The One Million Initiative aims to give one million people in rural Mozambique access to clean dr... more The One Million Initiative aims to give one million people in rural Mozambique access to clean drinking water and adequate sanitation by constructing new water points and providing sanitation training. We use panel survey data for 1600 households to analyze the health impact of the Initiative. The paper moves beyond a black box evaluation by analyzing the contribution of various channels through which the interventions affected health. To our knowledge this is the first rigorous evaluation of such a large scale program in the water and sanitation sector. We find that the water point intervention had a sizeable impact on the use of improved water sources and on the health of young children (up to 3 years), while the sanitation training had a strong impact on latrine ownership and on the health of both adults and older children. We are grateful to the UNICEF staff in Maputo, Rita Tesselaar of the Netherlands Ministry of Foreign Affairs and Menno Pradhan for very helpful comments on earlier drafts. Data collection was financed by the Evaluation Department (IOB) of he Netherlands Ministry of Foreign Affairs in the context of an evaluation study described in detail in UNICEF and IOB (2011).
Additional file 2. Results of the model comparison using the Akaike Information Criterion (AIC), ... more Additional file 2. Results of the model comparison using the Akaike Information Criterion (AIC), the Bayesian Information Criterion (BIC) and the Vuong's closeness test, and the stratified analysis on the rural and urban sample. Table S1. The AIC, BIC and results of Vuong test of different regression models for each outcome variable Table S2. Regression analysis of factors associated with self-reported emergent illness using NB model: rural vs urban. Table S3. Regression analysis of factors associated with the total times of conducting self-treatment using NB model: rural vs urban. Table S4. Regression analysis of factors associated with outpatient service use using NB model: urban vs. rural. Table S5. Regression analysis of factors associated with inpatient service use using logit model: urban vs. rural. Table S6. Regression analysis of factors associated with OOP health expenditure using a two-part model combining logit regression and GLM: urban vs. rural. Table S7. Logit regr...
Background In response to the high financial burden of health services facing tuberculosis (TB) p... more Background In response to the high financial burden of health services facing tuberculosis (TB) patients in China, the China-Gates TB project, Phase II, has implemented a new financing and payment model as an important component of the overall project in three cities in eastern, central and western China. The model focuses on increasing the reimbursement rate for TB patients and reforming provider payment methods by replacing fee-for-service with a case-based payment approach. This study investigated changes in out-of-pocket (OOP) health expenditure and the financial burden on TB patients before and after the interventions, with a focus on potential differential impacts on patients from different income groups. Methods Three sample counties in each of the three prefectures: Zhenjiang, Yichang and Hanzhong were chosen as study sites. TB patients who started and completed treatment before, and during the intervention period, were randomly sampled and surveyed at the baseline in 2013 a...
wish to thank Jishnu Das, Elisabeth Sadoulet and Alain de Janvry for valuable input, and Françoi... more wish to thank Jishnu Das, Elisabeth Sadoulet and Alain de Janvry for valuable input, and François Bourguignon and Martin Ravallion for stimulating our interest in the questions pursued here. Finally, the paper has benefited from the comments of two anonymous referees.
Madagascar, we simulate the impact on poverty of transferring an exogenously given budget to geog... more Madagascar, we simulate the impact on poverty of transferring an exogenously given budget to geographically defined sub-groups of the population according to their relative poverty status. We find large gains from targeting smaller administrative units, such as districts or villages. However, these gains are still far from the poverty reduction that would be possible had the planners had access to information on household level income or consumption. Our results suggest that a useful way forward might be to combine fine geographic targeting using a poverty map with within-community targeting mechanisms.
