Long-term effects of childhood work on human capital formation, migration decisions, and earnings in rural Ethiopia

In Ethiopia, a quarter of children are child laborers, of which one in every three works full-time. Currently, more children than ever before also combine schooling with work. In addition, although net primary school enrollment increased three-fold—to almost 90 percent over the last decade, more than half of these children drop out of school to join the labor market before completing their primary education. As a result, lower educational attainment, high illiteracy rates, and low technical skills continue to characterize the Ethiopian labor force. Lower human capital has also hampered the development in the rural and agricultural sector, which employs about three-quarters of the labor force. Therefore, this study examines the consequences of childhood work participation on children's long-term human capital formation (schooling progression), their migration decisions, and adulthood earnings in rural Ethiopia. In so doing, it contributes to a very limited literature on the long-term penalties of childhood work on outcomes later in life from a developing country perspective. This study uses a long-term panel dataset from five rural districts, collected in two survey waves: A baseline survey in 1999/2000 and a follow-up survey, 16 years later in 2015/2016. The random-effects Poisson model is used to analyze the effects of childhood work on children's long-term schooling progression, measured by the completed years of education. The findings show that full-time childhood work impedes long-term human capital formation, while in contrast, multitasking children (those who combined childhood work and school attendance) have attained more than twice as many years of schooling as their peers who worked full-time. The results also suggest that childhood work—excepting excessive, exclusive, and the worst forms of child labor—could be combined complementarily with child schooling to foster the long-term progression in human capital formation. However, these effects are heterogeneous according to child gender and childhood work type. Furthermore, using a doubly robust estimation method, the study also finds that full-time childhood work may limit the likelihoods of children's long-term village out-migration prospect compared to childhood educated peers. The results indicate that while those who worked exclusively during childhood are likely to be subsistence farmers when adults, schoolchildren tend to out-migrate in order to seek employment in non-farm jobs. In this regard, it was found that about 42, 34, and 24 percent of multitasking, school-only, and full-time childhood working children, respectively, currently work in non-farm jobs. Finally, using three-stage least squares approach, the estimates show that an extra one hour of childhood work per week could boost adulthood earnings by as much as 13.8 percent. The effects, however, exhibit diminishing returns when childhood work is more than five hours per day. Moreover, compared to schoolchildren, full-time childhood laborers earn, on average, 54.4 percent lower income in the adult labor markets. In indentifying the causal mechanisms, the study shows that childhood work may affect earnings through its effects on the probabilities of completing primary education and mobility to non-farming jobs later in life. The findings suggest that eliminating full-time childhood work should be at the core of the country's human capital development policy. In order to cut dropouts before completing primary education, compulsory school enrollment for all school-aged children should be combined with continued support to children and parents. Conditional incentives such as education subsidies and school feeding programs could be tied with child's school enrollment and continued attendance.Langzeiteffekte von Kinderarbeit auf die Humankapitalentwicklung, Migrationsentscheidungen und Zukünftige Einkommen im Ländlichen Äthiopien Eines von vier äthiopischen Kindern ist ein Kinderarbeiter, wobei ein Drittel in einem familiären Landwirtschaft und Hausarbeiten Vollzeit arbeitet. Derzeit kombinieren mehr Kinder denn je Schule mit ihrer Erwerbstätigkeit. Die Rate der Kinder die eine Grundschulausbildung beginnt liegt bei 90 Prozent, diese Zahl wurde in der letzten Dekade durch eine Verdreifachung der Anzahl der Kinder, die eine solche Ausbildung