India's fast-growing cities face three key challenges in improving public health outcomes. The first is the persistence of weak links in the chain -- notably, slums badly underserved with basic civic services -- that can pose public health threats to all.
... See More + Richer residents corner public resources, such as water and sanitation services, but their children's health indicators suggest they are deeply affected by contagion from the broader urban environment. The second challenge relates to devolution of services to elected bodies. Devolution works poorly for intangible and highly technical services, such as public health, where success is measured by the lack of (adverse) events. The third challenge is high fragmentation of services that directly affect health outcomes. In India, some cities have addressed these challenges more effectively than others have. This paper explores the management of municipal public health services in two major Indian metropolises with sharply contrasting health and sanitation indicators. The paper explains how Chennai mitigates these challenges through active service outreach to vulnerable populations, and a considered approach to devolution that distributes responsibilities appropriately between line agencies, technical personnel, and elected representatives. Services in Delhi are quite constrained. These policy lessons are pertinent to other Indian cities and beyond.
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Policy Research Working Paper WPS8197 SEP 18, 2017
Das Gupta,Monica; Dasgupta,Rajib; Kugananthan,P.; Rao,Vijayendra; Somanathan,Trikkur V.; Tewari,K.N.Disclosed
Sex ratios at birth rose sharply in the South Caucasus countries after 1991, but recent data indicate that this trend is turning. What caused this rise, and what can be done to accelerate its normalization?
... See More + Traditional kinship systems in the region are similar to those of other settings with sex-selection: structured for collaboration among male kin and dependence only on sons, not daughters. Yet it is anomalous to find sex-selection in a region that under the Soviet Union has for long been substantially urbanized and gender-equitable in public life — factors associated with declines in sex-selection elsewhere. Sex-selection manifested itself only after the sudden economic and governance meltdown following the dissolution of the Soviet Union in 1991. Jobs, basic services, and social protection mechanisms unraveled. People scrambled for coping mechanisms, and sons offer the traditional form of support under uncertainty. Basic services, pensions, and safety nets have been rebuilt, but the process involved years of policy changes. Strengthening these institutions, and maintaining credible continuity of expectations in them, is critical to accelerating normalization of sex ratios.
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Policy Research Working Paper WPS7236 APR 09, 2015
Sex ratios at birth rose sharply in the South Caucasus countries after 1991, but recent data indicate that this trend is turning. What caused this rise, and what can be done to accelerate its normalization?
... See More + Traditional kinship systems in the region are similar to those of other settings with sex-selection: structured for collaboration among male kin and dependence only on sons, not daughters. Yet it is anomalous to find sex-selection in a region that under the Soviet Union has for long been substantially urbanized and gender-equitable in public life factors associated with declines in sex-selection elsewhere. Sex-selection manifested itself only after the sudden economic and governance meltdown following the dissolution of the Soviet Union in 1991. Jobs, basic services, and social protection mechanisms unraveled. People scrambled for coping mechanisms, and sons offer the traditional form of support under uncertainty. Basic services, pensions, and safety nets have been rebuilt, but the process involved years of policy changes. Strengthening these institutions, and maintaining credible continuity of expectations in them, is critical to accelerating normalization of sex ratios.
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Working Paper (Numbered Series) 125541 APR 01, 2015
The World Bank Research Observer is intended for anyone who has a professional interest in development. Observer articles are written to be accessible to nonspecialist readers; contributors examine key issues in development economics, survey the literature and the latest World Bank research, and debate issues of development policy.
... See More + This edition has the following headings: (i) inequality in China : an overview; (ii) can civil society overcome government failure in Africa?; (iii) what are we learning from business training and entrepreneurship evaluations around the developing world?; (iv) population, poverty, and climate change; and (v) orderly sovereign debt restructuring : missing in action! (and likely to remain so).
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Publication 113056 FEB 01, 2014
Knight,John; Devarajan,Shantayanan; Khemani,Stuti; Walton,Michael; Mckenzie,David J.; Woodruff,Christopher M.; Das Gupta,Monica; Canuto,Otaviano; Pinto,Brian R.; Prasad,MonaDisclosed
This literature review focuses on the relationships between population, poverty, and climate change. Developed countries are largely responsible for global warming, but the brunt of the fallout will be borne by developing countries in forms such as lower agricultural output, poorer health, and more frequent natural disasters.