Assessing the scope for insurance in rural communities usually requires a structural model of hou... more Assessing the scope for insurance in rural communities usually requires a structural model of household behavior under risk. One of the few empirical applications of such models is the study by Rosenzweig and Wolpin (1993) who conclude that Indian farmers in the ICRISAT villages would not benefit from the introduction of formal weather insurance. In this paper we investigate how models such as theirs can be estimated from panel data on production and assets. We show that if assets can take only a limited number of values the coefficients of the model cannot be estimated with reasonable precision. We also show that this can affect the conclusion that insurance would not be welfare improving. 2 1
Poverty and vulnerability measures provide a basis for the targeting of policy interventions. In ... more Poverty and vulnerability measures provide a basis for the targeting of policy interventions. In applied work typically static versions of these measures are used so that the effect of asset changes on welfare is ignored. Unless the policymaker's concern with household welfare is myopic, policy design requires welfare measures that incorporate the dynamics of asset accumulation. We use a simple microeconomic growth model to show that the use of a static or dynamic welfare measure affects the choice between three types of interventions (transfers, productivity enhancements and reductions in risk). We also show (using data for rural households in Zimbabwe) that the composition of the group of low-welfare households may change dramatically over time. For both reasons static poverty (or vulnerability) measures may be a poor basis for policy. Using the Zimbabwe example we show that when it is not feasible to estimate a structural dynamic model then the accuracy of existing regression-based vulnerability measures can be greatly improved by including asset measures in the regression.
this paper are our own and should not be taken to reflect those of the World Bank or any of its a... more this paper are our own and should not be taken to reflect those of the World Bank or any of its affiliates. All errors are our own
The authors construct and derive the properties of Using data from Ecuador, the authors obtain es... more The authors construct and derive the properties of Using data from Ecuador, the authors obtain estimates estimators of welfare that take advantage of the detailed of welfare measures, some of which are quite reliable for information about living standards available in small populations as small as 15,000 households-a "town." household surveys and the comprehensive coverage of a They provide simple illustrations of their use. Such census or large sample. By combining the strengths of estimates open up the possibility of testing, at a more each, the estimators can be used at a remarkably convincing intra-country level, the many recent models disaggregated level. They have a clear interpretation, are relating welfare distributions to growth and a variety of mutually comparable, and can be assessed for reliability socioeconomic and political outcomes. using standard statistical theory. This paper-a product of the Poverty Team, Development Research Group-is part of a larger effort in the group to develop tools for the analysis of poverty and income distribution. Copies of the paper are available free from the World Bank,
Increasingly both donor agencies and recipient governments want to assess the effectiveness of ai... more Increasingly both donor agencies and recipient governments want to assess the effectiveness of aid. Unfortunately, existing methods for impact evaluation are designed for the evaluation of homogeneous interventions (‘projects’) where those with and without ‘treatment ’ can be compared. However, when assessing the effectiveness of sector aid or general budget support one is concerned about the impact of numerous heterogeneous interventions; there is then no obvious control group. The lack of a credible methodology for such high level evaluations is a serious constraint in the debate on aid effectiveness. We propose a method of statistical impact evaluation in situations with heterogeneous interventions, an extension of the double differencing method often used in project evaluations. We illustrate its feasibility with an example for the education sector in Zambia. 2
10BUZ281478|E Support to water supply and sanitary facilities has been a priority for Netherlands... more 10BUZ281478|E Support to water supply and sanitary facilities has been a priority for Netherlands development cooperation for many years. The purpose of support goes beyond sustainable access to improved facilities: it is intended to reduce the burden of water collection, improve health, raise school enrolment; improve livelihoods and ultimately reduce poverty. IOB is undertaking a series of impact studies in five countries to measure the effects of supported programmes, using a combination of quantitative and qualitative methods and techniques. Dutch support provided to the drinkwater supply and sanitation programme in Fayoum Governorate, Arab Republic of Egypt started in 1990. The impact evaluation report is the third report published in the series. Preface Support to water supply and sanitary facilities has been a priority for the Netherlands' development cooperation for many years. Current policy on development cooperation is guided by the Millennium Development Goals. The M...
