Health, Education and Economic Crisis : Protecting the Poor in Indonesia

When an economic crisis hits, a primary policy concern in developing countries is how social services can be protected and, in particular, how access to health and education for the poor can be maintained. Using the Indonesian Social Safety Net (SSN) as case study, this dissertation investigates the effectiveness of targeted demand side interventions in health and education as a tool to protect access to these services for the poor in times of crisis, when policy makers are faced with severe information and time constraints. The SSN was implemented in 1998 in response to the Southeast Asian economic crisis, and included a scholarship programme targeted to children from poor households, and a health card programme entitling poor households to free public health care. Both programmes followed a partly decentralised allocation process, involving geographic and community based individual targeting. The programmes were implemented at remarkable speed. In the first six months of the SNN, approximately 22 million people lived in a households that received a health card, and 2.1 million children aged 10 to 18 had a scholarship. This dissertation addresses targeting performance and dynamic marginal benefit incidence, and the impact of the programmes on education attainment, child labour and utilisation of outpatient health care. Using Indonesia's national socioeconomic survey (Susenas), the main challenge is to obtain a reliable estimate of the counterfactual: what would have happened if the SSN programmes had not been implemented? Because of non-random programme placement and data limitations, it requires non-experimental methods to answer this question. The scholarships were effective in keeping children in school and relieved the pressure on households to draw on the labour of their children. In absence of the programme 13 percent of the recipients would have dropped out of school. In addition, it reduced child labour amongst recipients by 27 percent. The scholarship were especially effective amongst those that were most vulnerable to crisis: poor rural households that reduced investment on education of the youngest and increased labour supply of the oldest children. Nevertheless, a large part of the funds have been allocated to students who would not have dropped out of school. Furthermore, priority should have been placed with protecting primary school enrolment, where the scholarships seem most effective, and with providing support for children from the poorest households in the transition from primary to secondary schooling. The effect of the health cards was compared with the effect of a supply side impulse in the form extra budgetary support that public health care facilities received as compensation for expected increased demand due to the health cards. The health card price subsidy increased health care utilisation and led to substitution from private to subsidised public care. For the non-poor the health card only affected their choice of health care provider without increasing overall utilisation. However, the poor were not responsive to the supply impulse, while utilisation of the non-poor was mainly supply driven. This emphasises that in absence of clear incentive mechanisms for health care providers, general increases in public spending are relatively ineffective in reaching the poor.Gunning, J.W. [Promotor]Pradhan, M.P. [Copromotor

Child Labor and Trade Liberalization in Indonesia

We examine the effects of trade liberalization on child work in Indonesia. Our estimation strategy identifies geographical differences in the effects of trade policy through district level exposure to reduction in import tariff barriers. We use a balanced panel of 261 districts, based on four rounds (1993 to 2002) of the Indonesian annual national household survey (Susenas), and relate workforce participation of children aged 10-15 to geographic variation in relative tariff exposure. Our main findings show that increased exposure to trade liberalization is associated with a decrease in child work among the 10 to 15 year olds. The effects of tariff reductions are strongest for children from low skill backgrounds and in rural areas. Favorable income effects for the poor, induced by trade liberalization, are likely to be the dominating effects underlying these results

Marginal benefit incidence of public health spending: evidence from Indonesian sub-national data

We examine the marginal effects of decentralized public health spending by incorporating estimates of behavioural responses to changes in public health spending through benefit incidence analysis. The analysis is based on a panel dataset of 207 Indonesian districts over a 4-year period from 2001 to 2004. We show that district-level public health spending is largely driven by central government transfers, with an elasticity of public health spending with respect to district revenues of around 0.9. We find a positive effect of public health spending on utilization of outpatient care in the public sector for the poorest two quartiles. We find no evidence that public expenditures crowd oututilization of private services or household health spending. Our analysis suggests that increased public health spending improves targeting to the poor, as behavioural changes in public health care utilization are pro-poor. Nonetheless, most of the benefits of the additional spending accrued to existing users of services, as initial utilization shares outweigh the behavioural responses

Indonesia's Domestic Biogas Programme – Household panel survey data

The data presented in this article are related to the research paper titled, “The impact of a household biogas programme on energy use and expenditure in East Java” (A.S. Bedi, R. Sparrow, L. Tasciotti, 2017) [1]. This Data in Brief article presents two rounds of survey data conducted in 2011 and 2012 for a panel of 677 dairy farm households in the province of East Java, Indonesia. The survey relied on structured questionnaires to collect data on the production and use of biogas, the use of other non-renewable energy sources, farm characteristics, and socioeconomic and demographic characteristics of households. The panel data set in STATA format and do files are made publicly available to promote replicability and extended analyses of a sustainable energy initiative