... See More + Although carbon emissions per capita have leveled off in developed countries, they are projected to rise rapidly in developing countries because of economic growth and population growth. Unfortunately, the latter will rise most notably in the poorest countries, combining with climate change to slow poverty reduction. These countries have many incentives to lower fertility. Previous studies indicate that in high fertility settings, fertility decline facilitates economic growth and poverty reduction. It also reduces the pressure on livelihoods and frees resources that can be used to cope with climate change. Moreover, slowing population growth helps avert some of the projected global warming, which will benefit the poorest countries far more than it will benefit developed countries that lie at higher latitudes and/or have more resources to cope with climate change. Natural experiments indicate that family-planning programs are effective and highly pro-poor in their impact. While the rest of the world wrestles with the complexities of reducing emissions, the poorest countries will benefit from simple programs to lower fertility.
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This paper is organized in following headings: economic development as opportunity equalization; the measurement of educational inequality: achievement and opportunity; economic growth and equality of opportunity; children’s health opportunities and project evaluation: Mexico’s oportunidades program; symposium on conflict and gender : armed conflict, gender, and schooling; short- and long-term impact of violence on education: the case of Timor Leste; education and civil conflict in Nepal; schooling, violent conflict, and gender in Burundi.
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Publication 113049 JAN 01, 2014
Roemer,John E.; Ferreira,Francisco H. G.; Gignoux,Jérémie; Peragine,Vito; Palmisano,Flaviana; Brunori,Paolo; Van de gaer,Dirk; Vandenbossche,Joost; Figueroa,José Luis; Buvinic,Mayra Lourdes; Das Gupta,Monica; Shemyakina,Olga N.; Justino,Patricia; Leone,Marinella; Salardi,Paola; Valente,Christine; Verwimp,Philip; Van Bavel,JanDisclosed
The impact of armed conflict on gender differentials in schooling appears to be highly context-specific, as the review of the literature and the findings from the three studies in this symposium reveal.
... See More + In some settings boys’ schooling is more negatively affected than that of girls. In others, the reverse is the case. Effects are largely shaped by events surrounding a conflict, pre-war gender differences in educational attainments, and education and labor market opportunities in the absence of war. Rigorous evaluations of post-conflict policies and aid projects can provide useful information to address educational needs and gender differentials in these environments.
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Journal Article 112401 OCT 14, 2013
Buvinic,Mayra Lourdes; Das Gupta,Monica; Shemyakina, Olga N.Disclosed
The literature is reviewed on the relationships between population, poverty, and climate change. While developed countries are largely responsible for global warming, the brunt of the fallout will be borne by the developing world, in lower agricultural output, poorer health, and more frequent natural disasters.
... See More + Carbon emissions in the developed world have leveled off, but are projected to rise rapidly in the developing world due to their economic growth and population growth -- the latter most notably in the poorest countries. Lowering fertility has many benefits for the poorest countries. Studies indicate that, in high fertility settings, fertility decline facilitates economic growth and poverty reduction. It also reduces the pressure on livelihoods, and frees up resources to cope with climate change. And it helps avert some of the projected global warming, which will benefit these countries far more than those that lie at higher latitudes and/or have more resources to cope with climate change. Natural experiments indicate that family planning programs are effective in helping reduce fertility, and that they are highly pro-poor in their impact. While the rest of the world wrestles with the complexities of reducing emissions, the poorest countries will gain much from simple programs to lower fertility.
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Policy Research Working Paper WPS6631 OCT 01, 2013
This brief summarizes the results of a gender impact evaluation study, entitled Improving child nutrition outcomes in India : can the integrated child development services (ICDS) program be more effective?
... See More + , conducted in 1975 and continued through the time the paper was written in India. The study observed the impact of ICDS program on child nutrition status in villages on the individual level. Overall, the program had no significant impact on nutritional outcomes. It did have a positive impact on boys' stunting in 1992. For girls there was no significant impact. There was actually a significant negative impact in the poor Northern states. Program placement was very regressive across states; the states with the greatest need have the lowest program coverage. Program placement within states is more progressive. Funding for the study derived from the ICDS Fund.
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What can other developing countries learn from Sri Lanka on achieving good health at low cost? While its well-organized medical and maternal-child health services have been documented elsewhere, this paper fills a gap in documenting how it organizes services to reduce the population's exposure to disease -- a pure public good.
