This book shows how to implement a variety of analytic tools that allow health equity - along different dimensions and in different spheres - to be quantified. Questions that the techniques can help provide answers for include the following: Have gaps in health outcomes between the poor and the better-off grown in specific countries or in the developing world as a whole? Are they larger in one country than in another? Are health sector subsidies more equally distributed in some countries than in others? Is health care utilization equitably distributed in the sense that people in equal need receive similar amounts of health care irrespective of their income? Are health care payments more progressive in one health care financing system than in another? What are catastrophic payments? How can they be measured? How far do health care payments impoverish households? This volume has a simple aim: to provide researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity. Each chapter includes worked examples and computer code. The authors hope that these guides, and the easy-to-implement computer routines contained in them, will stimulate yet more analysis in the field of health equity, especially in developing countries. They hope this, in turn, will lead to more comprehensive monitoring of trends in health equity, a better understanding of the causes of these inequities, more extensive evaluation of the impacts of development programs on health equity, and more effective policies and programs to reduce inequities in the health sector.

Analyzing health equity using household survey data : a guide to techniques and their implementation

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)60843-0.pdf

Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?

Acceleration of progress in nutrition will require eff ective, large-scale nutrition-sensitive programmes that address key underlying determinants of nutrition and enhance the coverage and eff ectiveness of nutrition-specifi c interventions. We reviewed evidence of nutritional eff ects of programmes in four sectors—agriculture, social safety nets, early child development, and schooling. The need for investments to boost agricultural production, keep prices low, and increase incomes is undisputable; targeted agricultural programmes can complement these investments by supporting livelihoods, enhancing access to diverse diets in poor populations, and fostering women’s empowerment. However, evidence of the nutritional eff ect of agricultural programmes is inconclusive—except for vitamin A from biofortifi cation of orange sweet potatoes—largely because of poor quality evaluations. Social safety nets currently provide cash or food transfers to a billion poor people and victims of shocks (eg, natural disasters). Individual studies show some eff ects on younger children exposed for longer durations, but weaknesses in nutrition goals and actions, and poor service quality probably explain the scarcity of overall nutritional benefi ts. Combined early child development and nutrition interventions show promising additive or synergistic eff ects on child development—and in some cases nutrition—and could lead to substantial gains in cost, effi ciency, and eff ectiveness, but these programmes have yet to be tested at scale. Parental schooling is strongly associated with child nutrition, and the eff ectiveness of emerging school nutrition education programmes needs to be tested. Many of the programmes reviewed were not originally designed to improve nutrition yet have great potential to do so. Ways to enhance programme nutrition-sensitivity include: improve targeting; use conditions to stimulate participation; strengthen nutrition goals and actions; and optimise women’s nutrition, time, physical and mental health, and empowerment. Nutrition-sensitive programmes can help scale up nutrition-specifi c interventions and create a stimulating environment in which young children can grow and develop to their full potential.

Maternal and Child Nutrition 3 Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?

This paper presents and compares two threshold approaches to measuring the fairness of health care payments, one requiring that payments do not exceed a pre-specified proportion of pre-payment income, the other that they do not drive households into poverty. We develop indices for 'catastrophe' that capture the intensity of catastrophe as well as its incidence and also allow the analyst to capture the degree to which catastrophic payments occur disproportionately among poor households. Measures of poverty impact capturing both intensity and incidence are also developed. The arguments and methods are empirically illustrated with data on out-of-pocket payments from Vietnam in 1993 and 1998. This is not an uninteresting application given that 80% of health spending in that country was paid out-of-pocket in 1998. We find that the incidence and intensity of 'catastrophic' payments - both in terms of pre-payment income as well as ability to pay - were reduced between 1993 and 1998, and that both incidence and intensity of 'catastrophe' became less concentrated among the poor. We also find that the incidence and intensity of the poverty impact of out-of-pocket payments diminished over the period in question. Finally, we find that the poverty impact of out-of-pocket payments is primarily due to poor people becoming even poorer rather than the non-poor being made poor, and that it was not expenses associated with inpatient care that increased poverty but rather non-hospital expenditures.

Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998

Many definitions of food security exist, and these have been the subject of much debate. As early as 1992, Maxwell and Smith (1992) reviewed more than 180 items discussing concepts and definitions, and more definitions have been formulated since (DEFRA, 2006). Whereas many earlier definitions centered on food production, more recent definitions highlight access to food, in keeping with the 1996 World Food Summit definition (FAO, 1996) that food security is met when “all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active and healthy life.” Worldwide attention on food access was given impetus by the food “price spike” in 2007–2008, triggered by a complex set of long- and short-term factors (FAO, 2009b; von Braun and Torero, 2009). FAO concluded, “provisional estimates show that, in 2007, 75 million more people were added to the total number of undernourished relative to 2003–05” (FAO, 2008); this is arguably a low-end estimate (Headey and Fan, 2010). More than enough food is currently produced per capita to feed the global population, yet about 870 million people remained hungry in the period from 2010 to 2012 (FAO et al., 2012). The questions for this chapter are how far climate and its change affect current food production systems and food security and the extent to which they will do so in the future (Figure 7-1).

