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The COVID-19 pandemic is an unprecedented global challenge that has affected the health and livelihood of billions worldwide. Citizens of low-income countries have been affected by the pandemic in nearly all areas of life, and the impacts have been particularly challenging for those with limited access to social safety nets. Bangladesh is especially susceptible to the negative economic impacts of the pandemic due to its strong ties to the global economy, and these negative demand shocks are likely to persist throughout and after the pandemic.

Researchers conducted two rounds of phone surveys in July 2020 and December 2020 with 3,125 vulnerable households with children across seven regions of Bangladesh. Across the two rounds of surveys, we find that the negative economic impacts of the COVID-19pandemic have persisted at least six months after the lifting of the general economic lockdown at the end of May 2020. Collectively, these findings point to several areas of need for vulnerable households, particularly in the area of education, mental health, and gender-based violence.

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March 24, 2021
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Founded in 2019, IPA Nigeria develops applicable research by building foundational research capacity and conducting evaluations in areas of pressing national concern. Examples of our work in this brief offer promising insights into critical issues that affect the lives of the Nigerian poor.

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March 01, 2021
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This study uses a randomized controlled trial in Pakistan to test whether one-on-one engagement with community religious leaders can encourage them to instruct congregants to comply with public health guidelines when attending religious gatherings. Treated religious leaders are 25% more likely to tell a "mystery shopper" he must wear a mask to attend. Treatment effects are driven by respondents who understand COVID transmission at baseline, suggesting the treatment does not work by correcting basic knowledge about the disease. Rather, it may work by connecting this knowledge to respondents' pro-social motivations and actions that they can take as community leaders.

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Working Paper
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February 01, 2021

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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Published Paper
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October 21, 2020
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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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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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Published Paper
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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

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