... See More + The key factors underlying the effectiveness of these services are (1) strong focal points in the central Health Ministry for supporting preventive services; (2) pro-active outreach by the health line agency to collaborate with other sectors / agents whose work influences public health outcomes; and (3) community-level delivery institutions with well-trained multivalent Public Health Inspectors -- all underpinned by (4) assured tax-based financing. This paper describes this system in some detail such that other countries can learn from Sri Lanka's successful approach to improving population health. It also makes some recommendations for strengthening the system in response to changing conditions.
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Policy Research Working Paper WPS6558 AUG 01, 2013
Das Gupta, Monica; Dalpatadu, K. C. S.; Shanmugarajah, C. K.; Herath, H. M. S. S. D.Disclosed
Violent conflict, a pervasive feature of the recent global landscape, has lasting impacts on human capital, and these impacts are seldom gender neutral.
... See More + Death and destruction alter the structure and dynamics of households, including their demographic profiles and traditional gender roles. To date, attention to the gender impacts of conflict has focused almost exclusively on sexual and gender-based violence. The authors show that a far wider set of gender issues must be considered to better document the human consequences of war and to design effective postconflict policies. The emerging empirical evidence is organized using a framework that identifies both the differential impacts of violent conflict on males and females (first-round impacts) and the role of gender inequality in framing adaptive responses to conflict (second-round impacts). War’s mortality burden is disproportionately borne by males, whereas women and children constitute a majority of refugees and the displaced. Indirect war impacts on health are more equally distributed between the genders. Conflicts create households headed by widows who can be especially vulnerable to intergenerational poverty. Second-round impacts can provide opportunities for women in work and politics triggered by the absence of men. Households adapt to conflict with changes in marriage and fertility, migration, investments in children’s health and schooling, and the distribution of labor between the genders. The impacts of conflict are heterogeneous and can either increase or decrease preexisting gender inequalities. Describing these gender differential effects is a first step toward developing evidence-based conflict prevention and postconflict policy. This overview examines the emerging empirical evidence on both the differential impacts of violent conflict on males and females and the role of gender inequality in framing adaptive responses to conflict
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Journal Article 112498 FEB 01, 2013
Buvinic,Mayra Lourdes; Das Gupta,Monica; Casabonne,Ursula; Verwimp,PhilipDisclosed
Violent conflict, a pervasive feature of the recent global landscape, has lasting impacts on human capital, and these impacts are seldom gender neutral.
... See More + Death and destruction alter the structure and dynamics of households, including their demographic profiles and traditional gender roles. To date, attention to the gender impacts of conflict has focused almost exclusively on sexual and gender-based violence. The authors show that a far wider set of gender issues must be considered to better document the human consequences of war and to design effective postconflict policies. The emerging empirical evidence is organized using a framework that identifies both the differential impacts of violent conflict on males and females (first-round impacts) and the role of gender inequality in framing adaptive responses to conflict (second-round impacts). War's mortality burden is disproportionately borne by males, whereas women and children constitute a majority of refugees and the displaced. Indirect war impacts on health are more equally distributed between the genders. Conflicts create households headed by widows who can be especially vulnerable to intergenerational poverty. Second-round impacts can provide opportunities for women in work and politics triggered by the absence of men. Households adapt to conflict with changes in marriage and fertility, migration, investments in children's health and schooling, and the distribution of labor between the genders. The impacts of conflict are heterogeneous and can either increase or decrease preexisting gender inequalities. Describing these gender differential effects is a first step toward developing evidence-based conflict prevention and postconflict policy.
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Policy Research Working Paper WPS6371 FEB 01, 2013
Buvinic, Mayra; Das Gupta, Monica; Casabonne, Ursula; Verwimp, PhilipDisclosed
There is a very large but scattered literature debating the economic implications of high fertility. This paper reviews the literature on three themes: (a) Does high fertility affect low-income countries' prospects for economic growth and poverty reduction?
