Strengthening theories of change in women's group interventions to improve learning.

Background: Supporting women's groups is increasingly seen as an important intervention strategy for advancing women's empowerment, economic outcomes, and family health in low- and middle-income countries. We argue that learning from investments in women's group platforms is often limited by the lack of a well-articulated, evaluable theory of change (ToC) developed by those designing the programmes. Methods: We first identify a simple set of steps important to specifying a ToC that is evaluable and supports learning (what could be done). We then propose a framework in which we hope social scientists can find a common starting point (reconciling what could be and is being done). The framework emphasises identifying untested assumptions around pathways for introducing and adopting new knowledge, opportunities, technologies, interventions or implementation approaches, and pathways from group participation to behaviour change. Finally, we apply this framework to a portfolio of 46 women's groups investments made by the Bill and Melinda Gates Foundation between 2005 and 2017 to understand the prevalence and clarity of their grantees' theories of change (some of what is done). Results: The majority of the investment documents reviewed did not make clear the embedded assumptions or hypothesised pathways from decisions to join a group, to women's group participation, to behaviour change and and whether pathways are connected or work independently. Conclusions: We use an example from an actual investment to illustrate how this framework can support accounting for assumptions in the ToC used to guide the evaluation, the testing and measuring of mechanisms assumed to be driving behaviour change and disentangling the effects of implementationfrom context. A ToC for group-based programmes should specify in what capacities the group-based model is essential to the hypothesised pathways of impact vs. its role as an efficient delivery mechanism for programmes that would potentially generate impacts even if delivered directly to individuals. In addition, without fully specifying the motivation for individuals to change behaviour in terms of their risk/return calculus and testing underlying assumptions, we miss an opportunity to better understand the pathways for how the programme influences or fails to influence individuals' health behaviours. However, fully specifying (and measuring) every link in the programme's ToC is not costless. We present suggestions for developing ToCs with testable hypotheses that foster learning about why a women's group intervention achieved or failed to achieve its intended impact.

Primary Health Care Management Effectiveness as a Driver of Family Planning Service Readiness: A Cross-Sectional Analysis in Central Mozambique.

INTRODUCTION: The effectiveness of facility-level management is an important determinant of primary health care (PHC) reach and quality; however, the nature of the relationship between facility-level management and health system effectiveness lacks sufficient empirical grounding. We describe the association between management effectiveness and facility readiness to provide family planning services in central Mozambique. METHODS: We linked data from the Ministry of Health's 2018 Service Availability and Readiness Assessment and a second 2018 health facility survey that included the World Bank's Service Delivery Indicators management module. Our analysis focused on 68 public sector PHC facilities in Manica, Sofala, Tete, and Zambézia provinces in which the 2 surveys overlapped. We used logistic quantile regression to model associations between management strength and family planning service readiness. RESULTS: Of the 68 facility managers, 47 (69.1%) were first-time managers and (18) 26.5% had received formal management training. Managers indicated that 63.6% of their time was spent on management responsibilities, 63.2% of their employees had received a performance review in the year preceding the survey, and 12.5% of employee incentives were linked to performance evaluations. Adjusting for facility type and distance to the provincial capital, facility management effectiveness, and urban location were significantly associated with higher levels of readiness for family planning service delivery. CONCLUSIONS: We found that a higher degree of management effectiveness is independently associated with an increased likelihood of improved family planning service readiness. Furthermore, we describe barriers to effective PHC service management, including managers lacking formal training and spending a significant amount of time on nonmanagerial duties. Strengthening management capacity and reinforcing management practices at the PHC level are needed to improve health system readiness and outputs, which is essential for achieving global Sustainable Development Goals and universal health coverage targets.

Definitions of "rural" and "urban" and understandings of economic transformation: Evidence from Tanzania.

Designing effective policies for economic development often entails categorizing populations by their rural or urban status. Yet there exists no universal definition of what constitutes an "urban" area, and countries alternately apply criteria related to settlement size, population density, or economic advancement. In this study, we explore the implications of applying different urban definitions, focusing on Tanzania for illustrative purposes. Toward this end, we refer to nationally representative household survey data from Tanzania, collected in 2008 and 2014, and categorize households as urban or rural using seven distinct definitions. These are based on official administrative categorizations, population densities, daytime and nighttime satellite imagery, local economic characteristics, and subjective assessments of Google Earth images. These definitions are then applied in some common analyses of demographic and economic change. We find that these urban definitions produce different levels of urbanization. Thus, Tanzania's urban population share based on administrative designations was 28% in 2014, though this varies from 12% to 39% with alternative urban definitions. Some indicators of economic development, such as the level of rural poverty or the rate of rural electrification, also shift markedly when measured with different urban definitions. The periodic (official) recategorization of places as rural or urban, as occurs with the decennial census, results in a slower rate of rural poverty decline than would be measured with time-constant boundaries delimiting rural Tanzania. Because the outcomes of analysis are sensitive to the urban definitions used, policy makers should give attention to the definitions that underpin any statistics used in their decision making.