Food security and food production systems

The spike in global food prices in 2008 led to significantly higher food prices across the developing world. Global commodity prices have since fallen but remain volatile, and local food prices remain high in many countries. The authors review the evidence on the potential impact of higher food prices on poverty, focusing on Sub-Saharan Africa, and examine the extent to which policy responses are able to protect the poor. They show that rising food prices are likely to lead to higher poverty in Sub-Saharan Africa as the negative impact on net consumers outweighs the benefits to producers. A recent survey shows that the most common policy response in Sub-Saharan African countries in 2008 was reducing taxes on food, while outside the region subsidies were the most popular measure. Sub-Saharan African countries also have a higher prevalence of food based safety net programs, some of which were scaled up to respond to rising prices. The review suggests that the benefits from reducing import tariffs on staples are likely to accrue largely to the non-poor. Safety net programs can be more effective, but geographic targeting and other investments to strengthen safety nets are necessary to ensure that fewer people are affected by future crises.

/pdf/rising-food-prices-in-sub-saharan-africa-poverty-impact-and-31a5adbcuz.pdf

Rising Food Prices in Sub-Saharan Africa: Poverty Impact and Policy Responses

Global food prices have increased substantially since mid-2010 as have prices in many developing countries. In this study we assess the poverty impact of the price changes between June and December 2010 in twenty-eight low and middle income countries. This is done by gathering detailed information on individual households' food production and consumption levels for thirty-eight agricultural and food commodities to assess the impacts on household welfare. This study estimates that this sudden food price surge increased the number of poor people globally, but with considerably different impacts in different countries. The heterogeneity of these impacts is partly related to the wide variation in the transmission of global prices to local prices and partly to differences in households' patterns of production and consumption. On balance, the adverse welfare impact on net buyers outweighs the benefits to net sellers resulting in an increase in the number of poor and in the depth of poverty. We estimate that the average poverty change was 1.1 percentage points in low income countries and 0.7 percentage points in middle income countries with a net increase of 44 million people falling below the $1.25 per day extreme poverty line.

Estimating the Short-Run Poverty Impacts of the 2010-2011 Surge in Food Prices

https://www.jstor.org/stable/10.1086/343884

Who gained from Vietnam's boom in the 1990s?

The author examines the extent to which micro-credit reduces poverty and vulnerability through a case study of BRAC, one of the largest providers of micro-credit to the poor in Bangladesh. Household consumption data collected from 1,072 households is used to show that the largest effect on poverty arises when a moderate-poor BRAC loanee borrows more than 10,000 taka (U$S 200) in cumulative loans. Different control groups and estimation techniques are used to illustrate this point. The author discusses several ways by which membership in micro-credit programs reduces vulnerability - by smoothing consumption, building assets, providing emergency assistance during natural disasters, and contributing to female empowerment. The reduction in female vulnerability in a patriarchal society is illustrated using 16 female empowerment indicators developed from data on 1,568 women. The results suggest that micro-credit's greatest impact is on the set of indicators relating to female control over assets and knowledge of social issues. The author also argues that micro-credit's impact on poverty and vulnerability can be strengthened if credit is provided jointly with other financial (savings and insurance) and non-financial (legal education, food relief) interventions.

Assessing the impact of micro-credit on poverty and vulnerability in Bangladesh

Vietnam's gains in poverty reduction between 1992 and 1998 were striking, and the country's impressive growth has been fairly broad-based. Households that have benefited most are well-educated, urban, white-collar households, while agricultural workers, ethnic minorities, and those residing in poorer regions have progressed least. Glewwe, Gragnolati, and Zaman assess the extent to which Vietnam's rapid economic growth in the 1990s was accompanied by reductions in poverty. They also investigate factors that contribute to certain households benefiting more than others. Using information from two household surveys, the Vietnam Living Standards Surveys (VNLSS) for 1992-93 and 1997-98, they show that Vietnam's gains in poverty reduction were striking during this period and that the country's impressive growth has been fairly broad-based. After discussing descriptive statistics for both years, the authors examine factors contributing to poverty reduction using both simple decomposition analysis and a multinomial logit model. The results show that: Returns to education increased significantly during this period, particularly for higher levels of education. Location significantly affected a household's probability of escaping poverty during this period. Urban households enjoyed a greater reduction in poverty than did rural households, and households residing in the Red River Delta and the southeast were also better able to take advantage of new opportunities. White-collar households benefited most, and agricultural laborers the least. However, Vietnam cannot afford to be complacent, as nearly half its rural population lives below the poverty line, poverty rates among ethnic minorities remain very high, and natural calamities are a serious impediment to poverty reduction. This paper - a product of Poverty and Human Resources, Development Research Group - is part of a larger effort in the group to understand the dynamics of poverty.

https://papers.ssrn.com/sol3/Delivery.cfm/1029.pdf?abstractid=629125&mirid=1

Hassan Zaman

Papers

Rising Food Prices in Sub-Saharan Africa: Poverty Impact and Policy Responses

Estimating the Short-Run Poverty Impacts of the 2010-2011 Surge in Food Prices

Who gained from Vietnam's boom in the 1990s?

Assessing the impact of micro-credit on poverty and vulnerability in Bangladesh

Who Gained from Vietnam's Boom in the 1990s? An Analysis of Poverty and Inequality Trends