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An Ounce of Prevention for a Pound of Cure: Basic Health Care and Efficiency in Health Systems
Get PDFWe examine the efficiency gains in health systems generated after the national roll out of basic healthcare in El Salvador between 2010 and 2013. Using data from over 120 million consultations and five million hospitalizations, we demonstrate that the expansion of community health teams, comprising less-specialized health workers, increases preventive care and decreases curative care and preventable hospitalizations. We also estimate coverage improvements for previously unattended chronic conditions amenable to effective primary care. These results suggest that decentralization of tasks to less-specialized health workers improves efficiency, maintaining quality of care
Measuring Racial Bias in Employment Services in Colombia
Get PDFIn this paper, we document de facto, implicit, and explicit racial biases within the public employment service in Colombia. By combining administrative data about job seekers and job openings with direct surveys to job counselors, including a Race Implicit Association Test, we compute different types of racial bias. We find that while job counselors do not self-report biased attitudes against Afro-descendant individuals, the majority exhibit high levels of implicit bias, which also correlates strongly with observed lower referral rates of Afro-descendants to job openings. In addition, we randomly provide information to job counselors about their implicit bias and test if this information changes their referral behavior. While we demonstrate that the implicit bias of counselors is a major contributor to racial gaps in labor outcomes, we do not find that providing feedback on this unconscious bias changes their referral behavior
Firms and Inequality in Latin America
Get PDFThe relationship between firms and inequality has been a focus of recent attention globally. This chapter summarizes basic facts about this relationship for Latin America. Unlike advanced economies where superstar firm growth has prompted concerns over disproportionate income growth at the top, the facts we summarize illustrate that the main concern for Latin America is the extreme prevalence of tiny businesses whose workers and owners tend to populate the bottom income segments. The empirical likelihood that these businesses improve their productivity and grow to hire more workers and pay better wages is also very low. The region displays a deficit of employment generation in SMEs, by contrast to both microbusinesses (including self-employment) and large corporations. While the former tend to remunerate both workers and owners with very low incomes, the latter pay high wages but also exhibit low labor shares
What Works to Improve Lives?: What Works to Foster Productive Sector Development
No full textThis publication is one of a series of five monographs produced by the Inter-American Development Bank to take stock of the lessons learned from impact evaluations of investments supported by the IDB Group for over a decade across a wide range of economic and social development sectors. This monograph studies the impact of productive sector programs and policies to support workers, private firms, and entrepreneurs, and to promote trade and investment. It presents key lessons on “what works” to increase productivity, including providing training to workers and entrepreneurs, increasing access to credit, promoting entrepreneurship with potential for growth, extending innovation and technology, improving efficiency through the agglomeration of firms, and taking steps to facilitate trade and investment
Unraveling the Paradox of Anticorruption Messaging: Experimental Evidence from a Tax Administration Reform
Get PDFRecent literature highlights a paradox in corruption prevention messaging: instead of reducing tolerance for corruption, such campaigns can inadvertently intensify it by priming the existence of corruption while failing to diminish citizens beliefs about government misbehavior. Building on Cheeseman and Peiffer (2022), which demonstrates that messages focused on combating corruption often backfire among individuals with preexisting negative perceptions of corruption, we posit that an effective strategy to mitigate backfiring involves shifting those pessimistic perceptions before delivering the corruption eradication messages. To test our hypothesis, we conducted a randomized survey experiment within the context of a major institutional reform to reduce tax agency corruption in Honduras. Results confirm the backfiring findings of previous literature, but also show that our approach effectively mitigates perceived corruption and diminishes the propensity for tax evasion, especially among skeptics
Does Reluctance to Share Personal Data Reduce Citizen Demand for Personalized Services? Evidence from a Survey Experiment
Get PDFTwo seemingly contradictory trends have accompanied the rise of digital transformation: a demand for better and more customized services, which require the use of personal data, and a concern for data protection. How do we reconcile these divergent trends? The answer to this question may influence not only the design of personalized services but also the strategies for their widespread adoption. This study explores how to mitigate the impact of citizens reluctance to share data on the uptake of personalized public services. Through a survey experiment, we offered two hypothetical personalized services: one educational service (a scholarship) and one health-related service (a checkup). Each respondent was randomly assigned to one of three possible intervention groups, receiving different types of information: (i) a summary outlining the service benefits; (ii) details on benefits with a data usage disclosure; and (iii) a data usage disclosure. The findings reveal that citizens exhibit a strong baseline interest in personalized services. However, a requirement to share personal data had an adverse impact on interest in both the educational and health-related services, resulting in declines of 2.6 to 3.0 percentage points. There are indications that the decrease in interest may be more pronounced for the health service. Providing detailed service descriptions increased interest by 4.5 and 5.5 percentage points for education and health services, respectively. This suggests that offering information about the benefits of the service can offset concerns about data privacy. These effects remained consistent among different population groups
