Essays on the Effects of Informal and Formal Protection Arrangements

__Abstract__ A feature of the development discourse in the past decade has been the emergence of large scale social safety net programmes in developing countries. In this thesis we look at the effects of different ‘safety net’ mechanisms, whereby the term ‘safety net’ is considered in a broader sense. The thesis does not only look at formal safety net programmes that are implemented by the government but also explores the effects of an informal social protection arrangement, i.e. the family, which acts as an important ‘safety net’ in contexts where formal protection mechanisms are not working or still fully absent

An assessment of the effects of the 2002 food crisis on children's health in Malawi

In 2002 Malawi experienced a serious shortage of cereals due to adverse climatic conditions. The World Food Programme assumed that about 2.1 to 3.2 million people were threatened of starvation at that time. However, not much research has been undertaken to investigate the actual consequences of this crisis. In particular, little is known about how the crisis affected the health status of children. Obviously, quantifying the health impact of such a crisis is a serious task given the lack of data and the more general problem of relating outcomes to specific shocks and policies. In this paper a difference-in-difference estimator is used to quantify the impact of the food crisis on the health status of children. The findings suggest that at least in the short run, there was neither a significant impact on child mortality nor on malnutrition. This would suggest that the shock might have been less severe than initially assumed and that the various policy interventions undertaken at the time have been effective or at least sufficient to counteract the immediate effects of the crisis

The health care burden in rural Burkina Faso: Consequences and implications for insurance design

This paper maps the health care burden of households in rural Burkina Faso. More specifically we investigate the financial burden of health shocks and the manner in which households respond. Our data allows us to differentiate the burden of chronic illness and handicap, more frequent and recurring illnesses and episodes of severe illness, accident and mortality. We find that the burden of health shocks and health spending is high, ranging from one third of monthly non-medical consumption for the treatment of common infectious illnesses to almost three times the monthly non-medical spending in case of death of a household member. To cope, households deplete savings, sell livestock or reduce consumption. In case of severe shocks they are also heavily reliant on transfers from outside. Looking at the economic consequences of health shocks we find that illness of whichever type – severe, chronic or more common – reduces household consumption. Furthermore, households which suffered from a severe illness show significantly lower livestock holdings. Many of the health insurance schemes implemented in developing countries are not yet taking note of the burden of severe and chronic illness. However, in light of the universal health insurance coverage objectives of the Sustainable Development Goals (SDGs) it should be considered an area for future expansion

Effects of decentralized health care financing on maternal care in Indonesia

We exploit variation in the design of sub-national health care financing initiatives in Indonesian districts to assess the effects of these local schemes on maternal care from 2004 to 2010

Effects of Decentralized Health Care Financing on Maternal Care in Indonesia

We exploit variation in the design of sub-national health care financing initiatives in Indonesian districts to assess the effects of these local schemes on maternal care from 2004 to 2010. The analysis is based on a district pseudopanel, combining data from a unique survey among District Health Offices with the Indonesian Demographic and Health Surveys, the national socioeconomic household surveys and the village census. Our results show that these district schemes contribute to an increase in antenatal care visits and the probability of receiving basic recommended antenatal care services for households that are not targeted by the national health insurance programs. We observe a decrease in home births. However, there is no effect on professional assistance at birth. We also observe variation in scheme design across districts as well as constraints to the effectiveness of local schemes. Including antenatal and delivery services explicitly in benefit packages and contracting local rather than national health care providers increases the effects on maternal care. Increasing population coverage reduces effectiveness, delineating limitations to local funding and risk pooling. Furthermore, we do not find any effects for districts outside Java and Bali, where access to basic health care remains a key policy concer

Arctic Study of Tropospheric Aerosol and Radiation (ASTAR) 2000: Arctic haze case study

The ASTAR 2000 (Arctic Study of Tropospheric Aerosol and Radiation) campaign ran from 12 March until 25 April 2000 with extensive flight operations in the vicinity of Svalbard (Norway) from Longyearbyen airport (78.25°N, 15.49°E). It was a joint Japanese (NIPR Tokyo)German (AWI Bremerhaven/Potsdam) airborne measurement campaign using AWI aircraft POLAR 4 (Dornier 228-101). Simultaneous ground-based measurements were done at the international research site Ny-lesund (78.95°N, 11.93°E) in Svalbard, at the German Koldewey station, at the Japanese Rabben station and at the Scandinavian station at Zeppelin Mountain (475 m above sea level). During the campaign 19 profiles of various aerosol properties were measured. In general, the Arctic spring aerosol in the vicinity of Svalbard had significant temporal and vertical variability.A strong haze event occurred between 21 and 25 March in which the optical depth from ground-based observation was 0.18, which was significantly greater than the background value of 0.06. Airborne measurements on 23 March during this haze event showed a high aerosol layer with an extinction coefficient of 0.03 km1 or more up to 3 km and a scattering coefficient from 0.02 in the same altitude range. From the chemical analyses of airborne measurements, sulfate, soot and sea salt particles were dominant, and there was a high mixing ratio of external soot particles in some layers during the haze event, whereas internal mixing of soot in sulfate was noticeable in some layers for the background condition. We argue that the high aerosol loading is due to direct transport from anthropogenic source regions. In this paper we focus on the course of the haze event in detail through analyses of the airborne and ground-based results

Weight Gain after Interferon-Free Treatment of Chronic Hepatitis C—Results from the German Hepatitis C-Registry (DHC-R)

Chronic hepatitis C can be treated very effectively with direct-acting antivirals (DAA) with only minor side effects compared to an interferon-containing treatment regimen. The significance of metabolic comorbidities after HCV cure is not well defined. This study aims to investigate short- and long-term weight change of patients receiving interferon-free antiviral treatment for chronic hepatitis C. The German Hepatitis C-registry (DHC-R) is a national multicenter real-world cohort. A total of 5111 patients were followed prospectively after DAA treatment for up to 3 years. Weight change compared to baseline was analyzed at end of treatment and at years 1, 2, and 3 after completion of antiviral therapy. Regression analysis was performed to identify baseline predictors for weight change. While there was no relevant mean weight change (−0.2 kg, SD 4.3 kg) at the end of antiviral treatment, weight started to increase during long-term follow-up reaching +1.7 kg (SD 8.0 kg, p < 0.001) compared to baseline at 3 years (follow-up year 3, FU3) after completion of antiviral therapy. 48%, 31%, and 22% of patients had a weight gain greater than 1, 3, and 5 kg at FU3, respectively. During follow-up, a body mass index (BMI) <30 proved to be the only consistent predictor for weight gain. DAA treatment is followed by a substantial weight gain (+3 kg or more) in one-third of the patients during long-term follow-up. Non-obese patients seemed to be most vulnerable to weight gain. The body compartment involved in weight gain as well as the mechanism of weight gain remain to be elucidated