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2013 (32)

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Book
Engaging for Results in Civil Service Reforms : Early Lessons from a Problem-Driven Engagement in Sierra Leone
Authors: ---
Year: 2013 Publisher: Washington, D.C., The World Bank,

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Two related propositions have been central in the recent debates on public sector reforms. The first of these is that the appropriate measure of institutional strength is the ability of public sector management systems to deliver ("functionality") rather than the institutional "form" or what these institutions look like. This is a central idea in the World Bank's Public Sector Management (PSM) Approach 2011-2020. Second, and consistent with this, is the recognition that the process of engagement matters in the sense that how problems, solutions, and reform approaches are identified matters at least as much as what the solution is. This suggests that development institutions should focus on bringing a broad range of stakeholders together and facilitate a process of collective problem and solution identification. Recent contributions to the literature describe a "Problem-Driven Iterative Adaptation" approach as a means of putting this idea into practice. While both of these propositions have considerable intellectual and intuitive appeal, they are based on an inductive logic and neither is currently backed with a large body of robust evidence. This paper contributes to this literature by documenting the experience of a civil service reform project-the World Bank-financed Sierra Leone Pay and Performance Project-the objective of which is to improve the performance of the civil service in Sierra Leone by targeting a narrowly defined set of critical reforms. The paper concludes that intensive, client-led engagement together with use of a results-based lending instrument provide a promising way forward on a difficult reform agenda.


Book
Returns on Investments of HIV Prevention in Vietnam
Authors: --- --- --- ---
Year: 2013 Publisher: Washington, D.C. : The World Bank,

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This study aimed to estimate the cost-effectiveness and returns on investments of HIV prevention programs implemented during 2006-2010 and to identify the optimal allocation of resources across combinations of programs for an effective HIV prevention response to inform the prioritization of funding and health resources in Vietnam. The spending-outcome relationships and an epidemiological model were used to compare observed conditions with counterfactual scenarios of reduced or no programs to calculate the cost-effectiveness and estimate healthcare costs saved and thus the return on investment. Model simulations of epidemic projections over many combinations of possible resource allocations were used to identify optimal allocations for reducing new infections over the next HIV budget period.


Book
Using Provider Performance Incentives to Increase HIV Testing and Counseling Services in Rwanda
Authors: --- --- --- --- --- et al.
Year: 2013 Publisher: Washington, D.C., The World Bank,

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Paying for performance provides financial rewards to medical care providers for improvements in performance measured by specific utilization and quality of care indicators. In 2006, Rwanda began a paying for performance scheme to improve health services delivery, including HIV/AIDS services. This study examines the scheme's impact on individual and couples HIV testing and counseling and using data from a prospective quasi-experimental design. The study finds a positive impact of paying for performance with an increase of 6.1 percentage points in the probability of individuals having ever been tested. This positive impact is stronger for married individuals: 10.2 percentage points. The results also indicate larger impacts of paying for performance on the likelihood that the respondent reports both partners have ever been tested, especially among discordant couples (14.7 percentage point increase) in which only one of the partners is HIV positive.


Book
Is Workfare Cost-Effective against Poverty in a Poor Labor-Surplus Economy?
Authors: --- ---
Year: 2013 Publisher: Washington, D.C., The World Bank,

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Workfare schemes impose work requirements on beneficiaries. This has seemed an attractive idea for self-targeting transfers to poor people. This incentive argument does not imply, however, that workfare is more cost-effective against poverty than even poorly-targeted options, given hidden costs of participation. In particular, even poor workfare participants in a labor-surplus economy can be expected to have some forgone income when they take up such a scheme. A survey-based method is used to assess the cost-effectiveness of India's Employment Guarantee Scheme in Bihar. Participants are found to have forgone earnings, although these fall well short of market wages on average. Factoring in these hidden costs, the paper finds that for the same budget, workfare has less impact on poverty than either a basic-income scheme (providing the same transfer to all) or uniform transfers based on the government's below-poverty-line ration cards. For workfare to dominate other options, it would have to work better in practice. Reforms would need to reduce the substantial unmet demand for work, close the gap between stipulated wages and wages received, and ensure that workfare is productive-that the assets created are of value to poor people. Cost-effectiveness would need to be reassessed at the implied higher levels of funding.


Book
It's Only Words : Validating the CPIA Governance Assessments
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Year: 2013 Publisher: Washington, D.C., The World Bank,

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This study analyzes the validity of the World Bank's Country Policy and Institutional Assessments governance ratings, an important factor in allocating the Bank's concessionary International Development Association funds. It tests for certain biases in the ratings, and examines the quality of the written justifications that accompany the ratings. The study finds no evidence of bias in favor of International Development Association-eligible countries, despite a potential moral hazard problem inherent in the ratings process. However, there is some evidence of an upward bias in ratings for one region, relative to the other five regions. The study finds significant regional differences in the quality of the written justifications accompanying the six World Bank regions' proposed ratings. The length of these write-ups has exploded over time. Although higher-quality write-ups are also longer on average, there is wide dispersion in the word count at any given quality level, and some long write-ups provide little relevant information. Higher quality write-ups are associated with a lower likelihood that central unit reviewers will either disagree with proposed ratings, or request additional information to assess the proposed rating. Controlling for quality, longer write-ups are associated with a greater probability that central reviewers will disagree with a proposed rating. Although checks and balances built into the process appear to work reasonably well, the author concludes that a more proactive role for central unit reviewers and regional chief economists' offices could further enhance the quality of write-ups and reduce regional bias.