... See More + (b) Does population growth exacerbate pressure on natural resources? and (c) Are family planning programs effective at lowering fertility, and should they be publicly funded? The literature shows broad consensus that while policy and institutional settings are key in shaping the prospects of economic growth and poverty reduction, the rate of population growth also matters. Recent studies find that low dependency ratios (as fertility declines) create an opportunity for increasing productivity, savings and investment in future growth. They find that lower fertility is associated with better child health and schooling, and better health and greater labor-force participation for women. They also indicate that rapid population growth can constrain economic growth, especially in low-income countries with poor policy environments. Population growth also exacerbates pressure on environmental common property resources. Studies highlight the deep challenges to aligning divergent interests for managing these resources. However, part of the pressure on these resources can be mitigated by reducing the rate of population growth. Although family planning programs are only one policy lever to help reduce fertility, studies find them effective. Such programs might help especially in the Sub-Saharan African region, where high fertility and institutional constraints on economic growth combine to slow rises in living standards.
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Policy Research Working Paper WPS5719 JUN 01, 2011
Das Gupta, Monica; Bongaarts, John; Cleland, JohnDisclosed
Fertility decline has fueled a sharp increase in the proportion of 'missing girls' in China, so an increasing share of males will fail to marry, and will face old age without the support normally provided by wives and children.
... See More + This paper shows that historically, China has had nearly-universal marriage for women and a very competitive market for men. Lower-educated men experience higher rates of bachelorhood while women favor men with better prospects, migrating if needed from poorer to wealthier areas. The authors examine the anticipated effects of this combination of bride shortage and hypergamy, for different regions of China. Their projections indicate that unmarried males will likely be concentrated in poorer provinces with low fiscal ability to provide social protection to their citizens. Such geographic concentration of unmarried males could be socially disruptive, and the papers findings suggest a need to expand the coverage of social protection programs financed substantially by the central government.
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Policy Research Working Paper WPS5351 JUN 01, 2010
Das Gupta, Monica; Ebenstein, Avraham; Sharygin, Ethan JenningsDisclosed
Son preference is known to be found in certain types of cultures, that is patrilineal cultures. But what explains the fact that China, South Korea, and Northwest India manifest such extreme child sex ratios compared with other patrilineal societies?
... See More + This paper argues that what makes these societies unique is that their pre-modern political and administrative systems used patrilineages to organize and administer their citizens. The interplay of culture, state, and political processes generated uniquely rigid patriliny and son preference. The paper also argues that the advent of the modern state in these settings has unraveled the underpinnings of the rigid patrilineal rules, and unleashed a variety of forces that reduce son preference. Firstly, the modern state has powerful tools for incorporating and managing its citizenry, rendering patrilineages a threat rather than an asset for the state. Secondly, the modern state has brought in political, social, and legal reforms aimed to challenge traditional social hierarchies, including the age and gender hierarchies of the kinship system. Thirdly, industrialization and urbanization have ushered in new modes of social organization, which reduce the hold of clans and lineages. Studies of the impact of the media suggest that states can accelerate the resultant decline in son preference, through media efforts to help parents perceive that daughters can now be as valuable as sons.
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Policy Research Working Paper WPS5148 DEC 01, 2009
Much has been written on gender inequality and how it affects fertility and mortality outcomes as well as economic outcomes. What is not well understood is the role of gender inequality, embedded in the behavior of the family, the market, and society, in mediating the impact of demographic processes on economic outcomes.
... See More + This article reviews the empirical evidence on the possible economic impacts of gender inequalities that work by exacerbating demographic stresses associated with different demographic scenarios and reducing the prospects of gains when demographic conditions improve. It defines four demographic scenarios and discusses which public policies are more effective in each scenario in reducing the constraints that gender inequality imposes on poverty reduction. See Less -
The central governments policies, though well-intentioned, have inadvertently de-emphasized environmental health and other preventive public health services in India since the 1950s, when it was decided to amalgamate the medical and public health services and to focus public health services largely on single-issue programs.
... See More + This paper discusses how successive policy decisions have diminished the Health Ministrys capacity for stewardship of the nations public health. These decisions have introduced policies and fiscal incentives that have inadvertently enabled states to prioritize medical services and single-issue programs over broader public health services, and diminished the capacity of the public health workforce to deliver public health services. Diseases resulting from poor environmental health conditions continue to impose high costs even among the more affluent, and hinder development. There are many approaches to strengthening the public health system, and the authors suggest one that may require relatively little modification of existing structures and systems. They suggest establishing a focal point in the Health Ministry for public health stewardship, and re-vitalizing the states public health managerial cadres as well as the grassroots public health workers. The central government could consider linking its fiscal support to states with phased progress in four areas: (1) the enactment of state Public Health Acts; (2) the establishment by states of separate public health directorates; (3) the re-vitalization of grassroots public health workers; and (4) health department engagement in ensuring municipal public health. The central focal point could provide the needed support, oversight, incentives, and sanctions to ensure that states build robust public health systems. These measures can do much to help governments use public funds more effectively for protecting peoples health.
