Showing papers by "Deon Filmer published in 2002"

Poverty, AIDS, and Children's Schooling : A Targeting Dilemma

Abstract: The authors analyze the relationship between orphan status, household wealth, and child school enrollment using data collected in the 1990s from 28 countries in Sub-Saharan Africa, Latin America, the Caribbean, and one country in Southeast Asia. The findings point to considerable diversity-so much so that generalizations are not possible. While there are some examples of large differentials in enrollment by orphan status, in the majority of cases the orphan enrollment gap is dwarfed by the gap between children from richer and poorer households. In some cases, even non-orphaned children from the top of the wealth distribution have low enrollments, pointing to fundamental issues in the supply or demand for schooling that are a constraint to higher enrollments of all children. The gap in enrollment between female and male orphans is not much different than the gap between girls and boys with living parents, suggesting that female orphans are not disproportionately affected in terms of their enrollment in most countries. These diverse findings demonstrate that the extent to which orphans are under-enrolled relative to other children is country-specific, at least in part because the correlation between orphan status and poverty is not consistent across countries. Social protection and schooling policies need to assess the specific country situation before considering mitigation measures.

Fever and its treatment among the more and less poor in sub-Saharan Africa.

Abstract: The author empirically explores the relationship between household poverty and the incidence and treatment of fever--as an indicator of malaria--among children in Sub-Saharan Africa. He uses household Demographic and Health Survey data collected in the 1990s from 22 countries in which malaria is prevalent. The analysis reveals a positive, but weak, association between reported fever and poverty. The geographic association becomes insignificant, however, after controlling for the mother's education. There is some evidence that higher levels of wealth in other households in the cluster in which the household lives are associated with lower levels of reported fever in Eastern and Southern Africa. Poverty and the type of care sought for an episode of fever are significantly associated: wealthier households are substantially more likely to seek care in the modern health sector. In Central and Western Africa those from richer households are more likely to seek care from all types of sources: government hospitals, lower-level public facilities such as health clinics, as well as private sources. In Eastern and Southern Africa the rich are primarily more likely to seek care from private facilities. In both regions there is substantial use of private facilities--use that increases with wealth. Like the incidence of fever, treatment-seeking behavior is strongly associated with the level of wealth in the cluster in which the child lives.

Weak Links in the Chain II: A Prescription for Health Policy in Poor Countries

Abstract: In an earlier article, the authors outline some reasons for the disappointingly small effects of primary health care programs and identified two weak links standing between spending and increased health care. The first was the inability to translate public expenditure on health care into real services due to inherent difficulties of monitoring and controlling the behavior of public employees. The second was the “crowding out” of private markets for health care, markets that exist predominantly at the primary health care level. This article presents an approach to public policy in health that comes directly from the literature on public economics. It identifies two characteristic market failures in health. The first is the existence of large externalities in the control of many infectious diseases that are mostly addressed by standard public health interventions. The second is the widespread breakdown of insurance markets that leave people exposed to catastrophic financial losses. Other essential considerations in setting priorities in health are the degree to which policies address poverty and inequality and the practicality of implementing policies given limited administrative capacities. Priorities based on these criteria tend to differ substantially from those commonly prescribed by the international community. In a previous article in this journal, we raise questions about the prevailing orthodoxy concerning appropriate health policy in developing countries (Filmer, Hammer, and Pritchett 2000). That article questions the strategy of promoting of primary health care (phc) for virtually all countries. It discusses the disappointing experience with this approach in some countries and concludes that it should not be universally promoted because the success of phc activities is likely to be highly context specific. That article raises doubts as to the universal applicability of the approach. This article addresses the question “What is to be done?” or, given the wide variety of circumstances in different developing countries, “How do we go about determining what is to be done?” We propose a return to first principles suggested by the standard literature of public economics.

Environmental degradation and the demand for children: searching for the vicious circle in Pakistan

Abstract: If children contribute to the household by using their time to collect natural resources from common property sources—such as collecting firewood, fetching water, collecting fodder, grazing animals—then local depletion of these resources could potentially increase the demand for children. This feedback could create a dynamically unstable ‘vicious circle’ between population growth and resource depletion. We empirically examine several elements of such a ‘vicious circle’ hypothesis using data from Pakistan with unusually rich detail on both child time use and firewood collection activities. We find that collection activities do absorb a substantial part of household resources; that children's tasks are relatively devoted to collection activities; that child time is a significant, but not a dominant, portion of collection activities; and the presence of older children in the household reduces the time that women devote to household tasks. Exploratory multivariate regressions show a partial correlation between indicators of firewood scarcity and fertility—a relationship that varies across regions of Pakistan.