Kenya, over the years, has attempted to introduce measures to improve access to health care servi... more Kenya, over the years, has attempted to introduce measures to improve access to health care services especially by the poor and vulnerable including women and children and therefore cushion them from the unintended consequences of having to pay for health care as point of consumption. In 2007, for instance, the government of Kenya reduced user fees at the lower level facilities - health centres and dispensaries – to a maximum of Kenya Shillings (KES) 10 and KES 20 respectively to cover for registration. Under this policy – commonly referred to as the 10/20 policy – children aged below five years and specific health conditions such as Malaria and Tuberculosis were exempted from payment. All fees for deliveries in public health facilities were also abolished in July 2007 to further increase access to maternal health care services. Even though user fees were low, there was widespread evidence to show that such fees encouraged self-treatment and in some cases acted as barrier to timely ...
How exposure to risk affects economic growth is a key issue in development. This article quantifi... more How exposure to risk affects economic growth is a key issue in development. This article quantifies both the ex ante and ex post effects of risk using long-running panel data for rural households in Zimbabwe. It proposes a simulation-based econometric methodology to estimate the structural form of a micro model of household investment decisions under risk. The key finding is that risk substantially reduces growth in this particular setting: the mean capital stock in the sample is (in expectation) 46 percent lower than in the absence of risk. About two-thirds of the impact of risk is due to the ex ante effect (that is, the behavioral response to risk), which is usually not taken into account in policy design. These results suggest that policy interventions that reduce exposure to shocks or that help households manage risk could be much more effective than is commonly thought.
In practice, social and development interventions are often targeted at groups or individuals wit... more In practice, social and development interventions are often targeted at groups or individuals with the largest expected benefits. In such cases, treatment effects are usually affected by selection on unobservable factors. We show that modeling the process of selective intervention placement allows us to correct for this and identify the Average Treatment Effect using observational panel data. We illustrate the estimation method using simulated data, as well as, data on a large-scale sanitation intervention in Mozambique. Our results provide a useful tool for the assessment of targeted policy interventions, and inform decisions on their continuation or replication.
Typescript prepared by Anna-Mari Vesterinen at UNU-WIDER. UNU-WIDER gratefully acknowledges the f... more Typescript prepared by Anna-Mari Vesterinen at UNU-WIDER. UNU-WIDER gratefully acknowledges the financial contributions to the research programme from the governments of Denmark, Finland, Sweden, and the United Kingdom. The World Institute for Development Economics Research (WIDER) was established by the United Nations University (UNU) as its first research and training centre and started work in Helsinki, Finland in 1985. The Institute undertakes applied research and policy analysis on structural changes affecting the developing and transitional economies, provides a forum for the advocacy of policies leading to robust, equitable and environmentally sustainable growth, and promotes capacity strengthening and training in the field of economic and social policy-making. Work is carried out by staff researchers and visiting scholars in Helsinki and through networks of collaborating scholars and institutions around the world.
International Journal of Environmental Research and Public Health
Many European countries have implemented pension reforms to increase the statutory retirement age... more Many European countries have implemented pension reforms to increase the statutory retirement age with the aim of increasing labor supply. However, not all older workers may be able or want to work to a very high age. Using a nation-wide register data of labor market transitions, we investigated in this natural experiment the effect of an unexpected change in the Dutch pension system on labor market behaviors of older workers. Specifically, we analyzed transitions in labor market positions over a 5-year period in two nation-wide Dutch cohorts of employees aged 60 years until they reached the retirement age (n = 23,703). We compared transitions between the group that was still entitled to receive early retirement benefits to a group that was no longer entitled to receive early retirement benefits. Results showed that the pension reform was effective in prolonging work participation until the statutory retirement age (82% vs. 61% at age 64), but also to a larger proportion of unemploy...
Background: Although public medical insurance covers over 95% of the population in China, dispari... more Background: Although public medical insurance covers over 95% of the population in China, disparities in health service use and out-of-pocket (OOP) health expenditure across income groups are still widely observed. This study aims to investigate the socio-economic disparities in perceived health care needs, informal care, formal care and payment for health care and explore their equity implication. Methods: We assessed healthcare needs, service use and payment in 400 households in rural and urban areas in Jiangsu, China, and included only the adult sample (N=925). One baseline survey and 10 follow-up surveys were conducted during the 7-month monitoring period, and the Affordability Ladder Program (ALP) framework was adopted for data analysis. Negative binomial/zero-inflated negative binomial and logit regression models were used to explore factors associated with perceived care needs and with the use of three types of health service (self-treatment, outpatient and inpatient care). T...
