Improving school management in low and middle income countries: A systematic review.

Improving school quality in low and middle income countries (LMICs) is a global priority. One way to improve quality may be to improve the management skills of school leaders. In this systematic review, we analyze the impact of interventions targeting school leaders' management practices on student learning. We begin by describing the characteristics and responsibilities of school leaders using data from large, multi-country surveys. Second, we review the literature and conduct a meta-analysis of the causal effect of school management interventions on student learning, using 39 estimates from 20 evaluations. We estimate a statistically significant improvement in student learning of 0.033 standard deviations. We show that effect sizes are not related to program scale or intensity. We complement the meta-analysis by identifying common limitations to program effectiveness through a qualitative assessment of the studies included in our review. We find three main factors which mitigate program effectiveness: (1) low take-up; (2) lack of incentives or structure for implementation of recommendations; and (3) the lengthy causal chain linking management practices to student learning. Finally, to assess external validity of our review, we survey practitioners to compare characteristics between evaluated and commonly implemented programs. Our findings suggest that future work should focus on generating evidence on the marginal effect of common design elements in these interventions, including factors that promote school leader engagement and accountability.

Delivering health insurance through informal financial groups: Evidence on moral hazard and adverse selection.

Moral hazard and adverse selection are potential explanations for missing health insurance in low-income countries. In recent years, informal financial institutions have attempted to complete health insurance markets by offering micro health insurance (MHI). We evaluate an MHI offered through informal financial institutions (Self-Help Groups) in Maharashtra, India. Exploiting random assignment of when villages were offered the MHI, we do not find support for MHI increasing health care utilization. In contrast, we do find evidence for adverse selection: enrollees are significantly more likely than non-enrollees to report poor health prior to the introduction of MHI. This adverse selection persists even when the MHI is offered as a group insurance to Self-Help Groups, as opposed to individual insurance. Our results suggest that MHI offered through informal financial groups may not suffer from moral hazard, but does fall short of eliminating adverse selection.

Does provider access to technology improve health care? Evidence from a national distribution of phototherapy in Rwanda.

This study assessed a large-scale national distribution of phototherapy (PT) for infants at risk for severe hyperbilirubinemia. We combined healthcare data for infants with jaundice (using local clinical definitions) with a randomized roll-out of PT devices to estimate the causal effect of the national distribution. Pre-intervention, <3.0% of infants were diagnosed as jaundiced, 41.7% of these infants were not tested for bilirubin, and 17.5% and 34.3% were treated with direct sunlight or standard PT, respectively. We found that providing hospitals with PT devices increased care practices: infants with jaundice were more likely to receive PT [+6.26 percentage points (pp)], and less likely to receive sunlight (-6.96 pp) or standard (irradiance < 30 µW/cm2/nm) PT (-14.0 pp). However, the intervention did not affect the low diagnosis rate. Our findings suggest that complementary investments in improving diagnosis and monitoring of bilirubin levels increases the benefits of expanding provider access to PT devices.

The usual suspects: do risk tolerance, altruism, and health predict the response to COVID-19?

We survey college students during California's stay-at-home order to test whether compliance with social distancing requirements depends on primary preferences and characteristics that affect their marginal benefit from doing so. We find a quarter of students violated the order. Yet, neither risk preference, altruism, nor preexisting health conditions were predictive of compliance. Our findings raise doubt about the efficiency of minimally enforced social distancing policies, as well as commonly assumed motivations for compliance. Our results also imply that those with preexisting health conditions may not voluntarily comply, resulting in higher health care congestion than otherwise expected.

What explains low adoption of digital payment technologies? Evidence from small-scale merchants in Jaipur, India.

The availability of digital payment technologies (such as internet banking, mobile money, and credit/debit cards) has rapidly increased in the developing world, and is a cornerstone for financial inclusion initiatives in developing countries. Despite significant efforts to promote digital payments, rates of adoption remain modest in some low-income countries. In particular, the rate of adoption in India remains low despite significant efforts to promote adoption. In this paper, we consider possible reasons for the low rates of adoption among merchants in Jaipur, India with small fixed-location store enterprises. Using survey data for 1,003 merchants, we find little evidence that supply-side barriers to obtaining necessary infrastructure or meeting prerequisite requirements to adopt digital payments explain the low level of adoption. Merchants are able to obtain infrastructure to transact digitally (such as bank accounts and smart phones), fees on digital platforms are affordable, and merchants are sufficiently literate to be able to use digital payment systems. We conclude that adoption is both feasible and inexpensive. Therefore, low rates of adoption do not appear to be the result of supply-side barriers, but due rather to demand-side factors or taxes. We find direct evidence of such demand-side factors, such as a perceived lack of customers wanting to pay digitally, and concerns that records of mobile payments might increase tax liability. Our results thus suggest that simply lowering the costs associated with adopting these technologies is unlikely to be successful in increasing adoption of digital payments.