Piped Water Access,Child Health and the Complementary Role of Education: Panel Data Evidence from South Africa

This study establishes the causal impact of piped water access on child health in rural South Africa (2008–2015) through the use of a panel dataset and a quasi-experimental sample space. By employing an ordinal measure of child health as the dependent variable within linear fixed effects, logit, ordinal probit, and propensity-score matched linear as well as non-linear Difference-in-Difference, it is demonstrated that positive health benefits for children with access to piped water are observed if and only if the minimum level of educational attainment of the primary-caregiver is equal to or greater than seven years. This finding of complementarity is demonstrated to be a function of an individual’s (in)capacity to evaluate water quality: people below this threshold suffer from a piped water bias, place insufficient weight on the observable characteristics of water when determining water quality, and are subsequently less likely to treat piped water preceding consumption.     

Child Schooling,Child Health,and Rainfall Shocks: Evidence from Rural Vietnam

Abstract

We study the effect of rainfall shocks on child schooling outcomes and on standardised height for age (a measure of child health) in rural Vietnam. We find that adverse rainfall shocks during pregnancy adversely affect children’s school entry delay and progress through school. Adverse rainfall shocks in the third year of life adversely affect both schooling and child health. These effects differ by region, as a result of constraints that reflect regional economic heterogeneity. We predict that policies that help rural families smooth income shocks will result in increases in human capital and in substantial cumulative returns over a worker’s working life.     

Labour Crisis and Innovation in Developing Countries: An Analysis of Locum Program for Health Personnel in Malawi

This article interrogates the dynamics of public sector innovation within the context of labor crisis in a developing country environment. It finds that to minimize the impacts of labor shortage in the health sector, Malawi uses a locum program where health workers are encouraged to work extra hours and are paid overtime allowances accordingly. The article observes that although the program has been pivotal in motivating the existing staff to go the extra mile and attempt to cover up for the labor shortages, it is rocked with several challenges which usually disrupt effective service delivery. These include delayed payments, sustainability problems, governance challenges, work ethics challenges, and negative effects of the quality of services delivered. Taking a qualitative approach, the analysis combines the use of primary and secondary data.     

Short-Term Impacts of Solar Lanterns on Child Health: Experimental Evidence from Bangladesh

We implemented a 16-month randomised field experiment in unelectrified areas of Bangladesh to identify health impacts of solar lanterns among school-aged children. Our analysis of various health-related indicators – self-reporting, spirometers, and professional medical checkups – showed modest improvements in eye redness and irritation but no noticeable improvement in respiratory symptoms among treated students. Varying the number of solar products received within treatment households did not alter these results. This limited health benefit was not caused by nonutilisation of the products by treated children, spillover effects from treated to control students, or contamination resulting from unfavourable family cooking environments.     

The Impact of Drinking Water Quality and Sanitation on Child Health: Evidence from Rural Ethiopia

This paper examines the association between stored drinking water quality and sanitation on diarrhoea incidence among under-five children in Ethiopia. Using primary household survey data and microbiological water quality testing for Escherichia coli, our results show that uncontaminated stored drinking water and safe child stool disposal are associated with decreased child diarrhoea incidences of 18 and 20 percentage points, respectively. In contrast, neighbourhood concentration of pit latrine shows an increased incidence of child diarrhoea of 16 percentage points. To protect rural children from the risk of contracting diarrhoea, improving household drinking water quality and changing people’s behaviour towards safe sanitation practices is needed.     

Food Aid and Malnutrition in Developing Countries: Evidence from Global Food Aid Allocation

This study investigates the allocation of dietary energy, iron, vitamin A and zinc within global food aid. The response of US and non-US donors to nutritional needs and donor interests is estimated with a dynamic correlated random effects Tobit model. Aid flows of the period 1993–2007 are analysed. The empirical results show that nutrient shipments in emergency food aid have been allocated towards poorer countries, but also face inertia and media bias. Project food aid from the US is found to be targeted towards politically stable and rural regions, while non-US project aid focuses on populations with high nutritional requirements.     

For Health,Strength, and Daily Food: The Dual Impact of Remittances and Public Health Expenditure on Household Health Spending and Child Health Outcomes

Abstract

Child and infant mortality in developing countries decreased 33.5 per cent and 30.9 per cent, respectively, during 1995–2009, while remittances and public health spending more than doubled. I examine how remittances and government health spending improve these child health outcomes. Neither government health spending nor remittances causally affect household health spending. Public health spending has an insignificant negative impact on mortality. The increase in remittances causally accounts for 32 per cent and 37 per cent of the decline in child and infant mortality, respectively. Remittances reduce mortality through improved living standards from the relaxation of households’ budget constraints.     