beginnt, erreicht. Etwas mehr als die Hälfte der Schüler bricht die Grundschulausbildung jedoch wieder ab, um eine Beschäftigung aufzunehmen und vorzeitig Teil der Erwerbsbevölkerung zu werden. Ein niedriger Bildungsgrad, eine hohe Analphabetenquote, sowie geringe technische Kompetenzen sind daher nach wie vor charakteristisch für die äthiopische Erwerbsbevölkerung. Drei Viertel dieser Erwerbsbevölkerung ist im landwirtschaftlichen Sektor, der niedrige Grad der Humankapitalentwicklung behindert die Entwicklung dieses Sektors, sowie die Entwicklung des ländlichen Raums im allgemeinen. Diese Studie untersucht die Auswirkungen von Kinderarbeit auf die langfristige Humankapitalentwicklung (Fortschreiten der Schulbildung) der Kinder, sowie den Einfluss der Erwerbstätigkeit auf Migrationsentscheidungen und die zu erwartende Einkommensentwicklung. Diese Studie ergänzt die im geringen Umfange vorhandne Fachliteratur in diesem Bereich mit einem Fokus auf den Preis der Kinderarbeit für das zu erwartende Leben von Kindern in Entwicklungsländern. Diese Studie arbeitet mit verwendet einen Langzeit-Panel-Datensatz aus fünf ländlichen Bezirken, der in zwei Erhebungswellen erfasst wurde: Eine Basiserhebung 1999/2000 und eine Folgebefragung 16 Jahre später 2015/2016. Das Random-Effects Poisson-Modell wird eingesetzt um die Auswirkungen von Kinderarbeit auf die Langzeit Fortschreiten der Schulbildung zu untersuchen. Die Anzahl der abgeschlossenen Schuljahre diente hier als Messgröße. Die Ergebnisse zeigen dass Vollzeitkinderarbeit die langfristige Humankapitalentwicklung generell behindert, während eine Kombination von Kinderarbeit und Schulausbildung führt im Gegensatz dazu zu einer Verdopplung der abgeschlossenen Jahre in der Schulbiographie der Kinder. Die Ergebnisse lassen darauf schließen, dass Kinderarbeit mit Ausnahme von exzessiver, exklusiver und schlimmsten Kinderarbeit mit einer Schulausbildung kombiniert werden kann, um eine langfristig Verbesserung der Humankapitalentwicklung zu bewirken. Diese Ergebnisse variieren jedoch stark mit Bezug auf das Geschlecht der Kinderarbeiter und die Art der ausgeführten Tätigkeit. Unter Verwendung einer robusten Schätzmethode kommt diese Studie weiter zu dem Ergebnis, dass Vollzeitkinderarbeit eine Migrationsbewegung der Kinder, und jungen Erwachsenen, aus den Dörfern heraus behindert. Die Ergebnisse dieser Studie zeigen des Weiteren, dass Kinder, die Vollzeit arbeiten, im Vergleich zu ihren Altersgenossen, mit höherer Wahrscheinlichkeit im Erwachsenenalter als Subsitenzlandwirte arbeiten werden. Kinder welche die Schule besucht haben haben im Gegensatz dazu häufiger die Möglichkeit aus den Dörfern wegzuziehen um zukünftig Tätigkeiten außerhalb der Landwirtschaft nachzugehen. Diesbezüglich hat diese Studie ergeben dass 42 Prozent der Kinderarbeiter welche die Arbeit mit Schulbesuch kombinieren zukünftig eine Tätigkeit außerhalb der Landwirtschaft aufnehmen werden. Der Wert beträgt 34 Prozent bei Kindern die nur zur Schule gehen und 24 Prozent bei Kindern die ausschließlich arbeiten. Die Studie hat letztlich unter Verwendung eines Three-stage least squares approach ergeben, dass eine Stunde Kinderarbeit pro Woche die Einkommenserwartung im Erwachsenenalter um 13,8 Prozent erhöhen kann. Diese Effekt kommen jedoch nicht zum tragen wenn die Kinder mehr als fünf Stunden pro Tag arbeiten müssen. Negative Effekte stellen sich ein, wenn die Kinder sehr viel arbeiten müssen, gerade ausschließlich arbeitende Kinder werden im Erwachsenenalter im Durchschnitt 54,4 Prozent weniger Einkommen am Arbeitsmarkt generieren können. Diese Studie zeigt in diesem Zusammenhang weiter, dass Kinderarbeit zukünftige Einkommenserwartungen negativ beeinträchtigt, da diese die Wahrscheinlichkeit des erfolgreichen Grundschulabschlusses verringert, und sich negative auf den Erwerbsverlauf ausübt, da sie die Mobilität aus den Dörfern hinaus behindert, was es erschwert, Tätigkeiten jenseits der Landwirtschaft aufzunehmen. Die Ergebnisse legen nahe, dass die Beseitigung der Ganztagsarbeit in der Kindheit im Mittelpunkt der Humankapitalentwicklungspolitik des Landes stehen sollte. Der frühzeitige Abbruch von Grundschulkarrieren sollte durch ein Schulpflicht für Kinder und gezielte finanzielle Förderung von Familien und Kindern verhindert werden. Bildungszuschüsse und Teilnahme and Schulspeisungsprogrammen sollten an eine konsequente Einhaltung der Schulpflicht geknüpft werden

