Deon Filmer

Bio: Deon Filmer is an academic researcher from World Bank. The author has contributed to research in topics: Poverty & Population. The author has an hindex of 43, co-authored 148 publications receiving 18682 citations. Previous affiliations of Deon Filmer include World Bank Group & International Monetary Fund.

Health policy in poor countries : weak links in the chain

Abstract: The authors show how the recent empirical and theoretical literature on health policy sheds light on the disappointing experience with the implementation of primary health care. They emphasize the evidence on two weak links between government spending on health and improvements in health status. First, the capability of developing country governments to provide effective services varies widely -- so health spending, even on the"right"services, may lead to little actual provision of services. Second, the net impact of government provision of health services depends on the severity of market failures. Evidence suggests these are the least severe for relatively inexpensive curative services, which often absorb the bulk of primary health care budgets. Government policy in health can more usefully focus directly on mitigating market failures in traditional public health activities and, in more developed settings, failures in the markets for risk mitigation. Addressing poverty requires consideration of a much broader set of policies which may -- or may not -- include provision of health services.

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.

If you build it, will they come? School availability and school enrollment in 21 poor countries

Abstract: Increasing the supply of schools is commonly advocated as a policy intervention to promote schooling. Analysis of the relationship between the school enrollment of 6 to 14 year olds and the distance to primary and secondary schools in 21 rural areas in low-income countries (including some of the poorest countries in Sub-Saharan Africa) reveals that the two are often statistically significantly related. However, the magnitudes of the associations are small. Simulating big reductions in distance yields only small increases in average school participation, and only small reductions in within-country inequality. The data are mostly cross-sectional and therefore it is difficult to assess the degree to which results might be driven by endogenous school placement. Data can be geographically matched over time in three of the study countries and under some assumptions the results from these countries are consistent with no substantial bias in the cross-sectional estimates. Although increasing school availability by decreasing the average distance to schools can be a tool for increasing enrollments, it cannot be expected to have a substantial effect. Other interventions, such as those geared toward increasing the demand for schooling or increasing the quality of schooling should be prioritized.

An Application to Educational Enrollments in States of India

Abstract: We use the National Family Health Survey (NFHS) data collected in Indian states in 1992 and 1993 to estimate the relationship between household wealth and the probability a child (aged 6 to 14) is enrolled in school. A methodological difficulty to overcome is that the NFHS, modeled closely on the Demographic and Health Surveys (DHS), measures neither household income nor consumption expenditures. As a proxy for long-run household wealth we construct a linear index from a set of asset indicators using principal components analysis to derive the weights. This "asset index" is robust, produces internally coherent results, and provides a close correspondence with State Domestic Product (SDP) and poverty rates data. We validate the asset index using data from Indonesia, Pakistan and Nepal which contain data on both consumption expenditures and asset ownership. The asset index has reasonable coherence with current consumption expenditures and most importantly, works as well, or better, than traditional expenditure based measures in predicting enrollment status. When the asset index is applied to the Indian data the results show large, and variable, wealth gaps in the enrollment of children across states of India. While on average across India a rich (top 20 percent of the asset index) child is 31 percentage points more likely to be enrolled than a poor child (bottom 40 percent), this wealth gap varies from only 4.6 in Kerala, to 38.2 in Uttar Pradesh and 42.6 percentage points in Bihar. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the World Bank, its Executive Directors, or the countries they represent.

Estimating Wealth Effects without Expenditure Data or Tears: With an Application to Educational Enrollments in States of India

Abstract: The relationship between household wealth and educational enrollment of children can be estimated without expenditure data. A method for doing so - which uses an index based on household asset ownership indicators - is proposed and defended in this paper. In India, children from the wealthiest households are over 30 percentage points more likely to be in school than those from the poorest households, although this gap varies considerably across states. To estimate the relationship between household wealth and the probability that a child (aged 6 to 14) is enrolled in school, Filmer and Pritchett use National Family Health Survey (NFHS) data collected in Indian states in 1992 and 1993. In developing their estimate Filmer and Pritchett had to overcome a methodological difficulty: The NFHS, modeled closely on the Demographic and Health Surveys, measures neither household income nor consumption expenditures. As a proxy for long-run household wealth, they constructed a linear asset index from a set of asset indicators, using principal components analysis to derive the weights. This asset index is robust, produces internally coherent results, and provides a close correspondence with data on state domestic product and on state level poverty rates. They validate the asset index using data on consumption spending and asset ownership from Indonesia, Nepal, and Pakistan. The asset index has reasonable coherence with current consumption expenditures and, more importantly, works as well as - or better than - traditional expenditure-based measures in predicting enrollment status. The authors find that on average a child from a wealthy household (in the top 20 percent on the asset index developed for this analysis) is 31 percent more likely to be enrolled in school than a child from a poor household (in the bottom 40 percent). This paper - a product of Poverty and Human Resources, Development Research Group - is part of a larger effort in the group to inform educational policy. The study was funded by the Bank`s Research Support Budget under the research project Educational Enrollment and Dropout (RPO 682-11).

