Pedro Olinto

Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial

BACKGROUND Scaling-up of effective preventive interventions in child and maternal health is constrained in many developing countries by lack of demand. In Latin America, some governments have been trying to increase demand for health interventions by making direct payments to poor households contingent on them keeping up-to-date with preventive health services. We undertook a public health programme effectiveness trial in Honduras to assess this approach, contrasting it with a direct transfer of resources to local health teams. METHODS 70 municipalities were selected because they had the countrys highest prevalence of malnutrition. They were allocated at random to four groups: money to households; resources to local health teams combined with a community-based nutrition intervention; both packages; and neither. Evaluation surveys of about 5600 households were undertaken at baseline and roughly 2 years later. Pregnant women and mothers of children younger than 3 years old were asked about use of health services (primary outcome) and coverage of interventions such as immunisation and growth monitoring (secondary outcome). Reports were supplemented with data from childrens health cards and government service utilisation data. Analysis was by mixed effects regression, accounting for the municipality-level randomisation. FINDINGS The household-level intervention had a large impact (15-20 percentage points; p<0.01) on the reported coverage of antenatal care and well-child check-ups. Childhood immunisation series could thus be started more opportunely, and the coverage of growth monitoring was markedly increased (15-21 percentage points; p<0.01. Measles and tetanus toxoid immunisation were not affected. The transfer of resources to local health teams could not be implemented properly because of legal complications. INTERPRETATION Conditional payments to households increase the use and coverage of preventive health care interventions.

Rural Nonfarm Employment and Income Diversification in Colombia

Abstract Using data for rural households from Colombia we find that off-farm employment contributes a significant share (45% on average) to household income but that the importance of off-farm income and returns to household labor vary over the income distribution. Analysis reveals significant gains from specialization but—for households able to specialize—no systematic differences in returns to labor between farm and nonfarm sources. We conclude that, in Colombia, there is no conflict between development of the farm and the nonfarm sector but that, to maximize gains from nonfarm development and reduce the scope for undesirable distributional consequences, policies enabling households to specialize might be called for.

Why Liberalization Alone Has Not Improved Agricultural Productivity in Zambia: The Role of Asset Ownership and Working Capital Constraints

The authors use a large panel data set from Zambia to examine factors that could explain the relatively lackluster performance of the countrys agricultural sector after liberalization. Zambias liberalization significantly opened the economy but failed to alter the structure of production or help realize efficiency gains. They reach two main conclusions. First, not owning productive assets (in Zambia, draft animals and implements) limits improvements in agricultural productivity and household welfare. Owning oxen increases income directly, allows farmers to till their fields efficiently when rain is delayed, increases the area cultivated, and improves access to credit and fertilizer markets. Second, the authors reject the hypothesis that the application of fertilizer is unprofitable because of high input prices. Rather, fertilizer use appears to have declined because of constraints on supplies, which government intervention exacerbated instead of alleviating. (Extending the use of fertilizer to the many producers not currently using it would be profitable, but increasing the amount applied by the few producers who now have access to it would not be.) Policies to foster accumulation of the assets needed for agricultural production (including draft animals and implements) and to provide complementary public goods (education, credit, and good agricultural extension services) could greatly help reduce poverty and improve productivity.

Gender Bias in Intrahousehold Allocation: Evidence from an Unintentional Experiment

We use data from a Brazilian social program to investigate the existence of gender bias in intrahousehold allocations of resources. The program makes cash transfers to mothers and pregnant women in poor households. Bureaucratic mistakes, beyond the control of the applicants, have inadvertently excluded many households that had applied and were accepted to the program. This unintentional natural experiment is used to identify the impact of an exogenous variation in female nonlabor income over household consumption. We find that program participation led to an increase in food expenditure, but this effect is not due to women being the benefit recipients.

Accelerating Poverty Reduction in a Less Poor World: The Roles of Growth and Inequality

This paper re-examines the roles of changes in income and inequality in poverty reduction. The study provides estimates of the relative effects of inequality reduction versus growth promotion in reducing poverty for countries with different levels of initial poverty. The analysis uses country panel-data for 1980-2010. The results indicate that, as countries become less poor, inequality-reducing policies are likely to become relatively more effective for poverty reduction than growth-promoting policies. The results indicate that the growth elasticity of poverty reduction either increases or remains constant with the level of initial poverty. Nevertheless, the results also strongly indicate that, as poverty declines, the inequality elasticity of poverty reduction increases faster. Therefore, if the marginal cost of reducing inequality relative to the marginal cost of increasing growth does not increase with lower poverty levels, to accelerate poverty reduction, greater emphasis should be given to equity rather than growth as countries attain higher levels of development.