Analysis of Resource Use Efficiency in Smallholder Mixed Crop-Livestock Agricultural Systems: Empirical Evidence from the Central Highlands of Ethiopia

The study uses data generated through a survey from rural households in Ethiopian central highland districts to assess farm-level resource use efficiency in the production of major crops including teff, wheat and chickpea in the mixed crop-livestock agricultural systems of Ethiopia, under conditions of diminishing land resource and environmental constraints. Data Envelopment Analysis (DEA) results show that smallholder farmers are resource use inefficient in the production of major crops with mean technical, allocative and economic efficiency levels of 0.74, 0.68 and 0.50, respectively. A Tobit model regression results on the determinants of inefficiency reveal that livestock ownership and participation in off-farm activities are associated with reduced level of resource use inefficiency. Furthermore, large family size and membership to associations contribute to higher level of resource use inefficiency. The findings suggest that resource use efficiency would be significantly improved through a better integrated livestock and crop production systems; expansion and promotion of off-farm activities; and reform of farmer’s associations. Keywords: Data Envelopment Analysis; Tobit; Resource use efficiency; mixed crop-livestock agriculture; Ethiopi

Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda

Background: The desire for universal health coverage in developing countries has brought attention to community-based health insurance (CBHI) schemes in developing countries. The government of Uganda is currently debating policy for the national health insurance programme, targeting the integration of existing CBHI schemes into a larger national risk pool. However, while enrolment has been largely studied in other countries, it remains a generally under-covered issue from a Ugandan perspective. Using a large CBHI scheme, this study, therefore, aims at shedding more light on the determinants of households’ decisions to enrol and renew membership in these schemes. Methods: We collected household data from 464 households in 14 villages served by a large CBHI scheme in south-western Uganda. We then estimated logistic and zero-inflated negative binomial (ZINB) regressions to understand the determinants of enrolment and renewing membership in CBHI, respectively.Results: Results revealed that household’s socioeconomic status, husband’s employment in rural casual work (odds ratio [OR]: 2.581, CI: 1.104-6.032) and knowledge of health insurance premiums (OR: 17.072, CI: 7.027-41.477) were significant predictors of enrolment. Social capital and connectivity, assessed by the number of voluntary groups a household belonged to, was also positively associated with CBHI participation (OR: 5.664, CI: 2.927-10.963). More positive perceptions on insurance (OR: 2.991, CI: 1.273-7.029), access to information were also associated with enrolment and renewing among others. Burial group size and number of burial groups in a village, were all significantly associated with increased the likelihood of renewing CBHI. Conclusion: While socioeconomic factors remain important predictors of participation in insurance, mechanisms to promote inclusion should be devised. Improving the participation of communities can enhance trust in insurance and eventual coverage. Moreover, for households already insured, access to correct information and strengthening their social network information pathways enhances their chances of renewing

Resource use efficiency of smallholder crop production in the central highlands of Ethiopia