A Treatise on the Family

Abstract: A Treatise on the Family. G. S. Becker. Cambridge, MA: Harvard University Press. 1981. Gary Becker is one of the most famous and influential economists of the second half of the 20th century, a fervent contributor to and expounder of the University of Chicago free-market philosophy, and winner of the 1992 Nobel Prize in economics. Although any book with the word "treatise" in its title is clearly intended to have an impact, one coming from someone as brilliant and controversial as Becker certainly had such a lofty goal. It has received many article-length reviews in several disciplines (Ben-Porath, 1982; Bergmann, 1995; Foster, 1993; Hannan, 1982), which is one measure of its scholarly importance, and yet its impact is, I think, less than it may have initially appeared, especially for scholars with substantive interests in the family. This book is, its title notwithstanding, more about economics and the economic approach to behavior than about the family. In the first sentence of the preface, Becker writes "In this book, I develop an economic or rational choice approach to the family." Lest anyone accuse him of focusing on traditional (i.e., material) economics topics, such as family income, poverty, and labor supply, he immediately emphasizes that those topics are not his focus. "My intent is more ambitious: to analyze marriage, births, divorce, division of labor in households, prestige, and other non-material behavior with the tools and framework developed for material behavior." Indeed, the book includes chapters on many of these issues. One chapter examines the principles of the efficient division of labor in households, three analyze marriage and divorce, three analyze various child-related issues (fertility and intergenerational mobility), and others focus on broader family issues, such as intrafamily resource allocation. His analysis is not, he believes, constrained by time or place. His intention is "to present a comprehensive analysis that is applicable, at least in part, to families in the past as well as the present, in primitive as well as modern societies, and in Eastern as well as Western cultures." His tone is profoundly conservative and utterly skeptical of any constructive role for government programs. There is a clear sense of how much better things were in the old days of a genderbased division of labor and low market-work rates for married women. Indeed, Becker is ready and able to show in Chapter 2 that such a state of affairs was efficient and induced not by market or societal discrimination (although he allows that it might exist) but by small underlying household productivity differences that arise primarily from what he refers to as "complementarities" between caring for young children while carrying another to term. Most family scholars would probably find that an unconvincingly simple explanation for a profound and complex phenomenon. What, then, is the salient contribution of Treatise on the Family? It is not literally the idea that economics could be applied to the nonmarket sector and to family life because Becker had already established that with considerable success and influence. At its core, microeconomics is simple, characterized by a belief in the importance of prices and markets, the role of self-interested or rational behavior, and, somewhat less centrally, the stability of preferences. It was Becker's singular and invaluable contribution to appreciate that the behaviors potentially amenable to the economic approach were not limited to phenomenon with explicit monetary prices and formal markets. Indeed, during the late 1950s and throughout the 1960s, he did undeniably important and pioneering work extending the domain of economics to such topics as labor market discrimination, fertility, crime, human capital, household production, and the allocation of time. Nor is Becker's contribution the detailed analyses themselves. Many of them are, frankly, odd, idiosyncratic, and off-putting. …

Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application to Educational Enrollments in States of India

Abstract: This paper has an empirical and overtly methodological goal. The authors propose and defend a method for estimating the effect of household economic status on educational outcomes without direct survey information on income or expenditures. They construct an index based on indicators of household assets, solving the vexing problem of choosing the appropriate weights by allowing them to be determined by the statistical procedure of principal components. While the data for India cannot be used to compare alternative approaches they use data from Indonesia, Nepal, and Pakistan which have both expenditures and asset variables for the same households. With these data the authors show that not only is there a correspondence between a classification of households based on the asset index and consumption expenditures but also that the evidence is consistent with the asset index being a better proxy for predicting enrollments--apparently less subject to measurement error for this purpose--than consumption expenditures. The relationship between household wealth and educational enrollment of children can be estimated without expenditure data. A method for doing so - which uses an index based on household asset ownership indicators- is proposed and defended in this paper. In India, children from the wealthiest households are over 30 percentage points more likely to be in school than those from the poorest households.

Growth is Good for the Poor

Abstract: When average incomes rise, the average incomes of the poorest fifth of society rise proportionately. This holds across regions, periods, income levels, and growth rates. But relatively little is known about the broad forces that account for the variations across countries and across time in the share of income accruing to the poorest fifth. When average incomes rise, the average incomes of the poorest fifth of society rise proportionately. This is a consequence of the strong empirical regularity that the share of income accruing to the bottom quintile does not vary systematically with average income. Dollar and Kraay document this empirical regularity in a sample of 92 countries spanning the past four decades and show that it holds across regions, periods, income levels, and growth rates. Dollar and Kraay next ask whether the factors that explain cross-country differences in the growth rates of average incomes have differential effects on the poorest fifth of society. They find that several determinants of growth - such as good rule of law, openness to international trade, and developed financial markets - have little systematic effect on the share of income that accrues to the bottom quintile. Consequently, these factors benefit the poorest fifth of society as much as everyone else. There is some weak evidence that stabilization from high inflation and reductions in the overall size of government not only increase growth but also increase the income share of the poorest fifth in society. Finally, Dollar and Kraay examine several factors commonly thought to disproportionately benefit the poorest in society, but find little evidence of their effects. The absence of robust findings emphasizes that relatively little is known about the broad forces that account for the cross-country and intertemporal variation in the share of income accruing to the poorest fifth of society. This paper - a product of Macroeconomics and Growth, Development Research Group - is part of a larger effort in the group to study growth and poverty reduction. The authors may be contacted at ddollar@worldbank.org or akraay@worldbank.org.