ne important strand of research in the area of political economy and public policy has focused on... more ne important strand of research in the area of political economy and public policy has focused on the appropriate level of governmental decentralization for financial and decisionmaking power regarding public service provisioning and financing. The advantage of decentralization-making use of better community-level information about priorities and the characteristics of residents-may be offset by a greater likelihood that the local governing body is controlled by "elites" to the detriment of weaker community members. The Need to Determine Local-Level Inequality While the level and heterogeneity of local inequality are determinants of the relative likelihood of capture at different levels of government, most theoretical predictions are ambiguous, and there is a need for empirical research into the causes of political capture. In addition to questions of political capture, decentralization also has the potential weakness that community-level decisions may be less likely to reflect social and economic costs and benefits across larger spatial scales. Detailed information on local-level inequality has traditionally been available only from case studies that focus on one or two specific localities. Construction of comprehensive "geographic profiles" of inequality across localities has been held back by limitations of conventional distributional data. This paper takes three developing countries-Ecuador, Madagascar, and Mozambique-and implements in each a recently developed methodology to produce disaggregated estimates of inequality. The countries are very unlike each other-with different geographies, stages of development, quality and types of data, and so on. The methodology works well in all three settings and produces valuable information about the spatial distribution of poverty and inequality within those countriesinformation that was previously not available.
We thank Ravi Kanbur, Tony Venables and other participants at the WIDER project meeting on Spatia... more We thank Ravi Kanbur, Tony Venables and other participants at the WIDER project meeting on Spatial Inequality in Development, May 2003, for comments on an earlier draft of this paper. Also we wish to thank Jishnu Das, Elisabeth Sadoulet and Alain de Janvry for valuable input, and François Bourguignon and Martin Ravallion for stimulating our interest in the questions pursued here. Finally, the paper has benefited from the comments of two anonymous referees.
The One Million Initiative aims to give one million people in rural Mozambique access to clean dr... more The One Million Initiative aims to give one million people in rural Mozambique access to clean drinking water and adequate sanitation by constructing new water points and providing sanitation training. We use panel survey data for 1600 households to analyze the health impact of the Initiative. The paper moves beyond a black box evaluation by analyzing the contribution of various channels through which the interventions affected health. To our knowledge this is the first rigorous evaluation of such a large scale program in the water and sanitation sector. We find that the water point intervention had a sizeable impact on the use of improved water sources and on the health of young children (up to 3 years), while the sanitation training had a strong impact on latrine ownership and on the health of both adults and older children. We are grateful to the UNICEF staff in Maputo, Rita Tesselaar of the Netherlands Ministry of Foreign Affairs and Menno Pradhan for very helpful comments on earlier drafts. Data collection was financed by the Evaluation Department (IOB) of he Netherlands Ministry of Foreign Affairs in the context of an evaluation study described in detail in UNICEF and IOB (2011).
Additional file 2. Results of the model comparison using the Akaike Information Criterion (AIC), ... more Additional file 2. Results of the model comparison using the Akaike Information Criterion (AIC), the Bayesian Information Criterion (BIC) and the Vuong's closeness test, and the stratified analysis on the rural and urban sample. Table S1. The AIC, BIC and results of Vuong test of different regression models for each outcome variable Table S2. Regression analysis of factors associated with self-reported emergent illness using NB model: rural vs urban. Table S3. Regression analysis of factors associated with the total times of conducting self-treatment using NB model: rural vs urban. Table S4. Regression analysis of factors associated with outpatient service use using NB model: urban vs. rural. Table S5. Regression analysis of factors associated with inpatient service use using logit model: urban vs. rural. Table S6. Regression analysis of factors associated with OOP health expenditure using a two-part model combining logit regression and GLM: urban vs. rural. Table S7. Logit regr...
