Abstract: The paper critically reviews the methods available for the ex-post counterfactual analysis of programs that are assigned exclusively to individuals, households or locations. The discussion covers both experimental and non-experimental methods (including propensity-score matching, discontinuity designs, double and triple differences and instrumental variables). Two main lessons emerge: Firstly, despite the claims of advocates, no single method dominates; rigorous, policy-relevant evaluations should be open-minded about methodology. Secondly, future efforts to draw more useful lessons from evaluations will call for more policy-relevant measures and deeper explanations of measured impacts than are possible from the classic (“black box”) assessment of mean impact.

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Abrahamian and Katherine Lee provided outstanding research assistance. We gratefully acknowledge financial support from the Division of Research and Faculty Development at the Harvard Business School. Making Self-Regulation More than Merely Symbolic: The Critical Role of the Legal Environment This article theorizes and empirically tests the conditions under which organizations ’ symbolic commitments to self-regulate are particularly likely to result in improved compliance practices and outcomes. We argue that the legal environment, particularly as it is constructed by the enforcement activities of regulators, significantly influences the likelihood that organizations will effectively implement the self-regulatory commitments they symbolically adopt. We investigate how different enforcement tools can foster or undermine organizations ’ normative motivations to self-regulate. We find that organizations are more likely to follow through on their commitments to self-regulate when they (and their competitors) are subject to heavy regulatory surveillance, and when they adopt self-regulation absent an explicit threaten of sanctions. We also find that historically poor compliers are significantly less likely to follow through on

Abstract: To what extent do differential levels of investment in public health inputs explain observed differences in health outcomes across socioeconomic and racial groups? This study investigates the impact of 3,700 projects that were part of a widespread Federal initiative to improve sanitation infrastructure on U.S. Indian reservations starting in 1960. Sanitation investment substantially reduced the cost of clean water for households, leading to sharp reductions in both waterborne gastrointestinal disease and infectious respiratory disease among Native American infants. The sanitation program was quite cost-effective, in part because improvements in the overall disease environment also reduced infectious respiratory disease among nearby white infants. Despite the health externalities, Federal sanitation interventions explain almost forty percent of the convergence in Native American and white infant mortality rates in reservation counties

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The literature contains very few impact evaluations of health sector reforms, especially those involving broad and simultaneous changes on both the demand and supply sides of the sector. This paper reports the results of a World Bank-funded health sector reform project in China known as Health VIII. On the supply-side, the project combined infrastructure investments (especially at the township level) with improved planning and management, including a referral system between township health centers and county hospitals, and interventions aimed at improving the effectiveness and quality of care, including the introduction of clinical protocols and essential drug lists. On the demand-side, the project sought to resurrect community health insurance, and to introduce a safety net for the very poor to provide them with financial assistance with their health care expenses. The evaluation reported here concerns just one of the project's seven provinces, namely Gansu, the reason being that no suitable data are available to undertake a rigorous evaluation in all provinces. This paper makes use of a panel dataset collected for quite another purpose but whose timing (just around the time the project started and four years later) and location (covering both project and non-project counties) makes it well suited to the task. The paper compares estimates obtained using a variety of different estimators, including naïve single differences (before and after, and with and without the project), and differences in

Connecting private dwellings to the water main is expensive and typically cannot be publicly financed. We show that households’ willingness to pay for a private connection is high when it can be purchased on credit, not because a connection improves health but because it increases the time available for leisure and reduces inter-and intra-household conflicts on water matters, leading to sustained improvements in well-being. Our results suggest that facilitating access to credit for households to finance lump sum quality-of-life investments can significantly increase welfare, even if those investments do not result in any health or income gains. (JEL D12, I31, O12, O13, O18, Q25) Worldwide, 1.1 billion people have no access to any type of improved drink-ing source of water within 1 kilometer. Furthermore, only about 42 percent of the people with access to water have a household connection or yard tap (World Health Organization, United Nations Children’s Fund Joint Monitoring Programme for Water Supply and Sanitation 2005). As a result, households in developing

“A 2020 Vision for Food, Agriculture, and the Environment ” is an initiative of the International Food Policy Research Institute (IFPRI) to develop a shared vision and consensus for action on how to meet future world food needs while reducing poverty and protecting the environment. 2020 discussion papers present technical research results that encompass a wide range of subjects drawn from research on policy-relevant aspects of agriculture, poverty, nutrition, and the environment. They contain materials that IFPRI believes are of key interest to those involved in addressing emerging food and development problems.

Water supply improvements are a frequent policy response to endemic diarrhea in developing countries. However, these interventions may unintentionally cause commu-nity sanitation to worsen. Such a response could occur because improved water supplies mitigate the consequences of poor sanitation for the community. Since sanitary behav-iors have large externalities, the negative health impact of this endogenous response may overwhelm the direct benefit of clean water. This paper shows how the expan-sion of municipal piped water in Metro Cebu, the Philippines has exacerbated public defecation, garbage disposal, and diarrhea. I rely on instrumental variables and house-hold fixed effects to rule out non-causal explanations for these results, and find that a neighborhood’s complete adoption of piped water increases the likelihood of observing excrement or garbage by 15-30 percent. Such a change increases diarrhea incidence by 35-40 percent.