Child Development and Migrant Transnationalism: The Health of Children Who Stay Behind in Ghana and Nigeria

This paper examines the relation between parental migration and children’s health in Ghana (N = 2760) and Nigeria (N = 2168) and considers four dimensions of parental migration: the type of separation, parental migration and the caregiver, stability of care arrangements, and the availability of remittances. By employing an ordered scale of children’s self-rated health, we found that children with international migrant parents who are divorced/separated are less likely than children in non-migrant families to have good health. The magnitude of the effects are higher in Nigeria, attesting for a greater vulnerability of Nigerian children in divorced migrant families. Among children with parents living abroad who are stably married, specific dimensions of children’s transnational life are associated with negative health, while others are not. This study highlights the sensitivity of results to the context of parent-child separation and to the transnational dimension being measured.     

Seasonality in suicide: a study of farming suicides in England and Wales

Seasonality in suicide rates has long been reported. Spring peaks in suicide deaths have been positively correlated with the proportion of the workforce engaged in agriculture. Some studies have indicated that suicides using violent methods are more likely to show seasonality. Recent research has suggested that seasonal patterns have diminished. This study examined deaths in male farmers, an occupational group which might be expected to be more vulnerable to seasonal influences because of the nature of their work and the relatively high proportion of farmers using violent methods for suicide. Data on suicides between 1982 and 1999 by males in England and Wales aged 15 years and over were provided by the Office for National Statistics. Seasonal patterns of suicide in farmers and nonfarmers were examined by nonparametric tests and harmonic analysis. No significant seasonal variation was found for farmers. For nonfarmers, although a chi-square test showed significant variation in monthly distribution, this was not found when a harmonic analysis was applied. There was no significant difference in the variation of violent suicides throughout the year. This study reinforces recent findings that seasonal variation in suicide appears to be diminishing, even in an occupational group where this might be expected.     

Health care policy: lessons from the past and issues of the future

Liberal distributional values, the increasingly powerful capacity of medicine to provide more and better care, and concern about the health hazards of an industrial society fueled the vast expansion of the health care sector during the last 20 years. That growth was facilitated by a growing economy. The current health policy debate at one level reexamines the distributional bases of entitlement programs, and at another seeks alternative resource allocation mechanisms to reduce the cost of health care. This article has two themes. First, distributional and allocational policies are shown to be intrinsically related, so that the health policy debate is fundamentally a clash between liberal and libertarian values. Second, the inexorable social forces driving the health care system are shown to be the aging of the population and the rapid expansion of technology. The resulting dynamics imply the further growth of the health sector, now in the environment of a sluggish economy. Future policies will have to struggle with how to ration scarce health resources and how to reorient the health care sector to the problems of the aged.     

Health care reform content and process:propositions from the states

Health care reform and cost containment have become central campaign and policy issues in the United States. Although focus now centers on federal health care reform policy, state governments have been actively introducing health care reform legislation. Some of the health care reform initiatives on the state level have influenced deliberations on the federal level and President Clinton's health care reform initiatives will spur further state experimentation regardless of legislative success in Congress, In 1992 nearly all 50 states had either legislation introduced, or special task forces assigned that addressed health care reform issues. This exploratory research compares the content and process of health reform in four states that attempted major reform in 1992—Florida, Washington, Michigan, and Wisconsin—and draws propositions for state reform based on comparisons of content and process. The four states chosen represent geographic diversity and a balance between legislation seeking partial change and legislation calling for universal health care reform. The principal reform bills in each state are compared and assessed on the degree to which they address eight reform elements; high tech medicine, administration, tort reform, long-term care, regulation, insurance mandates, small business insurance, and insurance portability. These initiatives are also compared on a series of reform process variables that relate to the political process for adopting reform: degree of health sector support, type of political strategy used, reform champion, degree of cooperation among policy stakeholders, and timing of initiative. Based on these four cases the phased/partial approach seems to have a greater chance for legislative success than immediate universal reform. Florida's partial, consensus-building approach resulted in the only signed bill of the four states. Washington's bill, which also took a partial approach, passed the state senate before ultimate defeat in 1992 and eventual passage in 1993. Neither of the more ambitious universal health care reform packages introduced in Wisconsin or Michigan got out of committee. Although some of the plans were thorough, none adequately addressed the tradeoff between increasing access to care and containing costs. In addition, this study will demonstrate that universal health care legislation, does not necessarily equate to comprehensive health care reform. The propositions derived from this research have implications for future state health care reform efforts, as well as for federal health care reform policy in terms of the substantive content of reform proposals and the political process by which they are advanced.     

The Making of the Middle-Class in Africa: Evidence from DHS Data

Abstract

This article examines the size and profile of the middle class in Africa using alternative definitions based on pooled unit record data from the Demographic and Health Survey for 37 African countries covering the period 1990–2011. Results suggest that size of the middle class has grown modestly in many countries in the 2000 decade as compared with the 1990s. The article approached the making of the middle class in Africa from institutional and policy perspectives. Quality of institutions, ethnic fractionalisation and education play a significant role in determining the rise of the middle class.     

