Encouraging citizens to apply pressure on underperforming service providers has emerged in recent years as a prominent response to the failure of states to provide needed services. We outline three theoretical mechanisms through which bottom-up citizen-oriented pressure campaigns may affect development outcomes and investigate them via a large-scale field experiment in the Ugandan health sector. While we find modest positive impacts on treatment quality and patient satisfaction, we find no effects on utilization rates, child mortality, or other health outcomes. We also find no evidence that citizens increased their monitoring or sanctioning of health workers. Our findings, therefore, cast doubt on the power of outside actors to generate bottom-up pressure by citizens or improvements in development outcomes. Held up against the findings of other, similar studies, our results point to the salience of mechanisms other than citizen pressure for improvements in service delivery, and to the importance of baseline health conditions for the success of bottom-up, citizen-oriented pressure campaigns. Such conditions shape outcomes both across countries and within countries over time, with the latter finding holding important implications for countries undergoing rapid socioeconomic change.

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Working Paper
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October 30, 2020
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Objectives: Disrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors, or associated outcomes. This study aimed to examine these practices and associations with health care satisfaction, use, and breastfeeding.

Design: Prospective cohort study

Setting: Health facilities in Nairobi and Kiambu counties in Kenya

Participants: Data were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1,014 women surveyed at baseline and at least one follow-up at 2-4 or 10 weeks postpartum.

Primary and secondary outcome measures: 1) Outcomes related to satisfaction with care and care utilization, 2) Continuation of post-discharge newborn care practices such as breastfeeding.

Results: 17.6% of women reported being separated from their newborns at the facility after delivery, of whom 71.9% were separated over 10 minutes. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 minutes) were 44% less likely to be exclusively breastfeeding at 2-4 weeks (aOR=0.56, 95%CI: 0.40, 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95%CI: 1.67, 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95%CI: 1.05, 4.41), and 33% greater likelihood of exclusive breastfeeding at 10 weeks (aOR=1.33, 95%CI: 1.10, 1.62).

Conclusions: Newborns, mothers, and families have a right to high quality, respectful care, including the ability to stay together, be informed and have proper consent for care. The implications of these practices on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care.

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October 21, 2020
Spanish

La contaminación atmosférica crónica en Bogotá, Colombia, tiene graves impactos en la salud humana. El uso de tecnologías de la información y la comunicación (TIC) para difundir información sobre la calidad del aire puede permitir a los ciudadanos reducir su exposición a la contaminación del aire, por ejemplo, evitando que las personas hagan ejercicio al aire libre en ciertos días y en ciertos lugares donde la calidad del aire no es buena, y también puede ayudar a cambiar sus actitudes ambientales y preferencias de política. Para investigar estos vínculos, investigadores del Banco Interamericano de Desarrollo se han asociado con IPA y el Laboratorio de Economía Experimental y del Comportamiento del Rosario (REBEL) para evaluar el impacto de la información sobre la calidad del aire, difundida a través de una aplicación para teléfonos inteligentes llamada AIRE BOGOTÁ, en: los comportamientos de evitación, las actitudes ambientales y las preferencias políticas.

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Brief
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October 19, 2020
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Objective: To understand perspectives and experiences related to participation in a quality improvement collaborative (QIC) to improve person-centered care (PCC) for maternal health and family planning (FP) in Kenya.

Design and setting: Semi-structured qualitative interviews were conducted with members of the QIC in four public health facilities in Kenya.

Participants: Clinical and nonclinical public health facility staff who had participated in the QIC were purposively sampled to participate in the semi-structured interviews.

Intervention: A QIC was implemented across four public health facilities in Nairobi and Kiambu Counties in Kenya to improve PCC experiences for women seeking maternity or FP services.

Main outcome measure: Semi-structured interviews with participants of the QIC to understand perspectives and experiences associated with sensitization to and implementation of PCC behaviors in maternity and FP services.

Results: Respondents reported that sensitization to PCC principles resulted in multiple perceived benefits for staff and patients alike, including improved interactions with patients and clients, deeper awareness of patient and client preferences, and improved interpersonal skills and greater job satisfaction. Respondents also highlighted system-level challenges that impeded their ability to consistently provide high-quality PCC to women, namely staff shortages and frequent turnover, high patient volumes and lack of space in their respective health facilities.

Conclusion: Respondents were easily able to articulate perceived benefits derived from participation in this QIC, although they were equally able to identify challenges that hindered their ability to consistently provide high-quality PCC to women seeking maternity or FP services.

