Out-of-pocket payments are the primary source through which health expenditure is met in Senegal. However, these payments are financial burdens that lead to impoverishment when they become catastrophic. The purpose of this study is to cast light on the determinants of catastrophic household out-of-pocket health expenditures and to assess their implications on poverty. The 2011 poverty monitoring survey is used in this study. This survey aims to draw poverty profiles and to highlight the socio-economic characteristics of different social groups. In line with the concerns raised by the new Supplemental Poverty Measure, poverty statistics are adjusted to take into account household health expenditures and to estimate their impoverishing effects. To identify the determinants of the magnitude of catastrophic health expenditure, we implement a seemingly unrelated equations system of Tobit regressions to take into account censoring through a conditional mixed-process estimator procedure. We identify major causes of catastrophic expenditures, such as the level of overall health spending, the expensiveness of health goods and services, the characteristics of health facilities, the health stock shocks, the lack of insurance, etc. Results show evidence that catastrophic health expenditures jeopardize household welfare for some people that fall into poverty as a result of negative effects on disposable income and disruption of the material living standards of households. Our findings warrant further policy improvements to minimize the financial risks of out-of-pocket health expenditures and increase the efficiency of health care system for more effective poverty reduction strategies.

This paper examines the impact of health expenditures on agricultural labour productivity in order to inform the necessary policy decisions about targeting scarce public resources towards their most effective uses. We link health sector expenditures in rural Tanzania to health outcomes and agricultural labour productivity using data from the 2008 Household Budget Survey (10,975 households) and the 2007/08 Agricultural Census (52,594 households) across 113 districts in Tanzania. The results indicate that the marginal productivity of labour as well as land and fertilisers respond significantly to health expenditures. However, the magnitude of the response varies across types of disease, categories of expenditures and agricultural inputs. These findings suggest both the need and scope for targeting public expenditures in the health sector to achieve better agricultural growth outcomes.

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Book chapterIn this chapter, we apply the CGPE model to analyzing the performance of policy processes with respect to the production of efficient policy choices. Within the CGPE approach participation of stakeholder organizations is modeled in two ways. First, as classical lobbying influence and second as informational influence within a model of political belief formation. An empirical application of the CGPE model to CAADP reforms in Malawi delivered the following results: (i) inefficient agricultural policies mainly result from lack of adequate political knowledge, while biased political incentives play only a minor rule. (ii) Policy beliefs of political practitioners differ significantly from economic models. Hence, our analyses imply a cleavage between the world of economic modeling and the world of political practice. (iii) As Bayesian estimation combining objective knowledge of scientific models with the subjective wisdom of practitioners results in a compromise of both worlds, we conclude that adequate political knowledge does not yet exist in the scientific system or in political praxis and must be created in the political process. (iv) Therefore, the only effective political therapy corresponds to the application of adequate tools that facilitate interactive communication and policy learning among stakeholders and economic modelers.IFPRI4WCAOP

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Journal articleIFPRI3WCAOP