Delivering development? Evidence on self-help groups as development intermediaries in South Asia and Africa.

Donors and governments increasingly seek to deliver development projects through community-based organizations such as self-help groups (SHGs), but little is known about the effectiveness of such arrangements. This article briefly summarizes hypotheses regarding the effectiveness of interventions using SHGs and presents the results of an evidence review on the impacts of interventions delivered through SHGs on health, finance, agriculture and empowerment outcomes in South Asia and sub-Saharan Africa. Though the impacts of SHG-based interventions are generally positive, the evidence base is limited and does not generally test whether alternative delivery mechanisms might be more effective.

Methods of crop yield measurement on multi-cropped plots: Examples from Tanzania.

Precise agricultural statistics are necessary to track productivity and design sound agricultural policies. Yet, in settings where multi-cropping is prevalent, even crop yield-perhaps the most common productivity metric-can be challenging to measure. In a survey of the literature on crop yield in low-income settings, we find that scholars specify how they estimate the area denominator used to measure yield in under 10% of cases. Using household survey data from Tanzania, we consider four alternative methods of allocating land area on multi-cropped plots, ranging from treatment of the entire plot as the yield denominator to increasingly precise approaches that account for the space taken up by other crops. We then explore the implications of this measurement decision for analyses of yield, focusing on one staple crop that is often grown on its own (rice) and one that is frequently found on mixed plots and in intercropped arrangements (maize). A majority (64%) of cultivated plots contain more than one crop, and average yield estimates vary with different methods of calculating area planted-particularly for maize. Importantly, the choice among area methods influences which of these two crops is found to be more calorie-productive per hectare. This choice also influences the statistically significant correlates of crop yield, such that the benefits of intercropping and including legumes on a maize plot are only evident when using an area measure that accounts for mixed cropping arrangements. We conclude that the literature would benefit from greater clarity regarding how yield is measured across studies.

Relating Seasonal Hunger and Prevention and Coping Strategies: A Panel Analysis of Malawian Farm Households.

Relative to chronic hunger, seasonal hunger in rural and urban areas of Africa is poorly understood. This paper examines the extent and potential correlates of seasonal hunger in Malawi using panel data from 2011-2013. We find that both urban and rural households report seasonal hunger in the pre-harvest months. Certain strategies to smooth consumption, including crop storage and livestock ownership, are associated with fewer months of hunger. In addition, we find that Malawian households that experience seasonal hunger harvest their crops earlier than average - a short-term coping mechanism that can reduce the crop's yield and nutritional value, possibly perpetuating hunger.

Variability in Cross-Domain Risk Perception among Smallholder Farmers in Mali by Gender and Other Demographic and Attitudinal Characteristics.

Previous research has shown that men and women, on average, have different risk attitudes and may therefore see different value propositions in response to new opportunities. We use data from smallholder farm households in Mali to test whether risk perceptions differ by gender and across domains. We model this potential association across six risks (work injury, extreme weather, community relationships, debt, lack of buyers, and conflict) while controlling for demographic and attitudinal characteristics. Factor analysis highlights extreme weather and conflict as eliciting the most distinct patterns of participant response. Regression analysis for Mali as a whole reveals an association between gender and risk perception, with women expressing more concern except in the extreme weather domain; however, the association with gender is largely absent when models control for geographic region. We also find lower risk perception associated with an individualistic and/or fatalistic worldview, a risk-tolerant outlook, and optimism about the future, while education, better health, a social orientation, self-efficacy, and access to information are generally associated with more frequent worry-with some inconsistency. Income, wealth, and time poverty exhibit complex associations with perception of risk. Understanding whether and how men's and women's risk preferences differ, and identifying other dominant predictors such as geographic region and worldview, could help development organizations to shape risk mitigation interventions to increase the likelihood of adoption, and to avoid inadvertently making certain subpopulations worse off by increasing the potential for negative outcomes.

Mobile money and branchless banking regulations affecting cash-in, cash-out networks in low- and middle-income countries.