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October 15, 2020
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In Sierra Leone, we have continued our global tradition of rigorous, applicable research by building foundational research capacity and generating evidence to reduce poverty and achieve the Sustainable Development Goals (SDGs). Examples of our key research findings are outlined in this brief.

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October 09, 2020
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La efectividad de las recomendaciones de mitigación de COVID-19, como el distanciamiento social y el uso de mascarillas, depende fundamentalmente del cumplimiento por parte de las personas, especialmente de los adultos jóvenes, quienes tienen menos probabilidades de sufrir complicaciones graves por el virus, pero más probabilidades de infectarse y propagarlo. En Colombia, los investigadores están trabajando junto con IPA para entender mejor el cumplimiento de las recomendaciones de mitigación del COVID-19 por parte de los adultos jóvenes y evaluar la efectividad de varias intervenciones informativas para impulsar su cumplimiento.

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September 03, 2020
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We examine some effects of Universal Basic Income (UBI) during the COVID-19 pandemic using a large-scale experiment in rural Kenya. Transfers significantly improved well-being on common measures such as hunger, sickness and depression in spite of the pandemic, but with modest effect sizes. They may have had public health benefits, as they reduced hospital visits and decreased social (but not commercial) interactions that influence contagion rates. During the pandemic (and contemporaneous agricultural lean season) recipients lost the income gains from starting new non-agricultural enterprises that they had initially obtained, but also suffered smaller increases in hunger. This pattern is consistent with the idea that UBI induced recipients to take on more income risk in part by mitigating the most harmful consequences of adverse shocks.

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September 02, 2020
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Understanding how to keep vulnerable people safe from violence and trauma is critically important, yet violence research is fraught with challenges. IPA’s Intimate Partner Violence (IPV) Initiative has been generating knowledge and solutions about how to reduce violence against women since 2016. This resource shares some strategies from the initiative on conducting responsible and ethical IPV research. 

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Research Resource
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August 20, 2020
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Se ha demostrado que en situaciones de emergencia la asistencia de dinero ayuda a los beneficiarios a mitigar las consecuencias económicas resultantes, por ejemplo, mediante el aumento de la seguridad alimentaria. La Devolución del IVA, una nueva transferencia de dinero incondicional en Colombia, asistirá a 1 millón de hogares de bajos ingresos en atravesar la crisis económica a causa de la pandemia del COVID-19. A través de una evaluación aleatoria, los investigadores podrán medir los efectos de la transferencia en la salud física y mental de los beneficiarios, la seguridad alimentaria, la seguridad financiera y el aprendizaje de los niños, entre otros. 

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August 11, 2020
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The Cox’s Bazar Panel Survey (CBPS) tracks representative samples of Rohingya refugees and host communities in Cox’s Bazar district in southern Bangladesh. A phone-based follow-up survey from April 2020 reveals that, despite widespread knowledge of COVID-19, attendance at religious gatherings is high, representing a potentially important pathway for disease spread in refugee camps and host communities in Cox’s Bazar. Even after the imposition of lockdown restrictions in early April, attendance to religious events was still common in refugee camps and host communities alike. Over 75% of men in refugee camps and over 50% of men in host communities reported attending religious services at least once in the week prior to the survey (April 9-16, 2020). Most male respondents who attended religious gatherings did so regularly, for an average of 4.0 days and 2.2 days in the last week for refugees and hosts, respectively. These behaviors are prevalent despite widespread awareness of the sources of COVID-19 trans-mission. When asked about trusted sources of advice on COVID-19, both hosts and refugees identified friends, acquaintances, and community leaders—including religious leaders—as important. In fact, 44% of refugees place their trust in community leaders such as block majhees; putting them in front of other trusted sources of information including family, relatives, and informational campaigns.

In a separate survey of Imams from around Bangladesh, we find considerable willingness to make changes: almost every respondent had adjusted their practices in some way. Still, some important measures remain uncommon, including discouraging attendance of the elderly, removal of the communal prayer mat, and postponing congregational prayer. This may be due to respondents’ subjective assessment of the risk posed by COVID-19. About two-thirds of Imams felt that COVID-19 posed no or low risk to their communities. Given the ongoing attendance of religious gatherings and the trust placed in religious leaders, policies should be targeted towards decreasing prayer gathering sizes, reducing frequency of prayer attendance, and disseminating public health and social distancing advice through a key trusted source of information: Imams and religious leaders themselves.

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July 29, 2020
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La propagación global del COVID-19 y las medidas de confinamiento para contenerle han incrementado el estrés económico y la violencia doméstica. Para enfrentar este desafío, los investigadores se han asociado en Colombia con IPA, Fundación Capital y Comfama para evaluar el impacto de una intervención interactiva basada en WhatsApp, que pretende mejorar la salud financiera y reducir la violencia doméstica al introducir consejos de comunicación de pareja en un programa existente de educación financiera. Los investigadores están midiendo el impacto en capacidad financiera, empoderamiento de las mujeres e incidencia de la violencia doméstica en el contexto de la pandemia por COVID-19. 

