Colin Andrews

Small area estimation of child malnutrition in Ethiopian woredas

Reducing child undernutrition is a key social policy objective of the Ethiopian government. Despite substantial reduction over the last decade and a half, child undernutrition is still high; with 48 percent of children either stunted, underweight or wasted, undernutrition remains an important child health challenge. The existing literature highlights that targeting of efforts to reduce undernutrition in Ethiopia is inefficient, in part due to lack of data and updated information. This paper remedies some of this shortfall by estimating levels of stunting and underweight in each woreda for 2014. The estimates are small area estimations based on the 2014 Demographic and Health Survey and the latest population census. It is shown that small area estimations are powerful predictors of undernutrition, even compared to household characteristics, such as wealth and education, and hence a valuable targeting metric. The results show large variations in share of children undernourished within each region, more than between regions. The results also show that the locations with larger challenges depend on the chosen undernutrition statistic, as the share, number and concentration of undernourished children point to vastly different locations. There is also limited correlation between share of children underweight and stunted across woredas, indicating that different locations face different challenges.

Liberia's Cash for Work Temporary Employment Project : responding to crisis in low income, fragile countries

Together with reductions in indirect taxes on food imports, cash for work programs were one of the main responses implemented by African governments following the food, fuel, and financial crisis of recent years. The main objective of those programs was to help the poor cope with the various shocks by increasing their net earnings through community-level work paid for under the programs. Yet it is unclear whether these cash for work programs indeed reached their intended beneficiaries and to what degree they generated other, potentially long-term beneficial impacts. This paper explores these issues in the context of Liberia and the performance of the Cash for Work Temporary Employment Program (CfWTEP) funded by the World Bank through an emergency crisis facility in response to the 2007/2008 food crisis. Both quantitative and qualitative data are presented, focusing on the operational and policy experiences emerging from program implementation. This paper analyzes the context that led to the creation and implementation of the CfWTEP in Liberia, the nature and administrative arrangements for the program, and its operational performance. The objective is to share the lessons learned from evaluation findings so that they can be useful for implementing similar programs in the future in Liberia itself or in other countries. Findings from the analysis highlight the possibilities of implementing public works program in low capacity, post conflict setting and the scope for using the program as a springboard towards a broader and more comprehensive social safety net.

Social Safety Nets in Fragile States: A Community-Based School Feeding Program in Togo

This paper reviews a small community-based school feeding program launched in Togo in response to the 2007/08 food price crisis. The discussion focuses on the operational and policy lessons emerging from the program, to better understand opportunities for scale up and sustainability in the future. A focus of the discussion is how to build safety nets in fragile states and in situations where there is weak and fragmented government capacity to deliver services to disadvantaged and vulnerable communities. In this context school feeding is explored as an entry point through the use of informal mechanisms based on the commitment of communities and civil society. The analysis is premised on quantitative and qualitative analysis carried out at program sites. The discussion identifies the operational challenges and opportunities in customizing school feeding within Togo with an emphasis on targeting, cost effectiveness, procurement and institutional aspects. Evidence on the economic and social benefits of the program is also presented, focusing on dietary impacts, as well as household and local community effects. The objective of the discussion is to share lessons learned from evaluation findings so that they can be useful for implementing similar programs in the future in Togo itself or in other countries. Findings from the analysis highlight the possibilities of implementing school feeding in a low capacity setting and the scope for using the program as a springboard towards a broader and more comprehensive social safety net.

Examining Changes in Maternal and Child Health Inequalities in Ethiopia

BackgroundEthiopia has made considerable progress in maternal, newborn, and child health in terms of health outcomes and health services coverage. This study examined how different groups have fared in the process. It also looked at possible factors behind the inequalities.MethodsThe study examined 11 maternal and child health outcomes and services: stunting, underweight, wasting, neonatal mortality, infant mortality, under-5 mortality, measles vaccination, full immunization, modern contraceptive use by currently married women, antenatal care visits, and skilled birth attendance. It explored trends in inequalities by household wealth status based on Demographic and Health Surveys conducted in 2000, 2005, 2011, and 2014. The study also investigated the dynamics of inequality, using concentration curves for different years. Decomposition analysis was used to identify the role of proximate determinants.ResultsThe study found substantial improvements in health outcomes and health services: Although there is still a considerable gap between the rich and the poor, inequalities in health services have been reduced. However, child nutrition outcomes have mainly improved for the rich. The changes observed in wealth-related inequality tend to reflect the changing direct effect of household wealth on child health and health service use.ConclusionsThe country’s efforts to improve access to health services have shown some positive results, but attention should now turn to service quality and to identifying multisectoral interventions that can change outcomes for the poorest.

Maternal and child health inequalities in Ethiopia

Recent surveys show considerable progress in maternal and child health in Ethiopia. The improvement has been in health outcomes and health services coverage. The study examines how different groups have fared in this progress. It tracked 11 health outcome indicators and health interventions related to Millennium Development Goals 1, 4, and 5. These are stunting, underweight, wasting, neonatal mortality, infant mortality, under-five mortality, measles vaccination, full immunization, modern contraceptive use by currently married women, antenatal care visits, and skilled birth attendance. The study explores trends in inequalities by household wealth status, mothers’ education, and place of residence. It is based on four Demographic and Health Surveys implemented in 2000, 2005, 2011, and 2014. Trends in rate differences and rate ratios are analyzed. The study also investigates the dynamics of inequalities, using concentration curves for different years. In addition, a decomposition analysis is conducted to identify the role of proximate determinants. The study finds substantial improvements in health outcomes and health services. Although there still exists a considerable gap between the rich and the poor, the study finds some reductions in inequalities of health services. However, some of the improvements in selected health outcomes appear to be pro-rich.