Abstract Resource use efficiency in agricultural production has been a major concern in Ethiopia. In this article data from 700 households in the central highland districts were used to assess farm-level resource use efficiency and to determine factors that influence inefficiencies in the production of teff (Eragrostis tef), wheat and chickpea, the major important crops in the country. The study established that smallholder farmers are resource use inefficient. Moreover, a two-limit Tobit regression model results reveal that inefficiency in resource use is positively and significantly affected by family size, farming experience and membership to associations. It is also found that those households whose decision makers have roles in their community activities show improved resource use efficiency. Moreover, the findings show that eliminating resource use inefficiency could contribute about 31.28% of the minimum annual income required for the sustenance of an average farm household. The study established that resource use efficiency and productivity gains are likely to be significantly improved through expansion of nonfarm sectors, reform of farmer related associations and integrating community leadership in various community activities and programs. Moreover, market infrastructure development would likely increase efficiency and agricultural productivity. JEL classification: C21, C61, Q1

Impact of community-based health insurance on health services utilisation among vulnerable households in Amhara region, Ethiopia

Background Ethiopia piloted community-based health insurance in 2011, and as of 2019, the programme was operating in 770 districts nationwide, covering approximately 7 million households. Enrolment in participating districts reached 50%, holding promise to achieve the goal of Universal Health Coverage in the country. Despite the government’s efforts to expand community-based health insurance to all districts, evidence is lacking on how enrolment in the programme nudges health seeking behaviour among the most vulnerable rural households. This study aims to examine the effect of community-based health insurance enrolment among the most vulnerable and extremely poor households participating in Ethiopia’s Productive Safety Net Programme on the utilisation of healthcare services in the Amhara region. Methods Data for this study came from Amhara pilot integrated safety net programme baseline survey in Ethiopia and were collected between December 2018 and February 2019 from 5,398 households. We used propensity score matching method to estimate the impacts of enrolment in community-based health insurance on outpatient, maternal, and child preventive and curative healthcare services utilisation. Results Results show that membership in community-based health insurance increases the probabilities of visiting health facilities for curative care in the past month by 8.2 percentage points (95% CI 5.3 to 11.1), seeking care from a health professional by 8.4 percentage points (95% CI 5.5 to 11.3), and visiting a health facility to seek any medical assistance for illness and check-ups in the past 12 months by 13.9 percentage points (95% CI 10.5 to 17.4). Insurance also increases the annual household per capita health facility visits by 0.84 (95% CI 0.64 to 1.04). However, we find no significant effects of community-based health insurance membership on utilisation of maternal and child healthcare services. Conclusions Findings that community-based health insurance increased outpatient services utilisation implies that it could also contribute towards universal health coverage and health equity in rural and informal sectors. The absence of significant effects on maternal and child healthcare services may be due to the free availability of such services for everyone at the public health facilities, regardless of insurance membership. Outpatient services use among insured households is still not universal, and understanding of the barriers to use, including supply-side constraints, will help improve universal health coverage. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-023-09024-3

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Youth aspirations, perceptions of farming, and migration decisions in rural Sub-Saharan Africa: Further empirical evidence from Ethiopia

The study discusses the aspirations and preferences of youth in rural sub-Saharan Africa using a large-scale SMS-based survey data and complements it with an investigation on the causal effects of adolescent aspirations on migration decisions when youth in southwestern Ethiopia. The cross-country youth study shows that most rural youth in Africa prefer working in nonfarm economic sectors. It also finds that above half of the rural youth are undecided about their migration aspirations, providing an opportunity for governments to influence the rural out migration of youth. However, policymakers should also be equally aware that anti-poverty policy measures that simply improve the incomes of rural youth might have unpredictable and unintended consequences on their migration decisions. As a result, policy measures may have to also influence the perceptions of youth toward farming and rural life, and to make rural areas more attractive to the youth. Taking southwestern Ethiopia as a case in point, it was found that above half the adolescents have negative perceptions about farming (both farming life and the pre-requisites to become a farmer). The results also show that educational and occupational aspirations during adolescence exert differing effects on migration decisions after four years. That is, while those who aspired to attain more years of schooling are unlikely to out-migrate within this time period, their counterparts who aspired to have high socio-economic status occupations tend to out-migrate from the respective areas. The study concludes that the out-migration of youth from rural areas and small towns may not be only due to push factors such as lack of farmland, but it could also be due to their aspirations to work in high socio-economic status occupations which are not often found in the rural areas. Thus, African countries should work to make rural areas and farming more attractive to the aspiring youth such as through improving access to technology, developing infrastructure, and providing support to rural non-farm sectors expansion

