Essays on Modeling and Evaluation of Pro-Poor-Growth Strategiesin Africa

This cumulative dissertation presents 5 contributions that deliver novel insights on development issues and investment strategies in Africa. Chapter II and IV focus on the analysis of potential impacts of public health expenditures on productivity and hence future growth. In particular, chapter II provides an empirical analysis of the impact of public health expenditures on farmer’s productivity using the Tanzania case study. Likewise, I investigate the potential impact of out-of-pocket health expenditures on agricultural productivity and poverty in Chapter III and IV, respectively. Beyond public spending, private expenditures, especially out-of-pocket health expenditures, also have an impact on productivity, although having an impoverishing effect on households and constraining the productivity generating process when they became catastrophic. The issue on the impoverishment of out-of-pocket health expenditures is largely discussed in chapter III, which additionally used a conditional mixed process to estimate their determinants. Both chapter II and IV emphasize the need for greater investment in the non-agricultural health sector in order to both meet the social demand and generate productivity growth. Chapter V provides the second major contribution to this dissertation by analyzing the policy-growth linkages in addition to the growth-poverty linkages. It provides a method that identifies the key sectors and key policy programs by considering the cost issue of generating growth that is often overlooked. This method combines empirical and expert survey data to estimate a Policy Impact Function and uses Senegal as a case study. Beyond all the identification of economic and political solutions, the implementation of the budget allocation between the different sectors and the different policy programs is a crucial point in achieving targeted growth and poverty reduction. Chapter VI analyzes the impact of a Medium-Term Expenditure Framework (MTEF) – a multi-year budget programming tool - in Africa, with a special focus in Senegal

Early detection of maternal deaths in Senegal through household-based death notification integrating verbal and social autopsy: a community-level case study

Background: Reliable detection of maternal deaths is an essential prerequisite for successful diagnosis of barriers to care and formulation of relevant targeted interventions. In a community-level case study, the use of household-level surveillance in Senegal unveiled an apparent increase in maternal deaths, which triggered a rapid-cycle collaborative response to implement a multipronged set of quick-win and sustained interventions intended to improve quality care. Methods: Part of a multi-country effort, the Millennium Villages Project is implementing a routine community-level information system in Senegal, able to detect maternal deaths in real-time and uncover clinical and social factors contributing to mortality. Within this geographically demarcated area of approximately 32 000 inhabitants, with a well-structured health system with patient referral services, deaths were registered and notified by community health workers, followed by timely verbal and social autopsies. Using the Pathway to Survival conceptual framework, case analysis and mortality reviews were conducted for evaluation and quality improvement purposes. Results: The estimated maternal mortality rates rose from 67/100000 births in 2009 (1 death), to 202/100000 births in 2010 (3 deaths) and 392/100000 births (5 deaths) in 2011. Although absolute numbers of maternal deaths remained too small for robust statistical analysis, following verbal autopsy analyses in 2011, it became evident that an unexpectedly high proportion of maternal deaths were occurring at the referral hospital, mostly post-Caesarian section. Inadequate case management of post-partum haemorrhage at the referral hospital was the most frequently identified probable cause of death. A joint task team systematically identified several layers of inefficiencies, with a potential negative impact on a larger catchment area than the study community. Conclusions: In this study, routine community-based surveillance identified inefficiencies at a tertiary level of care. Community-level surveillance systems that include pregnancy, birth and death tracking through household visits by community health workers , combined with verbal and social autopsy can identify barriers within the continuum of maternal care. Use of mHealth data collection tools sensitive enough to detect small changes in community-level mortality trends in real-time, can facilitate rapid-cycle quality improvement interventions, particularly when associated with social accountability structures of mortality reviews

Connectivity as engine for productivity among smallholder peanut farmers in Senegal