Background In response to the high financial burden of health services facing tuberculosis (TB) p... more Background In response to the high financial burden of health services facing tuberculosis (TB) patients in China, the China-Gates TB project, Phase II, has implemented a new financing and payment model as an important component of the overall project in three cities in eastern, central and western China. The model focuses on increasing the reimbursement rate for TB patients and reforming provider payment methods by replacing fee-for-service with a case-based payment approach. This study investigated changes in out-of-pocket (OOP) health expenditure and the financial burden on TB patients before and after the interventions, with a focus on potential differential impacts on patients from different income groups. Methods Three sample counties in each of the three prefectures: Zhenjiang, Yichang and Hanzhong were chosen as study sites. TB patients who started and completed treatment before, and during the intervention period, were randomly sampled and surveyed at the baseline in 2013 a...
wish to thank Jishnu Das, Elisabeth Sadoulet and Alain de Janvry for valuable input, and Françoi... more wish to thank Jishnu Das, Elisabeth Sadoulet and Alain de Janvry for valuable input, and François Bourguignon and Martin Ravallion for stimulating our interest in the questions pursued here. Finally, the paper has benefited from the comments of two anonymous referees.
Madagascar, we simulate the impact on poverty of transferring an exogenously given budget to geog... more Madagascar, we simulate the impact on poverty of transferring an exogenously given budget to geographically defined sub-groups of the population according to their relative poverty status. We find large gains from targeting smaller administrative units, such as districts or villages. However, these gains are still far from the poverty reduction that would be possible had the planners had access to information on household level income or consumption. Our results suggest that a useful way forward might be to combine fine geographic targeting using a poverty map with within-community targeting mechanisms.
Assessing the scope for insurance in rural communities usually requires a structural model of hou... more Assessing the scope for insurance in rural communities usually requires a structural model of household behavior under risk. One of the few empirical applications of such models is the study by Rosenzweig and Wolpin (1993) who conclude that Indian farmers in the ICRISAT villages would not benefit from the introduction of formal weather insurance. In this paper we investigate how models such as theirs can be estimated from panel data on production and assets. We show that if assets can take only a limited number of values the coefficients of the model cannot be estimated with reasonable precision. We also show that this can affect the conclusion that insurance would not be welfare improving. 2 1
Poverty and vulnerability measures provide a basis for the targeting of policy interventions. In ... more Poverty and vulnerability measures provide a basis for the targeting of policy interventions. In applied work typically static versions of these measures are used so that the effect of asset changes on welfare is ignored. Unless the policymaker's concern with household welfare is myopic, policy design requires welfare measures that incorporate the dynamics of asset accumulation. We use a simple microeconomic growth model to show that the use of a static or dynamic welfare measure affects the choice between three types of interventions (transfers, productivity enhancements and reductions in risk). We also show (using data for rural households in Zimbabwe) that the composition of the group of low-welfare households may change dramatically over time. For both reasons static poverty (or vulnerability) measures may be a poor basis for policy. Using the Zimbabwe example we show that when it is not feasible to estimate a structural dynamic model then the accuracy of existing regression-based vulnerability measures can be greatly improved by including asset measures in the regression.
