Community Participation and the Quality of Rural Infrastructure in Ethiopia

Ethiopia’s Productive Safety Net Programme (PSNP) is one of the world’s largest food security programmes. The programme supports chronically food insecure rural households and at the same time promotes long-term food security through the creation of rural infrastructure. While studies on the PSNP have examined various features of the programme, there is limited knowledge on the quality and durability of infrastructure built through the programme. Ensuring and maintaining the quality of local public goods built through the PSNP and similar social protection programmes is a costly and recurring issue. Motivated by the long-term objective of the programme, this paper analyses the role played by a key design feature of the PSNP, that is, its Community-Based Participatory Watershed Development approach in influencing a project’s physical condition and its operational status. The paper is based on survey data and technical assessments provided by soil and water conservation (SWC) engineers covering a sample of 249 SWC projects located in 53 watershed communities. The survey is complemented by qualitative information gathered through interviews and discussions. The location of multiple projects, with differing levels of participation in the same watershed communities, permits estimation of the effects of community participation after controlling for community fixed effects. We find that projects in which beneficiaries play a larger role in project monitoring and evaluation are substantially less likely to be damaged and in better operational condition. These results support the idea that community participation translates into more durable infrastructure

Essays on Evaluation of Social Protection Programmes in Ethiopia

Overall, this thesis shows that at the very least, in Ethiopia, “bundling” of social protection schemes and community participation are scheme design factors that are worth considering. However, there is no reason to expect that such design elements or related variants cannot also be used in other developing countries

Community participation and the quality of rural infrastructure in Ethiopia

Ethiopia’s Productive Safety Net Program (PSNP) is one of the world’s largest food security programs. The program supports chronically food insecure rural households and at the same time promotes long-term food security through the creation of rural infrastructure. While studies on the PSNP have examined various features of the program, there is limited knowledge on the quality and durability of infrastructure built through the program. Ensuring and maintaining the quality of local public goods built through the PSNP and similar social protection programs is a costly and recurring issue. Motivated by the long-term objective of the program, this paper analyses the role played by a key design feature of the PSNP, that is, its Community Based Participatory Watershed Development approach in influencing a project’s physical condition and its operational status. The paper is based on survey data and technical assessments provided by soil and water conservation engineers covering a sample of 249 Soil and Water Conservation (SWC) projects located in 53 watershed communities. The survey is complemented by qualitative information gathered through interviews and discussions. The location of multiple projects, with differing levels of participation in the same watershed communities permits estimation of the effects of community participation after controlling for community fixed effects. We find that projects in which beneficiaries play a larger role in project monitoring and evaluation are substantially less likely to be damaged and be in better operational condition. These results support the idea that community participation translates into more durable infrastructure

Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?:Evidence from Ethiopia

Objectives: This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance (CBHI) scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms. There is growing concern about the financial sustainability of CBHI schemes in developing countries. However, few empirical studies have identified potential contributors, including ex-ante and ex-post moral hazards. Methods: We implement a household fixed-effect panel data regression model, drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia. Results: The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals. However, CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms. Particularly, on average, we estimate about 4‒6 h delay for malaria symptoms, a little above 4 h for tetanus, and 10‒11 h for tuberculosis among the insured households. Conclusions: While there is evidence that CBHI improve the utilization of outpatient or primary care services, our study suggests that insured members may wait longer before visiting health facilities. This delay could be partly due to moral hazard problems, as insured households, particularly those from rural areas, may consider the opportunity costs associated with visiting health facilities for minor symptoms. Overall, it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.</p

Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?:Evidence from Ethiopia

Objectives: This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance (CBHI) scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms. There is growing concern about the financial sustainability of CBHI schemes in developing countries. However, few empirical studies have identified potential contributors, including ex-ante and ex-post moral hazards. Methods: We implement a household fixed-effect panel data regression model, drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia. Results: The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals. However, CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms. Particularly, on average, we estimate about 4‒6 h delay for malaria symptoms, a little above 4 h for tetanus, and 10‒11 h for tuberculosis among the insured households. Conclusions: While there is evidence that CBHI improve the utilization of outpatient or primary care services, our study suggests that insured members may wait longer before visiting health facilities. This delay could be partly due to moral hazard problems, as insured households, particularly those from rural areas, may consider the opportunity costs associated with visiting health facilities for minor symptoms. Overall, it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.</p

Linking Social Protection Schemes: The Joint Effects of a Public Works and a Health Insurance Programme in Ethiopia

In developing countries and in particular in sub-Saharan Africa, social protection schemes tend to operate in silos. However, schemes targeting the same geographical areas may have synergies that have not yet been examined, and which are worth scrutinising. This paper contributes to this knowledge gap by examining the joint impacts of two social protection programmes in Ethiopia, that is, the Productive Safety Net Programme and a Community Based Health Insurance Scheme. Based on three rounds of individual level panel data and several rounds of qualitative interviews, we find that individuals covered by both programmes, as opposed to neither or only one of the two programmes, provide greater labour supply, have larger livestock holdings, and have a lower amount of outstanding loans. Furthermore, joint participation is associated with greater use of modern health care facilities as compared to participating only in the safety net programme. These results show that bundling of interventions enhances protection against multiple risks and that linking social protection schemes yields more than the sum of their individual effects

Containing the spread of COVID-19 in Ethiopia

Ethiopia has a low although rising number of confirmed COVID-19 cases. Despite these low figures, stringent measures have been implemented since mid-March. In this viewpoint we describe the prevention and preparation measures taken in Ethiopia and comment on the consequences, challenges and strengths of the measures, keeping in mind the Ethiopian context

The Effect of Ethiopia’s Community-Based Health Insurance Scheme on Revenues and Quality of Care

Ethiopia’s Community-Based Health Insurance (CBHI) scheme was established with the objectives of enhancing access to health care, reducing out-of-pocket expenditure (OOP), mobilizing financial resources and enhancing the quality of health care. Previous analyses have shown that the scheme has enhanced health care access and led to reductions in OOP. This paper examines the impact of the scheme on health facility revenues and quality of care. This paper relies on a difference-in-differences approach applied to both panel and cross-section data. We find that CBHI-affiliated facilities experience a 111% increase in annual outpatient visits and annual revenues increase by 47%. Increased revenues are used to ameliorate drug shortages. These increases have translated into enhanced patient satisfaction. Patient satisfaction increased by 11 percentage points. Despite the increase in patient volume, there is no discernible increase in waiting time to see medical professionals. These results and the relatively high levels of CBHI enrollment suggest that the Ethiopian CBHI has been able to successfully negotiate the main stumbling block—that is, the poor quality of care—which has plagued similar CBHI schemes in Sub-Saharan Afric

International Collaboration in Times of Pandemics: An Urgent Need for Reforming our Global Financial System

Better, swifter and more responsive international coordination is needed within our global financial system for the containment of the pandemic and its effects. This requires better international tax coordination with a higher global minimum corporate tax, comprehensive coverage of sectors and firms, inclusion of all current tax havens and more generous redistribution of excess profits to developing nations based on user location. There also needs to be a more substantial and easier-to-access mechanism for debt relief and restructuring, one that generously suspends debt payments in periods of crises and provides financial support without strict and painful conditionalities