Procedural Justice and Police Legitimacy: Evidence from a Vignette Experiment in Central America
Get PDFThis paper examines the impact of procedural justice and sanctions on police legitimacy in a middle-income context using a between-subjects vignette experiment among civilians and police officers in Honduras. The scenarios involved civilian--police interactions following a minor infraction, varying in whether the police officer treated the civilian respectfully or disrespectfully, and whether a sanction (fine) was imposed. Respectful treatment increased satisfaction, acceptance of decisions, and willingness to cooperate, while sanctions had the opposite effects on these variables. Sanctions lowered the perceived likelihood of repeating the infraction, whereas respectful treatment had no effect on it. Results were similar for civilians and police officers, though officers assigned greater importance to procedural justice. The study concludes that, while sanctions deter repeated infractions, they can erode legitimacy if not applied respectfully, highlighting the importance of procedural justice in civilian--police interactions. The positive impact of procedural justice among both civilians and officers perceptions supports the desirability and feasibility of its application in this context
Innovations for Sargassum Resilience
Get PDFSince 2011, the influx of sargassum in the Caribbean and West Africa has posed significant socio-economic challenges. Despite these negative impacts, there is a growing effort to turn sargassum into an opportunity. This has led to the creation of innovative products and services made from sargassum, which are now being marketed both regionally and internationally. The "Sargassum Uses Guide" is the most comprehensive resource on the topic, providing an overview of current and potential uses, along with a directory of innovators and researchers. However, it does not assess the effectiveness of these solutions or provide a global outlook. This report offers a detailed update on the current landscape of sargassum innovation and governance. It introduces the "Sargometer," a proposed tool to help entrepreneurs evaluate the sustainability and effectiveness of different solutions. The study highlights case studies of leading innovators and their products, while also incorporating community perspectives on various technological solutions. The report concludes with considerations for the future development of the sargassum industry. Technological solutions for managing sargassum influxes in the Caribbean and Latin America primarily include machinery for onshore and in-water harvesting, as well as various by-products like compost, liquid extracts, bioplastics, biogas, construction materials, clothing, and cosmetics. Some products, such as biostimulants, biofertilizers, and compost, show high potential for short-term commercialization. To maximize the use of sargassum, the study suggests a biorefinery approach. As the industry grows, it is crucial to develop governance structures, including quality and regulatory frameworks, to ensure market success. Policies should also support sustainable sargassum businesses, such as duty-free concessions and free zones for equipment and property acquisition. With the right technology and supportive environment, even small enterprises can thrive internationally
Preliminary Findings: Task Clarity and Credibility in Relational Contracts
Get PDFWe develop and test a relational contracting model where building relationships requires the principal and agent to solve task clarity and credibility problems. We model task clarity as the likelihood of the agent finding a productive action for the principal and demonstrate that it influences the agents propensity to fulfill promises the usual notion of credibility in relational contracts. This is because improving task clarity increases the ease of replacing a relationship after a defection, making defection more tempting. We validate our model using a decade of administrative data from the Ethiopian floriculture industry. Our estimation documents that: i) task clarity problems are economically relevant in the industry and larger for domestic firms, ii) consistent with a unique prediction of our model, domestic firms, due to their lower task clarity and despite a lower discount factor, are less likely to defect on relationships as a response to improvements in the outside option, and iii) the buyer and seller components of task clarity explain differences between foreign and domestic firms in credibility and overall success in relational contracts
Barriers to Enrollment and Retention in Disease Management Programs
Get PDFManagement of chronic diseases has become increasingly important as the global burden of chronic diseases continues to increase. In Latin America there are significant gaps in the provision of chronic care management, with a pressing need to help patients better control their condition. One tool to address gaps in care management is through disease management programs, which include a set of coordinated interventions often with an educational component aimed to improve health outcomes and reduce costs. This paper uses the socio-ecological framework to describe barriers to disease management program enrollment and retention, as well as propose potential interventions to address these barriers. Addressing the many barriers ranging from the individual factors to larger organizational or policy factors requires multi-faceted interventions