this paper are our own and should not be taken to reflect those of the World Bank or any of its a... more this paper are our own and should not be taken to reflect those of the World Bank or any of its affiliates. All errors are our own
The authors construct and derive the properties of Using data from Ecuador, the authors obtain es... more The authors construct and derive the properties of Using data from Ecuador, the authors obtain estimates estimators of welfare that take advantage of the detailed of welfare measures, some of which are quite reliable for information about living standards available in small populations as small as 15,000 households-a "town." household surveys and the comprehensive coverage of a They provide simple illustrations of their use. Such census or large sample. By combining the strengths of estimates open up the possibility of testing, at a more each, the estimators can be used at a remarkably convincing intra-country level, the many recent models disaggregated level. They have a clear interpretation, are relating welfare distributions to growth and a variety of mutually comparable, and can be assessed for reliability socioeconomic and political outcomes. using standard statistical theory. This paper-a product of the Poverty Team, Development Research Group-is part of a larger effort in the group to develop tools for the analysis of poverty and income distribution. Copies of the paper are available free from the World Bank,
Increasingly both donor agencies and recipient governments want to assess the effectiveness of ai... more Increasingly both donor agencies and recipient governments want to assess the effectiveness of aid. Unfortunately, existing methods for impact evaluation are designed for the evaluation of homogeneous interventions (‘projects’) where those with and without ‘treatment ’ can be compared. However, when assessing the effectiveness of sector aid or general budget support one is concerned about the impact of numerous heterogeneous interventions; there is then no obvious control group. The lack of a credible methodology for such high level evaluations is a serious constraint in the debate on aid effectiveness. We propose a method of statistical impact evaluation in situations with heterogeneous interventions, an extension of the double differencing method often used in project evaluations. We illustrate its feasibility with an example for the education sector in Zambia. 2
10BUZ281478|E Support to water supply and sanitary facilities has been a priority for Netherlands... more 10BUZ281478|E Support to water supply and sanitary facilities has been a priority for Netherlands development cooperation for many years. The purpose of support goes beyond sustainable access to improved facilities: it is intended to reduce the burden of water collection, improve health, raise school enrolment; improve livelihoods and ultimately reduce poverty. IOB is undertaking a series of impact studies in five countries to measure the effects of supported programmes, using a combination of quantitative and qualitative methods and techniques. Dutch support provided to the drinkwater supply and sanitation programme in Fayoum Governorate, Arab Republic of Egypt started in 1990. The impact evaluation report is the third report published in the series. Preface Support to water supply and sanitary facilities has been a priority for the Netherlands' development cooperation for many years. Current policy on development cooperation is guided by the Millennium Development Goals. The M...
Kenya, over the years, has attempted to introduce measures to improve access to health care servi... more Kenya, over the years, has attempted to introduce measures to improve access to health care services especially by the poor and vulnerable including women and children and therefore cushion them from the unintended consequences of having to pay for health care as point of consumption. In 2007, for instance, the government of Kenya reduced user fees at the lower level facilities - health centres and dispensaries – to a maximum of Kenya Shillings (KES) 10 and KES 20 respectively to cover for registration. Under this policy – commonly referred to as the 10/20 policy – children aged below five years and specific health conditions such as Malaria and Tuberculosis were exempted from payment. All fees for deliveries in public health facilities were also abolished in July 2007 to further increase access to maternal health care services. Even though user fees were low, there was widespread evidence to show that such fees encouraged self-treatment and in some cases acted as barrier to timely ...
How exposure to risk affects economic growth is a key issue in development. This article quantifi... more How exposure to risk affects economic growth is a key issue in development. This article quantifies both the ex ante and ex post effects of risk using long-running panel data for rural households in Zimbabwe. It proposes a simulation-based econometric methodology to estimate the structural form of a micro model of household investment decisions under risk. The key finding is that risk substantially reduces growth in this particular setting: the mean capital stock in the sample is (in expectation) 46 percent lower than in the absence of risk. About two-thirds of the impact of risk is due to the ex ante effect (that is, the behavioral response to risk), which is usually not taken into account in policy design. These results suggest that policy interventions that reduce exposure to shocks or that help households manage risk could be much more effective than is commonly thought.
In practice, social and development interventions are often targeted at groups or individuals wit... more In practice, social and development interventions are often targeted at groups or individuals with the largest expected benefits. In such cases, treatment effects are usually affected by selection on unobservable factors. We show that modeling the process of selective intervention placement allows us to correct for this and identify the Average Treatment Effect using observational panel data. We illustrate the estimation method using simulated data, as well as, data on a large-scale sanitation intervention in Mozambique. Our results provide a useful tool for the assessment of targeted policy interventions, and inform decisions on their continuation or replication.