Peanut is a major source of income for many farmers in Senegal. However, this sector faces several problems in all the segments of the value chain such as yield decline and serious market disturbances. Agricultural production has to be increased to address these issues. This can be done by reinforcing the connectivity of farmers. This study aims to evaluate connectivity as a catalyst for agricultural productivity. An appropriate measure of connectivity integrating various dimensions is computed and an estimate of multilevel mixed-effects linear regression shows its positive and meaningful effect on the output. Results show that Information and Communication Technologies should be promoted and social networks should be reinforced in agricultural activities. One option is to help Rural Producer Organizations better develop and to be a gateway as community access points

Out-of-pocket health payments: a catalyst for agricultural productivity growth, but with potentially impoverishing effects

This paper analyses the relationship between health expenditures and productivity in Senegal by using a dynamic recursive Computable General Equilibrium (CGE) model that has been run from 2011 to 2020. This model links the growth rate of agricultural productivity to household investment in health goods taking into account catastrophic health payments considered as barriers to achieve maximal productivity gains. In fact, despite being a potential catalyst for productivity, out-of-pocket health expenditures can be a burden after a critical threshold has been crossed, and might potentially decrease household resources and place constraints on the productivity generating process. Results show a positive impact on poverty reduction when the Government reduces the burden on households by financing catastrophic payment overshoots. Lower health costs also appear to improve households’ well-being, especially in the case of agricultural households. These results suggest the need for policies which will reduce the health system’s reliance on out-of-pocket payments and demonstrate that health programs should reach the most vulnerable households. The effectiveness of poverty-oriented interventions can be increased by targeting households incurring catastrophic health expenditures

Case of the Medium-Term Expenditure Framework (MTEF) - Senegal's experience

PRIFPRI4WCA

Evidence from Senegal

PRIFPRI3; ISIWCA

Out-of-pocket health payments: a catalyst for agricultural productivity growth, but with potentially impoverishing effects in Senegal

PRIFPRI3WCA

Spatial modeling of orgin-destination flows of farmers in Senegal

PRIFPRI3WCA

Early detection of maternal deaths in Senegal through household-based death notification integrating verbal and social autopsy: a community-level case study

Background: Reliable detection of maternal deaths is an essential prerequisite for successful diagnosis of barriers to care and formulation of relevant targeted interventions. In a community-level case study, the use of household-level surveillance in Senegal unveiled an apparent increase in maternal deaths, which triggered a rapid-cycle collaborative response to implement a multipronged set of quick-win and sustained interventions intended to improve quality care.\ud \ud Methods: Part of a multi-country effort, the Millennium Villages Project is implementing a routine community-level information system in Senegal, able to detect maternal deaths in real-time and uncover clinical and social factors contributing to mortality. Within this geographically demarcated area of approximately 32 000 inhabitants, with a well-structured health system with patient referral services, deaths were registered and notified by community health workers, followed by timely verbal and social autopsies. Using the Pathway to Survival conceptual framework, case analysis and mortality reviews were conducted for evaluation and quality improvement purposes.\ud \ud Results: The estimated maternal mortality rates rose from 67/100000 births in 2009 (1 death), to 202/100000 births in 2010 (3 deaths) and 392/100000 births (5 deaths) in 2011. Although absolute numbers of maternal deaths remained too small for robust statistical analysis, following verbal autopsy analyses in 2011, it became evident that an unexpectedly high proportion of maternal deaths were occurring at the referral hospital, mostly post-Caesarian section. Inadequate case management of post-partum haemorrhage at the referral hospital was the most frequently identified probable cause of death. A joint task team systematically identified several layers of inefficiencies, with a potential negative impact on a larger catchment area than the study community.\ud \ud Conclusions: In this study, routine community-based surveillance identified inefficiencies at a tertiary level of care. Community-level surveillance systems that include pregnancy, birth and death tracking through household visits by community health workers, combined with verbal and social autopsy can identify barriers within the continuum of maternal care. Use of mHealth data collection tools sensitive enough to detect small changes in community-level mortality trends in real-time, can facilitate rapid-cycle quality improvement interventions, particularly when associated with social accountability structures of mortality reviews