Research

Publications 

Tafesse, W., & Chalkley, M. (2024). "The Difference in Clinical Knowledge Between Staff Employed at Faith-based and Public Facilities in Malawi", Christian Journal for Global Health, 11(1), 46–63. https://doi.org/10.15566/cjgh.v11i1.853 

Tafesse,  W., Jemutai, J.,  Mayora, C., Margini, F. (2024) "Scoping Review of Health Economics Research on Refugee Health in Sub-Saharan Africa", Value in Health Regional Issues, Volume 39, 98-106, https://doi.org/10.1016/j.vhri.2023.10.008.

Dolton, P., Tafesse, W. (2022) “Childhood obesity, is fast food exposure a factor?” Economics & Human Biology, 46, 101153, https://doi.org/10.1016/j.ehb.2022.101153. 

Tafesse, W. (2022) “The effect of Universal Salt Iodization on cognitive test scores in rural India”, World Development, Volume 152, 105796, https://doi.org/10.1016/j.worlddev.2021.105796.

Tafesse, W., Chalkley, M.(2021) “Faith-based provision of sexual and reproductive healthcare in Malawi”, Social Science & Medicine, 282, 113997, https://doi.org/10.1016/j.socscimed.2021.113997. 

Kamanzi, A., McKay, A., Newell, A., Rienzo, C., Tafesse, W. (2021). "Education, Access to Better Quality Work and Gender: Lessons from the Kagera Panel Data Set". Journal of African Economies, Volume 30, 103–127,  https://doi.org/10.1093/jae/ejaa011. 

Ramponi, F., Tafesse, W., Griffin, S. (2020). "Economic evaluation of interventions to address undernutrition: a systematic review". Health Policy and Planning. https://doi.org/10.1093/heapol/czaa149. 

Work in progress

The impact of shifting the financial burden from users to the government: the case of non-governmental healthcare providers in Malawi (with Gerald Manthalu and Martin Chalkley) Link to old version. 

Abstract: We study the impact of a financing reform for maternal healthcare in Malawi, wherein the government reimbursed maternal and newborn services supplied by non-profit private healthcare providers on a fixed price per service basis, in return for an agreement to remove user fees. We merge data on health facilities in Malawi with pregnancy histories from the 2010 Malawi Demographic and Health Survey, and investigate the differential effects on pregnancy related healthcare utilisation for mothers residing near and far from facilities subject to the reform over time using difference-in-differences. We exploit the staggered implementation of the reform across facilities accounting for mother fixed effects and subsequently by applying a robust imputation-based event-study. Our findings show that the reform reduced home births and increased skilled deliveries at the contracted out facilities and reduced neonatal and infant mortality in the short-term. The overall effects are driven by women with financial barriers to healthcare. Evidence also points to an increase in c-sections and longer breastfeeding duration which may explain the drop in newborn mortality, as no positive effects of the policy are found for antenatal care. The results suggest that user fee removal through contracting with non-profit non-governmental providers has the potential to increase equitable access to healthcare and improve health outcomes in low- and middle-income countries.

The causal effect of iodised salt consumption on children's height in rural India'' Link to paper (under review)

Abstract: Height is often used as a proxy for human capital. Research has established that nutrition in early life is an important predictor of height. Less is known about in what way  nutrition may impact height. Medical evidence points to a mechanistic relationship between iodine deficiency and growth. This paper investigates whether the consumption of iodised salt improves height among children in rural India. I use 2SLS regression to circumvent concerns regarding the endogeneity of a household's availability of iodised salt and children's anthropometric status. I instrument for iodised salt consumption with the distance to the major salt producing state. Salt transported for longer distances is likely to be transported by rail rather than by road. Monitoring of iodised salt is only mandatory before and during rail transport. Therefore, distance serves as a proxy for the likelihood that the salt has been inspected for iodine, and thus iodised. I find that the availability of adequately iodised salt improves height-for-age by 0.664 Z-scores for children up to 1 year.

What doesn’t kill you, makes you more anxious and depressed: The effect of civil conflict on mental health in Nepal

Abstract: This paper provides the first nationwide evidence on the effect of early-life exposure to civil conflict on mental health status in adolescence and adulthood. Leveraging variation by district and year of birth, I analyse the effect of childhood exposure to Nepal’s civil conflict in 1996-2006, on anxiety and depression among individuals of reproductive age using the 2022 Nepal Demographic and Health survey (DHS). For the first time, the DHS contains clinically valid measures of Generalised Anxiety Disorder (GAD) and depression measured by the Patient Health Questionnaire (PHQ). Controlling for a rich set of covariates, including physical health, the results show that any exposure to conflict in childhood increases the GAD score by 0.643 and the PHQ score by 0.592. This corresponds to approximately one-quarter and one-third of the respective sample means. Such exposure also raises the probability of developing moderate to severe anxiety by 7.5 percentage points. With each additional year of conflict exposure the risk of developing moderate to severe anxiety increases by 1.5 percentage points. For depressive disorders, an extra year of childhood conflict exposure leads to a 0.104 increase in the PHQ score and a 0.6-percentage point higher risk of moderate to severe depression.

Mind the gap: Accounting for the absence of health workers in Malawi (with Martin Chalkley)

Abstract: 30-50% of all healthcare workers in low- and middle-income countries (LMICs) are found to be absent from facilities. Previous research has not identified any successful interventions to reduce absenteeism in the long-run and there is limited information on how different types of absence depend on key incentive structures within the existing health system. We investigate the prevalence of different types of healthcare worker absence, their potential effects and predictors using a census of all facilities in Malawi, the 2018/2019 Malawi Harmonised Health Facility Assessment. The survey collects detailed facility information, including on the number of staff who are absent during an unannounced facility visit. We find that 30% of all healthcare workers are absent. The most common reasons are reported to be work-related and non-authorised absence constitutes 10% of all absences. Facility-level regressions indicate that higher average non-work absence is associated with longer facility waiting times for antenatal care and under 5 children's visits. Regression results at the individual staff level show that salary delay is a robust predictor of absence driven by non-authorised reasons or being on call. Accounting for hospital management practices reveals a negative association between external supervision and absence. Thus, timely salary payments and external monitoring potentially constitute important policy levers to reduce absence.

Long-run effects of missionary expansion and colonisation on health and healthcare in Eastern and Southern Africa (with Samuel Lordemus)

Short abstract: We investigate the long-run effects of historical missionary and colonial investments in healthcare on current health systems and health outcomes in Malawi, Tanzania and Zimbabwe.