Book
Cash Transfers and Child Schooling : Evidence from a Randomized Evaluation of the Role of Conditionality
Authors: --- ---
Year: 2013 Publisher: Washington, D.C., The World Bank,

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The authors conduct a randomized experiment in rural Burkina Faso to estimate the impact of alternative cash transfer delivery mechanisms on education. The two-year pilot program randomly distributed cash transfers that were either conditional or unconditional. Families under the conditional schemes were required to have their children ages 7-15 enrolled in school and attending classes regularly. There were no such requirements under the unconditional programs. The results indicate that unconditional and conditional cash transfer programs have a similar impact increasing the enrollment of children who are traditionally favored by parents for school participation, including boys, older children, and higher ability children. However, the conditional transfers are significantly more effective than the unconditional transfers in improving the enrollment of "marginal children" who are initially less likely to go to school, such as girls, younger children, and lower ability children. Thus, conditionality plays a critical role in benefiting children who are less likely to receive investments from their parents.


Book
A Public Strategy for Compliance Monitoring
Authors: --- ---
Year: 2013 Publisher: Washington, D.C., The World Bank,

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Theoretical accounts of compliance with court orders emphasize the importance of transparency. Most empirical studies of compliance center on high profile political cases, largely ignoring the high-volume, quotidian claims against the state for basic services that constitute the largest share of court dockets in many jurisdictions. This paper uses a unique dataset on compliance with orders from the Constitutional Chamber of the Supreme Court of Costa Rica to examine the determinants of compliance in low salience cases. It finds that orders issued just after the Court announced, in a press conference, that it was monitoring compliance were implemented roughly two months sooner than orders issued just prior to the press conference. These findings suggest that publicity can motivate compliance even in low salience cases.


Book
How Subjective Beliefs about HIV Infection Affect Life-Cycle Fertility : Evidence from Rural Malawi
Author:
Year: 2013 Publisher: Washington, D.C., The World Bank,

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This paper studies the effect of subjective beliefs about HIV infection on fertility decisions in a context of high HIV prevalence and simulates the impact of different policy interventions, such as HIV testing programs and prevention of mother-to-child transmission, on fertility and child mortality. It develops a model of women's life-cycle, in which women make sequential fertility decisions. Expectations about the life horizon and child survival depend on women's perceived exposure to HIV infection, which is allowed to differ from the actual exposure. In the model, women form beliefs about their HIV status and about their own and their children's survival in future periods. Women update their beliefs with survival to each additional period as well as when their HIV status is revealed by an HIV test. Model parameters are estimated by maximum likelihood with longitudinal data from the Malawi Diffusion and Ideational Change Project, which contain family rosters, information on HIV testing, and measures of subjective beliefs about own HIV status. The model successfully fits the fertility patterns in the data, as well as the distribution of reported beliefs about own HIV status. The analysis uses the model to assess the effect of HIV on fertility by simulating behavior in an environment without HIV. The results show that the presence of HIV reduces the average number of births a woman has during her life-cycle by 0.15. The paper also finds that HIV testing can reduce the fertility of infected women, leading to a reduction of child mortality and orphan-hood.


Book
Long-Term Impacts of Household Electrification in Rural India
Authors: --- --- ---
Year: 2013 Publisher: Washington, D.C., The World Bank,

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India's huge expansion in rural electrification in the 1980s and 1990s offers lessons for other countries today. The paper examines the long-term effects of household electrification on consumption, labor supply, and schooling in rural India over 1982-99. It finds that household electrification brought significant gains to consumption and earnings, the latter through changes in market labor supply. It finds positive effects on schooling for girls but not for boys. External effects are also evident, whereby households without electricity benefit from village electrification. Wage rates were unaffected. Methodologically, the results suggest sizeable upward biases in past estimates of the gains from electrification associated with how past analyses dealt with geographic effects.


Book
Using Provider Performance Incentives to Increase HIV Testing and Counseling Services in Rwanda
Authors: --- --- --- --- --- et al.
Year: 2013 Publisher: Washington, D.C., The World Bank,

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Abstract

Paying for performance provides financial rewards to medical care providers for improvements in performance measured by specific utilization and quality of care indicators. In 2006, Rwanda began a paying for performance scheme to improve health services delivery, including HIV/AIDS services. This study examines the scheme's impact on individual and couples HIV testing and counseling and using data from a prospective quasi-experimental design. The study finds a positive impact of paying for performance with an increase of 6.1 percentage points in the probability of individuals having ever been tested. This positive impact is stronger for married individuals: 10.2 percentage points. The results also indicate larger impacts of paying for performance on the likelihood that the respondent reports both partners have ever been tested, especially among discordant couples (14.7 percentage point increase) in which only one of the partners is HIV positive.

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