Typescript prepared by Anna-Mari Vesterinen at UNU-WIDER. UNU-WIDER gratefully acknowledges the f... more Typescript prepared by Anna-Mari Vesterinen at UNU-WIDER. UNU-WIDER gratefully acknowledges the financial contributions to the research programme from the governments of Denmark, Finland, Sweden, and the United Kingdom. The World Institute for Development Economics Research (WIDER) was established by the United Nations University (UNU) as its first research and training centre and started work in Helsinki, Finland in 1985. The Institute undertakes applied research and policy analysis on structural changes affecting the developing and transitional economies, provides a forum for the advocacy of policies leading to robust, equitable and environmentally sustainable growth, and promotes capacity strengthening and training in the field of economic and social policy-making. Work is carried out by staff researchers and visiting scholars in Helsinki and through networks of collaborating scholars and institutions around the world.
International Journal of Environmental Research and Public Health
Many European countries have implemented pension reforms to increase the statutory retirement age... more Many European countries have implemented pension reforms to increase the statutory retirement age with the aim of increasing labor supply. However, not all older workers may be able or want to work to a very high age. Using a nation-wide register data of labor market transitions, we investigated in this natural experiment the effect of an unexpected change in the Dutch pension system on labor market behaviors of older workers. Specifically, we analyzed transitions in labor market positions over a 5-year period in two nation-wide Dutch cohorts of employees aged 60 years until they reached the retirement age (n = 23,703). We compared transitions between the group that was still entitled to receive early retirement benefits to a group that was no longer entitled to receive early retirement benefits. Results showed that the pension reform was effective in prolonging work participation until the statutory retirement age (82% vs. 61% at age 64), but also to a larger proportion of unemploy...
Background: Although public medical insurance covers over 95% of the population in China, dispari... more Background: Although public medical insurance covers over 95% of the population in China, disparities in health service use and out-of-pocket (OOP) health expenditure across income groups are still widely observed. This study aims to investigate the socio-economic disparities in perceived health care needs, informal care, formal care and payment for health care and explore their equity implication. Methods: We assessed healthcare needs, service use and payment in 400 households in rural and urban areas in Jiangsu, China, and included only the adult sample (N=925). One baseline survey and 10 follow-up surveys were conducted during the 7-month monitoring period, and the Affordability Ladder Program (ALP) framework was adopted for data analysis. Negative binomial/zero-inflated negative binomial and logit regression models were used to explore factors associated with perceived care needs and with the use of three types of health service (self-treatment, outpatient and inpatient care). T...
ne important strand of research in the area of political economy and public policy has focused on... more ne important strand of research in the area of political economy and public policy has focused on the appropriate level of governmental decentralization for financial and decisionmaking power regarding public service provisioning and financing. The advantage of decentralization-making use of better community-level information about priorities and the characteristics of residents-may be offset by a greater likelihood that the local governing body is controlled by "elites" to the detriment of weaker community members. The Need to Determine Local-Level Inequality While the level and heterogeneity of local inequality are determinants of the relative likelihood of capture at different levels of government, most theoretical predictions are ambiguous, and there is a need for empirical research into the causes of political capture. In addition to questions of political capture, decentralization also has the potential weakness that community-level decisions may be less likely to reflect social and economic costs and benefits across larger spatial scales. Detailed information on local-level inequality has traditionally been available only from case studies that focus on one or two specific localities. Construction of comprehensive "geographic profiles" of inequality across localities has been held back by limitations of conventional distributional data. This paper takes three developing countries-Ecuador, Madagascar, and Mozambique-and implements in each a recently developed methodology to produce disaggregated estimates of inequality. The countries are very unlike each other-with different geographies, stages of development, quality and types of data, and so on. The methodology works well in all three settings and produces valuable information about the spatial distribution of poverty and inequality within those countriesinformation that was previously not available.
We thank Ravi Kanbur, Tony Venables and other participants at the WIDER project meeting on Spatia... more We thank Ravi Kanbur, Tony Venables and other participants at the WIDER project meeting on Spatial Inequality in Development, May 2003, for comments on an earlier draft of this paper. Also we wish to thank Jishnu Das, Elisabeth Sadoulet and Alain de Janvry for valuable input, and François Bourguignon and Martin Ravallion for stimulating our interest in the questions pursued here. Finally, the paper has benefited from the comments of two anonymous referees.
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