Indian politics in the 1990s: Trends and transformations

This article examines significant transformations that have occurred in Indian politics in the last decade, particularly after the eclipse of the one‐party dominant system. India is said to have entered the era of coalition politics with all its attendant consequences. The advent of coalition politics has induced pronounced political changes but coalition politics itself can be seen as a consequence of these changes. Cause and effect is therefore hard to separate but transformations can be identified with respect to India's electoral politics; stability of governments and the party system; federal‐regional equations; and, participation and empowerment. This article discusses these themes to provide an understanding of the noticeable mutations that the Indian political system has undergone.     

Unequal Laws and the Disempowerment of Women in the Labour Market: Evidence from Firm-Level Data

Institutions are defined as the set of rules that govern human interactions. When these rules are discriminatory, they may disempower segments of a population in the economic spheres of activity. In this study, we explore whether laws that discriminate against women influence their engagement in the economy. We adopt a holistic approach where we explore an overall measure of unequal laws also known as legal gender disparities and relate it to several labour market outcomes for women. Using data for over 59,000 firms across 94 economies, we find that unequal laws not only discourage women’s participation in the private sector workforce, but also their likelihood to become top managers and owners of firms. Suggestive evidence indicates that access to finance, property ownership, business registration, and labour market constraints are pathways by which legal gender disparities disempower women in the private sector.     

Health strategy and development planning: Lessons from the people's republic of China

In Section I of this paper we present an analytical paradigm by which to evaluate health and medical care services in underdeveloped countries. In Section II, we apply this framework to an analysis of the health policies of one developing country, China. In Section III, we evaluate the Chinese health and medical care policies within the framework of a cost‐benefit analysis and argue that these policies are appropriate to China's factor proportions and health needs. Finally, in Section IV, we raise a number of questions to be considered in any more detailed studies on the transferring of the Chinese services to other developing countries.     

Managing the Public Sector in Hong Kong: Trends and Adjustments

Public sector management in Hong Kong was initially designed to rule the territory as a British colony. A number of changes took place in the last quarter century before Hong Kong's reintegration with China and the nature of public sector management has transformed over this period. An overview of administrative principles and practices and an analysis of changes reveal trends that were influenced by both local and international factors. The framework of traditional public administration in the territory adapted effectively to embrace the principles of new public management without much difficulty. The global economic crisis compelled the government to revise its strategies to expand public spending and adopt a further reduced role in the provision of public services. New social, economic and political challenges are driving Hong Kong to adjust to the changing circumstances and trends, and four noticeable shifts can be identified. They include shifts from an administrative to a political executive, from job cuts to job creation, from financial restraint to increased spending, and from public to private sector provision of public services. The trends are driven by local and international forces as well as the progress of democratization and political awareness in Hong Kong.     

Law and order as a development issue: Land conflicts and the creation of social order in Southern Malawi

Registration of individual title to land in order to create legal security has been the central concern in the rich literature on land and law in Africa. The problem of legal insecurity is approached here from a different angle which has received relatively less attention: dispute settlement. The article results from the observation of land disputes in local political arenas. It portrays a local legal cultural universe in which legal insecurity arises especially from legal situations stressing group consensus. It appears that people who are accused of witchcraft and groups which are said not to belong are particularly vulnerable in such a legal culture. The conclusion argues that this case material reveals connections between law, land and the creation of social order which may throw light on many other situations. It pleads for more attention to be paid to the development of jurisprudence in attempts to create legal security.     

The Contribution of Donor Support Programs to Decentralized Development: Learning from the District Level in Ghana

Donor aid has over the years turned out to be a very decisive development component for most developing nations, but aid is often criticized for ineffectiveness. This article seeks to share perspectives on the relevance of direct project or program support and the need to refrain from homogeneity in aid research by assessing the contribution of the Government of Ghana/European Union (GoG/EU) Micro-Projects Programme in the Nadowli District of Ghana from 1997–2009. The findings acknowledge positive impacts of the program in the district. There are sector consistencies between the donor interest and local development priorities in health, education and the water and sanitation sectors. However, selectivity of project within and among sectors brings potential conflicts of interest and tradeoffs between the program and local community needs. The results imply a reexamination of decentralized development through a lens of new partnership between donors’ interest and local needs. Stepping up community awareness to ensure full participation in project design, execution, operation, and maintenance could serve as a start-up platform for new partnerships. It is imperative to align donor interest with local realities, which prompts a rethinking of adoption of new project approaches such as co-development, design, and implementation.     

Linkages between Decentralisation and Inequalities in Neonatal Health: Evidence from Indonesia

This study uses five waves of the Indonesian Demographic Health Surveys to analyse decentralisation and geographical inequality in health services delivery. Accounting for unobserved community-level heterogeneity with random effects and correlated random effects models, we link facility-based birth delivery to the period of decentralisation and Indonesia’s major island groups using a pooled sample of 71,815 children. We also generate direct estimates of neonatal mortality from 1990 to 2007. The results show that the implementation of decentralisation has accorded with a marked expansion in both health service and outcome inequalities in Indonesia, at least with respect to neonates. Systemic funding failures for health and decision-space issues resulting from decentralisation are likely to have greater impact in disadvantaged regions where local capacity is weakest. The need to address these fundamental issues to reduce inequalities and improve general health outcomes appears supportable.