Background: We examined recent trends in mobile money and branchless banking regulations related to cash-in, cash-out (CICO) networks (physical access points allowing users to exchange physical cash and electronic money) in low- and middle-income countries, and reviewed evidence on the impacts of CICO regulations on markets and financial inclusion.  Methods: Regulation and literature searches began in August 2017 and concluded in June 2018. For the regulatory search we compiled an original database of regulations targeting CICO networks in Bangladesh, India, Indonesia, Kenya, Nigeria, Pakistan, Tanzania, and Uganda. To review evidence of impacts of regulations we conducted additional global searches on Scopus, Google Scholar, and Google using keywords for specific regulatory approaches (e.g., regulation of CICO agents) or hypothesized impacts (e.g., financial inclusion). Results: The resulting database of CICO regulations in the eight focus countries includes 127 regulatory documents, which we coded for four groups of regulations, namely: Business Channel Requirements; Agent Requirements; Regulations on Caps, Fees and Charges; and Customer Identification Requirements. Early CICO regulations focused on agent selection rules, limits on fees, and know-your-customer requirements. More recent waves of regulation have expanded or restricted services CICO agents provide, and also imposed reporting requirements on service providers in an effort to prevent fraud or enhance financial inclusion. Our search for evidence of impacts of CICO regulations resulted in a sample of 90 documents published since 2005, of which only 31 provided evidence on CICO regulation impacts, with most limited in scope-suggesting rigorous policy analysis remains lacking in this quickly expanding sector. Conclusions: Many low- and middle-income countries have introduced regulations that may affect CICO networks, with regulatory approaches differing across geographies and over time. While anecdotal reports of regulatory impacts exist, we found limited evidence of impacts of regulations on CICO networks or on CICO-related financial inclusion.

Husband and Wife Perspectives on Farm Household Decision-making Authority and Evidence on Intra-household Accord in Rural Tanzania.

We use OLS and logistic regression to investigate variation in husband and wife perspectives on the division of authority over agriculture-related decisions within households in rural Tanzania. Using original data from husbands and wives (interviewed separately) in 1,851 Tanzanian households, the analysis examines differences in the wife's authority over 13 household and farming decisions. The study finds that the level of decision-making authority allocated to wives by their husbands, and the authority allocated by wives to themselves, both vary significantly across households. In addition to commonly considered assets such as women's age and education, in rural agricultural households women's health and labor activities also appear to matter for perceptions of authority. We also find husbands and wives interviewed separately frequently disagree with each other over who holds authority over key farming, family, and livelihood decisions. Further, the results of OLS and logistic regression suggest that even after controlling for various individual, household, and regional characteristics, husband and wife claims to decision-making authority continue to vary systematically by decision-suggesting that decision characteristics themselves also matter. The absence of spousal agreement over the allocation of authority (i.e., a lack of "intra-household accord") over different farm and household decisions is problematic for interventions seeking to use survey data to develop and inform strategies for reducing gender inequalities or empowering women in rural agricultural households. Findings provide policy and program insights into when studies interviewing only a single spouse or considering only a single decision may inaccurately characterize intra-household decision-making dynamics.

Perception of Climate Risk among Rural Farmers in Vietnam: Consistency within Households and with the Empirical Record.

Rural farmers in Vietnamese communes perceive climate risk and potential impacts on livelihood within a complex context that may influence individual and household decisions. In a primary survey of 1,145 residents of the Thach Ha district of Ha Tinh province, we gathered data regarding perception about stability in climate, potential risks to livelihood, demographic characteristics, orientation toward risk, and interest in expanding economic activity. Temporal analysis of meteorological and economic indicator data forms an empirical basis for comparison with human perception. We ask the basic question: Are rural farmers' perceptions of climate consistent with the historical record and reproducible within households? We find that respondents do perceive climate anomalies, with some anchoring on recent extreme events as revealed by climate observational data, and further that spouses disproportionately share perceptions relative to randomly simulated pairings. To put climate-related risk perception in a larger context, we examine patterns across a range of risks to livelihood faced by farmers (livestock disease, pests, markets, health), using dimension reduction techniques. We find that our respondents distinguish among potential causes of low economic productivity, with substantial emphasis on climate-related impacts. They do not express uniform concern across risks, but rather average patterns reveal common modes and distinguish climate concern. Still, among those expressing concern about climate-related risks to livelihood we do not find an association with expressed intention to pursue changes in economic activity as a risk management response.

Are women as likely to take risks and compete? Behavioural findings from central Vietnam.

Using controlled experiments to compare the risk attitude and willingness to compete of husbands and wives in 500 couples in rural Vietnam, we find that women are more risk averse than men and that, compared to men, women are less likely to choose to compete, irrespective of how likely they are to succeed. Relevant to development programmes concerned with lifting women out of poverty, our findings suggest that women may be more reluctant to adopt new technologies, take out loans, or engage in economic activities that offer higher expected returns, in order to avoid setups that require them to be more competitive or that have less predictable outcomes.