James Allen IV

Publications

Brief

Community health worker caseloads, home visits, and child survival: Experimental evidence of heterogenous effects from Mali

2025Allen IV, James

Details

Community health worker caseloads, home visits, and child survival: Experimental evidence of heterogenous effects from Mali

I examine whether the effectiveness of community health worker (CHW) home visits in reducing under-five mortality varies with the population-to-CHW ratio in rural, fragile, and conflict-affected Mali. Muso, a global health NGO focused on reducing child and maternal mortality, recently signed a data use agreement with IFPRI to enable study of new research questions using data from its recent randomized controlled trial (RCT) of proactive home visits in Mali’s Bankass region. The original trial found that proactive home visits by professional CHWs did not lead to detectable reductions in child mortality relative to fixed-site care, although health infrastructure improvements in both treatment arms likely led to experienced large declines in under-five mortality across all study communities amid ongoing conflict. In this project note, I study heterogeneous effects of the proactive home visit model by population-to-CHW ratios using nearly census level baseline population data and administrative records on CHW assignment. I test the hypothesis that home visits may operate differently when CHWs face particularly high or low caseloads. In theory, CHWs serving small populations may not be necessary for improving access because travel distances to fixed sites are already short, whereas CHWs serving very large populations may be unable to conduct sufficiently frequent and high-quality home visits. If both mechanisms operate, an optimal population-to-CHW ratio may exist. Instead, I find evidence that CHW home visits are more effective when the population-to-CHW ratio is high. At 900 people per CHW (about the 90th percentile in the trial data), children in control clusters experience significantly higher mortality risk. This elevated risk, however, is offset in clusters assigned to proactive home visits. Additional checks indicate that this is driven by CHW coverage rather than underlying population size. These findings suggest that proactive home visits may be most beneficial in areas where fixed-site CHWs otherwise face heavy caseloads.

Year published

2025

Authors

Allen IV, James

Citation

Allen IV, James. 2025. Community health worker caseloads, home visits, and child survival: Experimental evidence of heterogenous effects from Mali. FCA Brief. Washington, DC: International Food Policy Research Institute. https://hdl.handle.net/10568/178959

Country/Region

Mali

Keywords

Africa; Sub-saharan Africa; Western Africa; Community Organizations; Health Care; Child Health; Fragility

Language

English

Access/Licence

Open AccessCC-BY-4.0

Source

Source record

Record type

Brief

Livelihoods and recovery after Cyclone Idai: Short- and long-run household evidence from Mozambique

2025Allen IV, James; Yu, Hang

Details

Livelihoods and recovery after Cyclone Idai: Short- and long-run household evidence from Mozambique

Sub-Saharan Africa bears a disproportionate share of global poverty and is also among the regions most vulnerable to natural disasters that pose persistent threats to livelihoods, food security, and long-run development. This study examines how exposure to a major natural disaster—Cyclone Idai, one of the deadliest and costliest disasters in Mozambique’s history—affected household well-being and economic behavior in central Mozambique following its landfall in March 2019. We combine satellite-based best-track data on Cyclone Idai’s trajectory with longitudinal household survey data collected both shortly after the disaster and five to six years later. Specifically, we link predicted maximum wind speed at the community level to a pre-defined sample of households surveyed before the cyclone, allowing us to estimate impacts in the short run (within the same year) and the longer run. This design leverages rich pre-baseline data and province fixed effects to mitigate concerns about selection bias, displacement, and omitted variables that commonly complicate causal inference in disaster impact studies. We find that greater cyclone exposure is strongly associated with short-run reports of shock experience and asset loss, validating predicted wind speed as a measure of disaster intensity. In the long run, however, households appear to recover from the immediate shock. Cyclone exposure is associated with persistent declines in reliance on agriculture as a primary livelihood and increases in small business activity and formal wage employment. At the same time, we observe mixed effects on asset ownership, with sustained declines in housing ownership alongside increases in durable asset holdings. Future work will continue to highlight how complex and heterogeneous pathways through which large-scale disasters reshape household livelihoods and economic behavior over time.

Year published

2025

Authors

Allen IV, James; Yu, Hang

Citation

Allen IV, James; and Yu, Hang. 2025. Livelihoods and recovery after Cyclone Idai: Short- and long-run household evidence from Mozambique. FCA Brief. Washington, DC: International Food Policy Research Institute. https://hdl.handle.net/10568/178950

Country/Region

Mozambique

Keywords

Southern Africa; Sub-saharan Africa; Africa; Livelihoods; Cyclones; Extreme Weather Events; Households

Language

English

Access/Licence

Open AccessCC-BY-4.0

Source

Source record

Record type

Brief

Gendered work norms in Egypt: Evidence on preferences and social perceptions

2025Allen IV, James; Gilligan, Daniel O.; Kurdi, Sikandra; Shokry, Nada; Yassa, Basma

Details

Gendered work norms in Egypt: Evidence on preferences and social perceptions

We examine the nature and scope of gendered work norms in Egypt using new experimental evidence from a household survey. Societal norms around work, care responsibilities and the types of jobs women and men can hold can have a profound effect on gender differences in employment, earnings and life satisfaction. Indeed, while lack of childcare and secure transportation remain widely cited constraints to women’s employment in low-income settings, descriptive and experimental evidence also suggest that deeply rooted social norms about gender roles play a prominent role in driving the persistence of such barriers and in how households evaluate women’s work. Norms emphasizing men as primary breadwinners and women as primary caregivers shape both economic decisions and perceptions of behavior in ways that may limit women’s labor force participation even when opportunities exist. We implement three survey-based experiments among economically disadvantaged households to elucidate these norms and measure their salience. A wage‐comparison choice experiment shows that households strongly prefer that men—not women—take on additional paid work, even when this preference entails substantial forgone income for the household. When offered identical wages for equal hours of work, only 12.4 percent of respondents select the wife to take it as a first part-time job versus the husband taking it as a second part-time job. Even when her wage is double that of her husband, a clear majority still prefer that the husband works instead. These results indicate a large implicit cost that households place on women working outside the household. Two randomized vignette experiments further demonstrate that identical actions are interpreted differently depending on whether they are performed by men or women. Men who take on a second job to support their financially struggling household are widely viewed as more competent and more moral, whereas perceptions of women making the same choice are far more divided. Perceptions of workplace effort are broadly similar across genders, with small differences appearing only in perceptions of morality. Together, these findings emphasize the strength of gendered work norms in Egypt and reveal nuance in how they shape behavior. The findings also underscore the relevance of gender norms for designing programs affecting household work decisions and testing new approaches to promote women’s economic inclusion.

Year published

2025

Authors

Allen IV, James; Gilligan, Daniel O.; Kurdi, Sikandra; Shokry, Nada; Yassa, Basma

Citation

Allen IV, James; Gilligan, Daniel O.; Kurdi, Sikandra; Shokry, Nada; and Yassa, Basma. 2025. Gendered work norms in Egypt: Evidence on preferences and social perceptions. IFPRI Project Note. Washington, DC: International Food Policy Research Institute. https://hdl.handle.net/10568/178587

Country/Region

Egypt

Keywords

Africa; Northern Africa; Middle East; Gender Norms; Women; Social Structure; Labour

Language

English

Access/Licence

Open AccessCC-BY-4.0

Source

Source record

Record type

Brief