Combining social protection interventions for better food security: Evidence from female-headed households in Amhara region, Ethiopia.

Ethiopia introduced its flagship poverty-targeted social protection program, the Productive safety net program (PSNP), in 2005 and Community-Based Health Insurance (CBHI) in 2011. Although both programs operate in several districts with some overlaps, evidence is scarce on how these large-scale programs jointly affect the food security of vulnerable groups. This study examines the impacts of a combination of these programs on food security outcomes among female-headed households in a chronically food-insecure and drought-prone district. Cross-sectional data were collected from 365 female-headed households selected through multi-stage sampling technique and analyzed using Inverse-probability-weighted regression adjustment (IPWRA) strategy to assess the effect of the programs on food security. The results show that while 63.6% of sample households are enrolled in CBHI and 48.8% are beneficiaries of PSNP's conditional cash transfer (CCT) component, membership in both social protection programs was 38.9%. The IPWRA analysis finds that inclusion in the CCT combined with CBHI, on average, increased dietary diversity score by 0.918 (95% CI 0.779-1.057) and food consumption score by 0.576 (95% CI 0.464-0.688). It also reduced household food insecurity access scale by 8.658 (95% CI -9.775 - -7.541). In all assessments, a combination of CBHI and CCT always produced results of a larger magnitude than each of CBHI and CCT alone. The findings provide evidence of the potentials of integrating social protection programs to increase food security outcomes among the most vulnerable and marginalized groups in a developing country. In addition, the results have also useful implications to achieve sustainable development goals related to ending hunger and achieving food security among vulnerable groups

Impact of Community-Based Health Insurance on Child Health Outcomes: Evidence on Stunting from Rural Uganda

While community-based health insurance (CBHI) becomes increasingly integrated into health systems in developing countries, there is still limited research and evidence on its probable health impacts beyond its functions for health financing or for facilitating access to services. Using a cross-sectional data from rural south-west Uganda, we apply a two-stage residual inclusion instrumental variables method to study the impact of community health insurance on stunting in children under five years. Results indicate that each year a household was enrolled in insurance was causally associated with a reduction in the probability of stunting of 5.7 percentage points. Predictive marginal effects show that children in households which have had insurance for at least 5 years had a probability of stunting of only 0.353 compared to 0.531 for children in households with no insurance. Households in CBHI were more likely to attend more free antenatal and postnatal care visits and report fewer illnesses and reported less health expenditures. Moreover, CBHI enrolment was also associated with reduced health costs. We recommend that developing countries should facilitate the expansion of community health insurance scheme not only for their contribution to health financing but even more for mortality and morbidity aversion

Impact of community-based health insurance on utilisation of preventive health services in rural Uganda: a propensity score matching approach

The effect of voluntary health insurance on preventive health has received limited research attention in developing countries, even when they suffer immensely from easily preventable illnesses. This paper surveys households in rural south-western Uganda, which are geographically serviced by a voluntary Community-based health insurance scheme, and applied propensity score matching to assess the effect of enrolment on using mosquito nets and deworming under-five children. We find that enrolment in the scheme increased the probability of using a mosquito net by 26% and deworming by 18%. We postulate that these findings are partly mediated by information diffusion and social networks, financial protection, which gives households the capacity to save and use service more, especially curative services that are delivered alongside preventive services. This paper provides more insight into the broader effects of health insurance in developing countries, beyond financial protection and utilisation of hospital-based services