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July 24, 2020

This study exploits a randomized school health intervention that provided deworming treatment to Kenyan children and utilizes longitudinal data to estimate impacts on economic outcomes up to 20 years later. The effective respondent tracking rate was 84%. Individuals who received 2 to 3 additional years of childhood deworming experience an increase of 14% in consumption expenditure, 13% in hourly earnings, 9% in non-agricultural work hours, and are 9% more likely to live in urban areas. Most effects are concentrated among males and older individuals. Given deworming's low cost, a conservative annualized social internal rate of return estimate is 37%.

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July 01, 2020
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This study reports results from a randomized evaluation of a mandatory six-month internet-based sexual education course implemented across public junior high schools in 21 Colombian cities. Six months after finishing the course, the study finds a 0.4 standard deviation improvement in knowledge, a 0.2 standard deviation improvement in attitudes, and a 55 percent increase in the likelihood of redeeming vouchers for condoms as a result of taking the course. The data provide no evidence of spillovers to control classrooms within treatment schools. However, the analysis provides compelling evidence that treatment effects are enhanced when a larger share of a student’s friends also takes the course. The low cost of the online course along with the effectiveness the study documents suggests this technology is a viable alternative for improving sexual education in middle-income countries.

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June 03, 2020
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We study the prevalence of COVID‐19 symptoms in refugee and host communities and their correlates with current and pre‐COVID‐19 living conditions. We administered a phone‐based survey to a sample of 909 households in Cox’s Bazar which was drawn from a household panel representative of Rohingya refugees and the host population. We conducted a symptoms checklist to assess COVID‐19 risk based on the WHO guidelines. We included questions covering returning migration, employment, and food security. We asked additional questions on health knowledge and behaviors to a random subsample (n=460). 24.6% of camp residents and 13.4% of those in host communities report at least one common symptom of COVID‐19. Among those seeking treatment, a plurality did so at a pharmacy (42.3% in camps, 69.6% in host communities). While most respondents report good respiratory hygiene, between 76.7% (camps) and 52.2% (host community) had attended a communal prayer in the previous week. Another 47.4% (camps) 34.4% (host community) had attended a non‐religious social gathering. The presence of returning migrants, respondent mobility, and food insecurity strongly predict COVID‐19 symptoms. Conclusion. COVID‐19 symptoms are highly prevalent in Cox’s Bazar, especially in refugee camps. Attendance at religious and social events threatens efforts to contain the spread of the disease. Pharmacies and religious leaders are promising outlets to disseminate life‐saving information.

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May 19, 2020
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Cox’s Bazar district in Bangladesh has received multiple waves of Rohingya refugees from Myanmar since the 1970s, but late 2017 saw the largest and fastest refugee influx in Bangladesh’s history. Between August 2017 and December 2018, 745,000 Rohingya refugees fled Myanmar into Cox’s Bazar, Bangladesh, following an outbreak of violence in Rakhine State. As of December 31, 2019, Teknaf and Ukhia sub-districts host an estimated 854,704 stateless Rohingya refugees, almost all of whom live in densely populated camps (UNHCR 2019).

Researchers from Yale University, the World Bank, and the Gender and Adolescence: Global Evidence (GAGE) initiative started the Cox’s Bazar Panel Survey (CBPS) in order to provide accurate data to humanitarian and government stakeholders involved in the response to the influx of refugees. The survey is an in-depth household survey covering 5,020 households living in both refugee camps and host communities. This quantitative data collection is complemented with qualitative interviews with adolescents and their caregivers.

In line with the 2018 Global Compact for Refugees commitment to promote economic opportunities, decent work, and skills training for both host community members and refugees, this brief presents a set of stylized facts on the socioeconomic status of Rohingya refugees in 2019 and in the year preceding the latest outbreak of violence.

The aim is to better understand the ways in which the challenges faced by Rohingya refugees while they were living in Myanmar are likely to affect their ability—and the ability of future generations of Rohingya—to attain a better living standard in their host communities, with a view to informing policy and programming.

Drawing from a survey on retrospective employment and labor income from the first round of panel data in 2019, we compare three groups: the population of Myanmar, Rohingya people who crossed the border into Bangladesh in 2017, and those who left Myanmar prior to 2017 and are currently living in Cox’s Bazar.

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Brief
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April 30, 2020

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