Ben D'Exelle

Identification of poor households for premium exemptions in Ghana's National Health Insurance Scheme: empirical analysis of three strategies

Objectives  To evaluate the effectiveness of three alternative strategies to identify poor households: means testing (MT), proxy means testing (PMT) and participatory wealth ranking (PWR) in urban, rural and semi‐urban settings in Ghana. The primary motivation was to inform implementation of the National Health Insurance policy of premium exemptions for the poorest households.

Gender and network formation in rural Nicaragua : a village case study

Abstract This contribution examines the relation between gender and network formation in rural Nicaragua in 2007 and studies differences in the structure and contents of mens and womens networks. Such differences are relevant, as network theory suggests that structural characteristics – as well as the contents of networks – strongly influence the type and amount of benefits generated. Through the application of dyadic regression techniques, this study examines the determinants of the size and socioeconomic heterogeneity of individual networks. Research findings suggest gender segregation of networks and considerable differences in the structure and content of mens and womens networks. These differences relate to the gendered division of labor and to womens time poverty in particular. Our results are relevant in a context where policy makers increasingly consider social networks an important policy tool. We caution against a gender-blind alignment on existing social networks and argue for detailed mapping and unpacking of social networks through a gender lens.

Who Engages in Water Scarcity Conflicts? A Field Experiment with Irrigators in Semi-Arid Africa

Does water scarcity induce conflict? And who would engage in a water scarcity conflict? In this paper we look for evidence of the relation between water scarcity and conflictive behavior. With a framed field experiment conducted with smallholder irrigators from semi-arid Tanzania that replicates appropriation from an occasionally scarce common water flow we assess what type of water users is more inclined to react in conflictive way to scarcity. On average, water scarcity induces selfish appropriation behavior in the experiment which is regarded conflictive in the Tanzanian irrigator communities where strong noncompetition norms regulate irrigation water distribution. But not all react to water scarcity in the same way. Poor, marginalized, dissocialized irrigators with low human capital and with higher stakes are most likely to react with conflictive appropriation behavior to water scarcity. Viewed a political ecology perspective we conclude that circumstances in Tanzania are conducive to resource scarcity conflicts. Water scarcity and water values are increasing. Water governance institutions entail exclusionary elements. Moreover, a higher likelihood to react in a conflictive way to water scarcity coincides with real economic and political inequalities which could form a basis for mobilization for more violent ways of competing for scarce resources.

Excluded Again: Village Politics at the Aid Interface

Abstract Making use of a rural household survey, we show that in villages with a stronger monopolisation of the aid interface by local élites, households are more likely excluded from all aid. Moreover, these villages have less access to aid but this tends to be insufficient for political alternatives to emerge spontaneously, mainly due to their relatively low visibility in these villages. Finally, if village members themselves manage to bring about a political change, this does not automatically improve the conditions of the most excluded. We recommend aid donors to assume a more active role in searching and selecting community representatives.

The long term economic impact of severe obstetric complications for women and their children in Burkina Faso

This study investigates the long term economic impact of severe obstetric complications for women and their children in Burkina Faso, focusing on measures of food security, expenditures and related quality of life measures. It uses a hospital based cohort, first visited in 2004/2005 and followed up four years later. This cohort of 1014 women consisted of two main groups of comparison: 677 women who had an uncomplicated delivery and 337 women who experienced a severe obstetric complication which would have almost certainly caused death had they not received hospital care (labelled a “near miss” event). To analyze the impact of such near miss events as well as the possible interaction with the pregnancy outcome, we compared household and individual level indicators between women without a near miss event and women with a near miss event who either had a live birth, a perinatal death or an early pregnancy loss. We used propensity score matching to remove initial selection bias. Although we found limited effects for the whole group of near miss women, the results indicated negative impacts: a) for near miss women with a live birth, on child development and education, on relatively expensive food consumption and on women’s quality of life; b) for near miss women with perinatal death, on relatively expensive foods consumption and children’s education and c) for near miss women who had an early pregnancy loss, on overall food security. Our results showed that severe obstetric complications have long lasting consequences for different groups of women and their children and highlighted the need for carefully targeted interventions.

Modernisation and Time Preferences in Tanzania: Evidence from a Large-Scale Elicitation Exercise

Abstract Assumptions about individual time preferences are important for explanations of poverty and development. Data from a large-scale elicitation exercise in Tanzania show significantly higher levels of impatience in urban areas than in rural areas. This result remains robust to adding controls for socio-economic differences between rural and urban areas, which possibly correlate with time preferences. We attribute this to differences in ‘modernisation’ between urban and rural areas, with modernisation leading to increased impatience. This is corroborated by the observed positive correlation between impatience and education; the latter being an important vehicle of modernisation for traditional societies in Tanzania.

Equity–Efficiency Optimizing Resource Allocation: The Role of Time Preferences in a Repeated Irrigation Game†

We study repeated water allocation decisions among small scale irrigation users in Tanzania. In a treatment replicating water scarcity conditions, convexities in production make that substantial efficiency gains can be obtained by deviating from equal sharing, leading to an equity–efficiency trade-off. In a repeated game setting, it becomes possible to reconcile efficiency with equity by rotating the person who receives the largest share, but such a strategy requires a longer run perspective. Correlating experimental data from an irrigation game with individual time preference data, we find that less patient irrigators are less likely to use a rotation strategy.

Sharing Common Resources in Patriarchal and Status Based Societies: Evidence from Tanzania

ABSTRACT In rural African societies, socioeconomic differentiation linked to gender and social status exerts an important influence on the distribution of common-pool resources. Through a behavioral experiment conducted in 2008 in rural Tanzania, this contribution examines the influence of gender and social status on distribution behavior of users of self-governed common watersheds. It finds that men and women with low social status distribute water equally when water is abundant but keep larger shares when water is scarce, although low-status women try to be as fair as possible at the expense of their returns from irrigated agriculture. Men of high social status keep more than half of the available water for themselves, both in abundance and scarcity, and deprive others from sizeable returns from irrigated agriculture. Women of high social status share altruistically when water is abundant and equally when water is scarce, giving up on returns from irrigated agriculture.

Investment Behaviour, Risk Sharing and Social Distance

Using a lab-in-the-field experiment in Uganda we study how risk sharing influences investment behaviour. Depending on the treatment, an investor may decide to share profits with a paired person, and/or the paired person may compensate the investor for investment losses. Following sharing norms in African societies, predicted investment is higher if loss sharing is possible, and/or profit sharing is not possible. Contrary to these predictions, we find that investment is higher when losses may not be shared or when profits may be shared with friends. A combination of directed altruism and expected reciprocity appears most plausible to explain these results.

How Economic Empowerment Reduces Women’s Reproductive Health Vulnerability in Tanzania

Abstract This article uses data from Northern Tanzania to analyse how economic empowerment helps women reduce their reproductive health (RH) vulnerability. It analyses the effect of women’s employment and economic contribution to their household on health care use at three phases in the reproductive cycle: before pregnancy, during pregnancy and at child birth. Economic empowerment shows a positive effect on health seeking behaviour during pregnancy and at child birth, which remains robust after controlling for bargaining power and selection bias. This indicates that any policy that increases women’s economic empowerment can have a direct positive impact on women’s RH.