational cycles of hunger and poverty. Notably, benefits to households and communities offer important synergies. The economic growth in poor communities helps provide stability and better-quality education and health systems that promote human capital. At the same time, children and adolescents grow up to enjoy better employment and social opportunities as their communities grow

Women, Schooling, and Marriage in Rural Philippines

Using data from the Bicol region of the Phillipines, we examine why women are more educated than men in a rural, agricultural economy in which women are significantly less likely than men to participate in the labor market. We hypothesize that educational homogamy in the marriage market and cross-productivity effects in the household allow Filipino women to reap substantial benefits from schooling regardless of whether they enter the labor market. Our estimates reveal that the return to schooling for women is approximately 20 percent in both labor and marriage markets. In comparison, men experience a 12 percent return to schooling in the labor market. By using birth order, sibship size, percent of male siblings, and parental education as instruments, we correct for a significant downward bias that is caused by the endogeneity of schooling attainment