Unemployment Assistance and Transition to Employment in Argentina

In 2001-02, Argentina experienced a wrenching economic crisis. Plan Jefes, implemented in May 2002, was Argentina's institutional response to the increases in unemployment and poverty triggered by the crisis. The program provided a social safety net and appears to have successfully protected families against indigence. Despite this success, the continued existence of the program, which provides benefits to eligible unemployed individuals for an unlimited duration, may have unappealing long-term consequences. Reliance on the plan may reduce the incentive to search for work and in the long-run may damage individual employability and perpetuate poverty. Motivated by these concerns, this paper examines the effect of participating in Plan Jefes on the probability of exiting from unemployment. Regardless of the data set, the specification, the empirical approach and the control group, the evidence assembled in this paper shows that for the period under analysis individuals enrolled in the Plan are at least 20 percentage points less likely to transit to employment as compared to individuals who are not on the Plan. The negative effect of the program tends to be larger for females and as a consequence, over time, the program becomes increasingly feminized. Prima facie, the estimates suggest that programs such as Plan Jefes need to re-consider the balance between providing a social safety net and dulling work incentives

Sickness and death

This paper investigates the economic consequences of sickness and death and the manner in which poor urban households in Bangladesh respond to such events. Based on longitudinal data we assess the effects of morbidity and mortality episodes on household income, medical spending, labour supply and consumption. We find that despite maintaining household labour supply, a serious illness exerts a n

Remittances, liquidity constraints and human capital investments in Ecuador.

Over the last decade Ecuador has experienced a strong increase in financial transfers from migrated workers. This paper investigates how remittances via trans-national networks affect human capital investments through relaxing resource constraints and facilitate households in consumption smoothing by reducing vulnerability to economic shocks. Our results show that remittances increase school enrolment and decrease incidence of child work, especially for girls and in rural areas. Furthermore, we find that aggregate shocks are associated with increased work activities, while remittances are used to finance education when households are faced with these shocks

Community-Based Health Insurance Schemes

Due to the limited ability of publicly financed health systems in developing countries to provide adequate access to health care, community-based health financing has been proposed as a viable option. This has led to the implementation of a number of Community- Based Health Insurance (CBHI) schemes, in several developing countries. To assess the ability of such schemes in meeting their stated objectives, this study systematically reviews the existing empirical evidence on three outcomes – access to schemes, effect on health care utilization and effect on financial protection. In addition to collating and summarizing the evidence we analyse the link between key scheme design characteristics and their effect on outcomes and comment on the role that may be played by study characteristics in influencing outcomes. The review shows that the ultra-poor are often excluded and at the same time there is evidence of adverse selection. The bulk of the studies find that access to CBHI is associated with increased health care utilization, especially with regard

Child malnutrition and antenatal care: Evidence from three Latin American countries

The importance of ever-earlier interventions to help children reach their physical and cognitive potential is increasingly being recognized. In part, as a result of this, in developing countries, antenatal care is becoming an important element of strategies to prevent child stunting in utero and later. Notwithstanding their policy relevance and substantial expansion, empirical evidence on the role of antenatal care (ANC) programs in combating stunting is scarce. This study analyzes the role of ANC programs in determining the level and distribution of child stunting in three Andean countries - Bolivia, Colombia, and Peru - where since the 1990s, expanding access to such care has been an explicit policy intervention to tackle child malnutrition. We find that the use of such services is associated with a reduction in the level of malnutrition and at the same time access to such services is relatively equally distributed. While this is a positive sign, it also suggests that further expansion of ANC programs is unlikely to play a large role in reducing inequalities in malnutrition

Child malnutrition and prenatal care: Evidence from three Latin American countries

Objective. To examine the effect of prenatal care (PNC) on the level and distribution of child stunting in three Andean countries-Bolivia, Colombia, and Peru-where expanding access to such care has been an explicit policy intervention to tackle child malnutrition in utero and during early childhood. Methods. An econometric analysis of cross-sectional Demographic and Health Survey (DHS) data was conducted. The analysis included ordinary least-squares (OLS) regressions, estimates of concentration curves, and decompositions of a concentration index. Results. The analysis shows that the use of PNC in Bolivia, Colombia, and Peru is only weakly associated with a reduction in the level of child malnutrition. Conclusions. Further expansion of PNC programs is unlikely to play a large role in reducing inequalities in malnutrition