The Medium-Run and Scale-Up Effects of Performance-Based Financing: An Extension of Rwanda’s 2006 Trial Using Secondary Data - Working Paper 497
Rwanda’s performance-based incentives were effective for some indicators, but unconditional financing also induced improvements. The incentive effects persisted in the mediumrun and as the program was scaled-up.
The Impact of Civil Conflict on Child Malnutrition and Mortality, Nigeria, 2002-2013 - Working Paper 494
In this paper, we show a strong association between living close to a conflict zone and acute malnutrition in Nigerian children in 2013. This is related to the severity of the conflict, measured both in terms of the number of conflict deaths and the length of time the child was exposed to conflict.
In recent years, many global health institutions have adopted eligibility and transition frameworks for the countries they support, generating questions about how these frameworks apply in practice—and whether global health progress will be put at risk through premature or poorly planned transition processes.
Using Supervised Learning to Select Audit Targets in Performance-Based Financing in Health: An Example from Zambia - Working Paper 481
We examine alternative strategies for targeted sampling of health clinics for independent verification. Our results indicate that machine learning methods, particularly Random Forest, outperform other approaches and can increase the cost-effectiveness of verification activities.
Does Deforestation Increase Malaria Prevalence? Evidence from Satellite Data and Health Surveys - Working Paper 480
In this paper we combine fourteen years of high-resolution satellite data on forest loss with individual-level survey data on malaria in more than 60,000 rural children in 17 countries in Africa, and fever in more than 470,000 rural children in 41 countries in Latin America, Africa, and Asia. We did not find that deforestation increases malaria prevalence nor that intermediate levels of forest cover have higher malaria prevalence.
The Sustainable Development Goals are an ambitious set of targets for global development progress by 2030 that were agreed by the United Nations in 2015. A review of the literature on meeting "zero targets" suggests very high costs compared to available resources, but also that in many cases there remains a considerable gap between financing known technical solutions and achieving the outcomes called for in the SDGs. In some cases, we (even) lack the technical solutions required to achieve the zero targets, suggesting the need for research and development of new approaches.
Family Planning and Fertility Behavior: Evidence from Twentieth Century Malaysia - Working Paper 470
There is longstanding debate about the contribution of family planning programs to fertility decline. Studying the staggered introduction of family planning across Malaysia during the 1960s and 1970s, we find modest responses in fertility behavior. Overall, Malaysia’s total fertility rate declined by about one quarter birth under family planning, explaining only about 10 percent of the national fertility decline between 1960 and 1988. Our findings are consistent with growing evidence that global fertility decline is predominantly due to underlying changes in the demand for children.
Family Planning and Women’s Economic Empowerment: Incentive Effects and Direct Effects among Malaysian Women - Working Paper 471
Although family planning programs can improve women’s welfare directly through changes in realized fertility, they may also have important incentive effects by increasing parents’ investments in girls not yet fertile. We study these potential incentive effects, finding that family planning may have raised raise girls’ educational attainment substantially. We also find that these early investments are linked to gains in women’s paid labor at prime working ages and to greater support for women’s elderly parents (a marker for women’s bargaining power within the household). Notably, these incentive effects may be larger than the direct effects of family planning alone.
We analyzed a large-scale municipal water disinfection program in Mexico in 1991 that rapidly increased access to chlorinated water. Our results suggest that childhood diarrheal disease mortality in Mexico would have declined by 86 percent if all municipalities had good quality infrastructure—a decline consistent with historical experience.
Different Strokes for Different Folks: Experimental Evidence on the Effectiveness of Input and Output Incentive Contracts for Health Care Providers with Different Levels of Skills - Working Paper 464
A central issue in designing performance incentive contracts is whether to reward the production of outputs versus use of inputs: the former rewards efficiency and innovation in production, while the latter imposes less risk on agents.
Evaluating Evaluations: Assessing the Quality of Aid Agency Evaluations in Global Health - Working Paper 461
We assessed the methodological quality of global health program evaluations from five major funders between 2009 and 2014. We found that most evaluations did not meet social science methodological standards in terms of relevance, validity, and reliability. Nevertheless, good quality evaluations made it possible to identify ten recommendations for improving evaluations, including a robust finding that early planning is associated with better quality.
In this paper, I examine the effects of power sharing on vulnerability to adverse shocks in a multiethnic setting.
Estimating the Avertable Disease Burden and Cost-Effectiveness in Millions Saved Third Edition - Working Paper 429
Millions Saved (2016) is a new edition of detailed case studies on the attributable impact of global health programs at scale. As an input to the book, this paper provides an independent assessment of the cost-effectiveness of a selection of the cases using ex post information from impact evaluations, with the objective of illustrating how economic evaluation can be used in decision making and to provide further evidence on the extent of health gains produced for the funding provided.
There is longstanding debate in population policy about the relationship between modern contraception and abortion. Although theory predicts that they should be substitutes, the existing body of empirical evidence is difficult to interpret. In this paper, we study Nepal’s 2004 legalization of abortion provision and subsequent expansion of abortion services.
This paper uses contract theory to suggest simple contract designs that could be used by the Global Fund. Using a basic model of procurement, we lay out five alternative options and consider when each is likely to be most appropriate. We ultimately provide a synthesis to guide policy makers as to when and how 'results-based' incentive contracts can be used in practice.
Global Health Donors Viewed as Regulators of Monopolistic Service Providers: Lessons from Regulatory Literature - Working Paper 424
Controlling healthcare costs while promoting maximum health impact in the recipient countries is one the biggest challenges for global health donors. This paper views global health donors as the regulators of monopolistic service providers, and explores potential optimal fund payment systems under asymmetric information. It provides a summary and assessment of optimal price regulation designs for monopolistic service providers.
This paper reviews empirical evidence on the micro-level consequences of family planning programs in middle- and low-income countries. In doing so, it focuses on fertility outcomes (the number and timing of births), women’s health and socio-economic outcomes, and children’s health and socio-economic outcomes throughout the life cycle. In practice, family planning programs may only explain a modest share of fertility decline in real-world settings, and may also have quantitatively modest - but practically meaningful - effects on the socio-economic welfare of individuals and families.