Autonomy, participation, and learning in Argentine schools - findings andtheir implications for decentralization

Abstract: According to a theoretical model, school autonomy and parental participation in schools, can increase student learning through separate channels. Greater school autonomy increases the rent that can be distributed among stakeholders in the school, while institutions for parental participation (such as school board) empower parents to command a larger share of this surplus - for example, through student learning. Using a rich cross-sectional data set from Argentine schools (sixth and seventh grades), the authors find that autonomy, and participation raise student test scores for a given level of inputs, in a multiplicative way, consistent with the model. Autonomy has a direct effect on learning (but not for very low levels of participation), while participation affects learning only through the mediation of the effect of autonomy. The results are robust to a variety of robustness checks, and for sub-samples of children from poor households, children of uneducated mothers, schools with low mean family wealth, and public schools. It is possible that autonomy, and participation are endogenously determined, and that this biases the results - the data available do not allow this to be ruled out with certainty. Plausible predicators of autonomy, and participation are also plausible predicators of test scores, and they fail tests for the over-identifying restrictions. Heuristically argued, however, the potential for correlation with unobserved variables may be limited: the data set is rich in observed variables, and autonomy and participation show very low correlation with observed variables. Subject to these caveats, the results may be relevant to decentralization in two ways. First, as decentralization moves responsibility from the central, toward the provincial or local government, the results should be directly relevant if the decentralization increases autonomy, and participation in schools. Second, if the results are interpreted as representing a more general effect of moving decision-making toward users, and the local community, the results are relevant even if little happens to autonomy, and participation in schools. More important, perhaps, the authors illustrate empirically the importance of knowing who is empowered when higher levels of government loosen control.

Poverty, AIDS, and children's schooling - a targeting dilemma

Abstract: The authors analyze the relationship between orphan status, household wealth, and child school enrollment using data collected in the 1990s from 28 countries in Sub-Saharan Africa, Latin America, the Caribbean, and one country in Southeast Asia. The findings point to considerable diversity-so much so that generalizations are not possible. While there are some examples of large differentials in enrollment by orphan status, in the majority of cases the orphan enrollment gap is dwarfed by the gap between children from richer and poorer households. In some cases, even non-orphaned children from the top of the wealth distribution have low enrollments, pointing to fundamental issues in the supply or demand for schooling that are a constraint to higher enrollments of all children. The gap in enrollment between female and male orphans is not much different than the gap between girls and boys with living parents, suggesting that female orphans are not disproportionately affected in terms of their enrollment in most countries. These diverse findings demonstrate that the extent to which orphans are under-enrolled relative to other children is country-specific, at least in part because the correlation between orphan status and poverty is not consistent across countries. Social protection and schooling policies need to assess the specific country situation before considering mitigation measures.

Fever and Its Treatment among the More and Less Poor in Sub-Saharan Africa

Abstract: Filmer empirically explores the relationship between household poverty and the incidence and treatment of fever - as an indicator of malaria - among children in Sub-Saharan Africa. He uses household Demographic and Health Survey data collected in the 1990s from 22 countries in which malaria is prevalent. The analysis reveals a positive, but weak, association between reported fever and poverty. The geographic association becomes insignificant, however, after controlling for the mother's education. There is some evidence that higher levels of wealth in other households in the cluster in which the household lives are associated with lower levels of reported fever in Eastern and Southern Africa. Poverty and the type of care sought for an episode of fever are significantly associated: wealthier households are substantially more likely to seek care in the modern health sector. In Central and Western Africa those from richer households are more likely to seek care from all types of sources: government hospitals, lower-level public facilities such as health clinics, as well as private sources. In Eastern and Southern Africa the rich are primarily more likely to seek care from private facilities. In both regions there is substantial use of private facilities - use that increases with wealth. Like the incidence of fever, treatment-seeking behavior is strongly associated with the level of wealth in the cluster in which the child lives. This paper - a product of Public Services, Development Research Group - is part of a larger effort in the group to understand the relationship between poverty and health. The author may be contacted at dfilmer@worldbank.org.

Fever and its treatment among the more and less poor in Sub-Saharan Africa

Abstract: The author empirically explores the relationship between household poverty and the incidence and treatment of fever--as an indicator of malaria--among children in Sub-Saharan Africa. He uses household Demographic and Health Survey data collected in the 1990s from 22 countries in which malaria is prevalent. The analysis reveals a positive, but weak, association between reported fever and poverty. The geographic association becomes insignificant, however, after controlling for the mother's education. There is some evidence that higher levels of wealth in other households in the cluster in which the household lives are associated with lower levels of reported fever in Eastern and Southern Africa. Poverty and the type of care sought for an episode of fever are significantly associated: wealthier households are substantially more likely to seek care in the modern health sector. In Central and Western Africa those from richer households are more likely to seek care from all types of sources: government hospitals, lower-level public facilities such as health clinics, as well as private sources. In Eastern and Southern Africa the rich are primarily more likely to seek care from private facilities. In both regions there is substantial use of private facilities--use that increases with wealth. Like the incidence of fever, treatment-seeking behavior is strongly associated with the level of wealth in the cluster in which the child lives.

The World Bank research observer 17 (1)

Abstract: Weathering the storm : the impact of the East Asian crisis on farm households in Indonesia and Thailand; by Fabrizio Bresciani, Gershon Feder, Daniel O. Gilligan, Hanan G. Jacoby, Tongroj Onchan, and Jaime Quizon. The impact of financial crises on labor markets, household incomes, and poverty : a review of evidence; by Peter R. Fallon and Robert E.B. Lucas. Weak links in the chain II : a prescription for health policy in poor countries; by Deon Filmer, Jeffrey S. Hammer, and Lant H. Pritchett. Public intervention in health insurance markets : theory and four examples from Latin America; by William Jack. Urbanization in developing countries; by Vernon Henderson. Developing countries and a new round of WTO negotiations; by Thomas W. Hertel, Bernard M. Hoekman, and Will Martin.