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Policy Research Working Paper WPS5140 NOV 01, 2009
Das Gupta, Monica; Shukla, Rajendra; Somanathan, T.V.; Datta, K.K.Disclosed
This issue includes the following: gender, poverty and demography: an overview, by Mayra Buvinic, Monica Das Gupta, and Ursula Casabonne; Development, modernization, and childbearing: the role of family sex composition, by Deon Filmer, Jed Friedman, and Norbert Schady; the consequences of the 'missing girls' of China, by Avraham Y.
... See More + Ebenstein and Ethan Jennings Sharygin; the gender and intergenerational consequences of the demographic dividend: an assessment of the micro and macro linkages between the demographic transition and economic development, by T. Paul Schultz; macroeconomic stability and the distribution of growth rates, by Vatcharin Sirimaneetham and Jonathan R.W. Temple; the effect of male migration on employment patterns of women in Nepal, by Michael Lokshin and Elena Glinskaya; and political accountability and regulatory performance in infrastructure industries: an empirical analysis, by Farid Gasmi, Paul Noumba Um, and Laura Recuero Virto.
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Publication 62999 NOV 01, 2009
Buvinic, Mayra; Das Gupta, Monica; Casabonne, Ursula; Filmer, Deon; Friedman, Jed; Schady, Norbert; Ebenstein, Avraham Y.; Sharygin, Ethan Jennings; Schultz, T. Paul; Sirimaneetham, Vatcharin; Temple, Jonathan R.W.; Lokshin, Michael; Glinskaya, Elena; Gasmi, Farid; Um, Paul Noumba; Virto, Laura RecueroDisclosed
Public health systems in India have weakened since the 1950s, after central decisions to amalgamate the medical and public health services, and to focus public health work largely on single-issue programs - instead of on strengthening public health systems broad capacity to reduce exposure to disease.
... See More + Over time, most state health departments de-prioritized their public health systems. This paper describes how the public health system works in Tamil Nadu, a rare example of a state that chose not to amalgamate its medical and public health services. It describes the key ingredients of the system, which are a separate Directorate of Public Health - staffed by a cadre of professional public health managers with deep firsthand experience of working in both rural and urban areas, and complemented with non-medical specialistswith its own budget, and with legislative underpinning. The authors illustrate how this helps Tamil Nadu to conduct long-term planning to avert outbreaks, manage endemic diseases, prevent disease resurgence, manage disasters and emergencies, and support local bodies to protect public health in rural and urban areas. They also discuss the systems shortfalls. Tamil Nadus public health system is replicable, offering lessons on better management of existing resources. It is also affordable: compared with the national averages, Tamil Nadu spends less per capita on health while achieving far better health outcomes. There is much that other states in India, and other developing countries, can learn from this to revitalize their public health systems and better protect their peoples health.
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Policy Research Working Paper WPS5073 OCT 01, 2009
Das Gupta, Monica; Desikachari, B.R.; Somanathan, T.V.; Padmanaban, P.Disclosed
Aid to developing countries has largely neglected the population-wide health services that are core to communicable disease control in the developed world.
... See More + These mostly non-clinical services generate "pure public goods" by reducing everyone's exposure to disease through measures such as implementing health and sanitary regulations. They complement the clinical preventive and treatment services which are the donors' main focus. Their neglect is manifested, for example, in a lack of coherent public health regulations in countries where donors have long been active, facilitating the spread of diseases such as avian flu. These services can be inexpensive, and dramatically reduce health inequalities. Sri Lanka spends less than 0.2% of GDP on its well-designed population-wide services, which contribute to the country's high levels of health equity and life expectancy despite low GDP per head and civil war. Evidence abounds on the negative externalities of weak population-wide health services. Global public health security cannot be assured without building strong national population-wide health systems to reduce the potential for communicable diseases to spread within and beyond their borders. Donors need greater clarity about what constitutes a strong public health system, and how to build them. The paper discusses gaps in donors' approaches and first steps toward closing them.
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Policy Research Working Paper WPS4907 APR 01, 2009
