We use data from seven low and middle income countries with diverse drug procurement systems to assess the effect of centralized procurement on drug prices and provide a theoretical mechanism that explains this effect. We find that centralized procurement of drugs by the public sector allows much lower prices but that the induced price reduction is smaller when the supply side is more concentrated.
This paper focuses on the role that price transparency may play in the efficient and effective procurement of medicines by middle- and low-income countries. Will making prices publicly available make procurement more efficient and cost-effective medicines more accessible? We conclude that transparency of the procurement process significantly lowers costs by encouraging bidders.
Midline Effects of a Randomized Controlled Trial to Increase the Utilization of Financial Services by Women Business Owners in Rural Indonesia - Working Paper 506
This is the report of a midline evaluation of a randomized controlled trial to increase the utilization of saving and other financial services by women business owners in Indonesia.
The Limits (And Human Costs) of Population Policy: Fertility Decline and Sex Selection in China under Mao - Working Paper 505
Most of China’s fertility decline predates the famous One Child Policy—and instead occurred under its predecessor, the Later, Longer, Fewer (LLF) policy. Studying LLF’s contribution to fertility and sex selection behavior, we find that it i) reduced China’s total fertility rate by 0.9 births per woman (explaining 28% of China’s modern fertility decline), ii) doubled the use of male-biased fertility stopping rules, and iii) promoted postnatal neglect (implying 210,000 previously unrecognized missing girls). Considering Chinese population policy to be extreme in global experience, our paper demonstrates the limits of population policy—and its potential human costs.
Learning Equity Requires More than Equality: Learning Goals and Achievement Gaps between the Rich and the Poor in Five Developing Countries - Working Paper 504
Achieving some absolute standard of learning for all children is a key element of global equity in education. Using the Annual Status of Education Report (ASER) data from India and Pakistan, and Uwezo data from Kenya, Tanzania, and Uganda that test all children of given ages, whether in school or not, on simple measures of learning in math, reading (local language), and English, we quantify the role of achieving equality between the richest 20% and the poorest 40% in terms of grade attainment and learning achievement toward accomplishing the global equity goal of universal numeracy and literacy for all children.
Can institutionalized transfers of resource rents be a source of civil conflict? Are cohesive institutions better at managing conflicts over distribution? We exploit exogenous variation in revenue disbursements to local governments and use new data on local democratic institutions in Nigeria to answer these questions.
Enhancing Young Children’s Language Acquisition through Parent-Child Book-Sharing: A Randomized Trial in Rural Kenya - Working Paper 502
Worldwide, 250 million children under five (43 percent) are not meeting their developmental potential because they lack adequate nutrition and cognitive stimulation in early childhood. Several parent support programs have shown significant benefits for children’s development, but the programs are often expensive and resource intensive. The objective of this study was to test several variants of a potentially scalable, cost-effective intervention to increase cognitive stimulation by parents and improve emergent literacy skills in children.
Measuring the Spatial Misallocation of Labor: The Returns to India-Gulf Guest Work in a Natural Experiment - Working Paper 501
‘Guest workers’ earn higher wages overseas on temporary low-skill employment visas. This wage gap can be used to measure gaps in the productivity of workers due to where they are, not who they are. This paper estimates the effects of guest work on Indian applicants to a construction job in the United Arab Emirates, where an economic crisis allocated guest work opportunities as-good-as-randomly among several thousand families. Guest work raised the return to poor families' labor by a factor of four, with little evidence of systematic fraud.
Gender languages assign many—sometimes all—nouns to distinct sex-based categories, masculine and feminine. We construct a new data set, documenting this property for more than four thousand languages which together account for more than 99 percent of the world’s population.
Who are the world’s poor? This paper presents a new global profile of multidimensional poverty using three specifications of multidimensional poverty.
The Dilemma of the African Development Bank: Does Governance Matter for the Long-Run Financing of the MDBs? - Working Paper 498
Does governance matter for the long-run financing and effectiveness the multilateral development banks? Does their system of weighted voting matter for their long-run access to financing and their effectiveness as development institutions? Does the voting structure involve some tradeoff between the confidence of creditor countries in the different MDBs, and the sense of ownership, legitimacy, and trust of borrowers?
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.
There are over 25 million refugees in the world today and most of them—especially those in developing countries—do not have formal labor market access (LMA). Granting refugees formal LMA has the potential to create substantial benefits for refugees and their hosts.
DFIs are frequently asked to demonstrate their additionality—meaning that they make investments that the private sector would not—but what evidence of additionality would look like is rarely articulated. This paper examines potential quantitative and qualitative evidence.
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.
How Do African Firms Respond to Unreliable Power? Exploring Firm Heterogeneity Using K-Means Clustering - Working Paper 493
While previous studies have found a positive relationship between the reliability of power and firm growth, we find that such a clear relationship seems not to prevail. In other words, some firms are able to cope with an unreliable supply of power while many others do not.
The rising popularity of randomized controlled trials (RCTs) in development applications has come with continuing debates on the pros and cons of this approach. The paper revisits the issues.
If You Build It, Will They Consume? Key Challenges for Universal, Reliable, and Low-Cost Electricity Delivery in Kenya - Working Paper 491
Kenya’s rapid electrification in the past decade has improved the lives of millions, but significant challenges remain. This paper provides analysis that shows electrification can be improved by considering cheaper options that still meet the needs of low consumers and that low consumption is a first-order problem for the sustainability of utilities.