Achyuta Adhvaryu

We test whether early-life war exposure influences later-life political engagement in Africa. We combine data on the location and intensity of conflicts since 1945 with nationally representative data on political attitudes and behaviors from 17 sub-Saharan African countries. Exposure from ages 0 to 14 has a very small (standardized) impact on later attitudes and behaviors. Our results are robust to migration, and hold across several definitions, specifications, and sources of data. Our results are consistent with recent studies demonstrating that, on average, individuals and localities recover quickly from the destructive effects of conflict, though those most exposed experience large and prolonged effects.

Studies of entrepreneurship in the developing world have struggled to explain the high prevalence of small, low-growth enterprises, and the limited success of financial and training interventions. Using data from a unique panel of coffee farmer households in Tanzania, we demonstrate an important role for microenterprise activity as a means of mitigating the effects of income shocks. We first verify that global coffee prices matter for these households, through their effects on farmgate prices, quantity of coffee sold, farm revenues and, consequently, household expenditures. We then show that households are more likely to engage in enterprise activity during coffee price busts. Those households whose businesses stay open during booms, however, actually increase input intensity and reap large rewards in terms of business survival and profits. Our results suggest that many agricultural households only intermittently engage in enterprise activity, as a way to weather productivity or revenue shocks in their principal sector. While some of these household businesses may grow when financial or managerial constraints are relaxed, many find little value in entrepreneurship beyond as a means of smoothing.

We study the role of small-scale enterprise as a means of mitigating the effects of health shocks in a sample of agricultural households in Tanzania. Using temporal and geographic variation in the cost of traveling to formal sector health facilities to predict the speed of recovery from acute illness, we show that individuals who are slow to recover switch from farm labor to enterprise activity. This response occurs along both the extensive (entry) and intensive (capital stock and labor supply) margins. Family members who are not ill exhibit the same pattern of responses, suggesting complementarities in household labor. We discuss, in the context of recent studies, how the smoothing value of microenterprises may help to explain the high prevalence of small, low-growth businesses in the developing world.

Do parents invest more in higher quality children, or do they compensate for lower quality by giving more to children with lower endowments? We answer this question in the context of a large-scale iodine supplementation program in Tanzania. We find that children with higher program exposure were more likely to receive necessary vaccines and were breastfed for longer. Siblings of treated children were also more likely to be immunized. Fertility behavior and investments at the time of birth were unaffected, suggesting that parents reacted to observed endowment changes rather than indirect program effects.

Improving access to the formal health care sector is a primary public health goal in many low-income countries. But the returns to this access are unclear, given that the quality of care at public health facilities is often considered inadequate. We exploit temporal and geographic variation in the cost of traveling to formal sector health facilities to show that treatment at these facilities improves short-term health outcomes for acutely ill children in Tanzania. Our results suggest that these improvements are driven in part by more timely receipt of and better adherence to antimalarial treatment.

I study how the misallocation of new technology to individuals who have low ex post returns to its use affects learning and adoption behavior. I focus on antimalarial treatment, which is frequently over-prescribed in many low-income country contexts where diagnostic tests are inaccessible. I show that misdiagnosis reduces average therapeutic effectiveness, because only a fraction of adopters actually have malaria, and slows the rate of social learning due to increased noise. I use data on adoption choices, the timing and duration of fever episodes, and individual blood slide confirmations of malarial status from a pilot study for a new malaria therapy in Tanzania to show that individuals whose reference groups experienced fewer misdiagnoses exhibited stronger learning effects and were more likely to adopt. Improving targeting by subsidizing diagnostic technology may thus accelerate the acceptance and appropriate adoption of effective new medical treatments via learning.

A key prediction of dynamic labor demand models is that firing restrictions attenuate firms' employment responses to economic fluctuations. We provide the first direct test of this prediction using data from India. We exploit the fact that rainfall fluctuations, through their effects on agricultural productivity, generate variation in local demand within districts over time. Consistent with the theory, we find that industrial employment is more sensitive to shocks where labor regulation is less restrictive. Our results are robust to controlling for endogenous firm placement and vary across factory size in a pattern consistent with institutional features of Indian labor law.

We study the effects of accessing better healthcare on the schooling and labor supply decisions of sick children in Tanzania. Using variation in the cost of formal sector healthcare to predict treatment choice, we show that accessing better healthcare decreases length of illness and changes children's allocation of time to school and work. Children attend school for more days per week--but not for more hours per day--as a result of accessing better healthcare. There are no significant effects on child labor, but the results suggest that time spent in physically strenuous activities such as farming and herding increases.

HIV/AIDS is drastically changing the demographic landscape in high-prevalence countries in Africa. The prime-age adult population bears the majority of the mortality burden, and these "missing" prime-age adults have implications for the socioeconomic well-being of surviving family members. This study uses a 13-year panel from Tanzania to examine the impacts of prime-age mortality on the time use and health outcomes of older adults, with a focus on long-run impacts and gender dimensions. Prime-age deaths are weakly associated with increases in working hours of older women when the deceased adult was co-resident in the household. The association is strongest when the deceased adult was living with the elderly individual at the time of death and for deaths in the distant past, suggesting that shorter-run studies may not capture the full extent of the consequences of adult mortality for survivors. Holding more assets seems to buffer older adults from having to work more after these shocks. Most health indicators are not worse for older adults when a prime-age household member has died, although more distant adult deaths are associated with an increased probability of acute illness for the surviving elderly. For deaths of children who were not residing with their parents at baseline, the findings show no impact on hours worked or health outcomes.

Objectives: Mental health disorders account for 13% of the global burden of disease, a burden that low-income countries are generally ill-equipped to handle. Research evaluating the association between mental health and employment in low-income countries, particularly in sub-Saharan Africa, is limited. We address this gap by examining the association between employment and psychological distress.

Methods: We analyzed data from the Ghana Socioeconomic Panel Survey using logistic regression (N=5,391 adults). In multivariable analysis, we estimated the association between employment status and psychological distress, adjusted for covariates. We calculated lost productivity from unemployment and from underemployment that respondents reported was because of their feelings of psychological distress.

Findings: Approximately 21% of adults surveyed had moderate or severe psychological distress. Increased psychological distress was associated with increased odds of being unemployed. Men and women with moderate versus mild or no psychological distress had more than twice the odds of being unemployed. The association of severe versus mild or no distress with unemployment differed significantly by sex (P-value for interaction 0.004). Among men, the adjusted OR was 12.4 (95% CI: 7.2, 21.3), whereas the association was much smaller for women (adjusted OR=3.8, 95% CI: 2.5, 6.0). Extrapolating these figures to the country, the lost productivity associated with moderate or severe distress translates to approximately 7% of the gross domestic product of Ghana.

Conclusions: Psychological distress is strongly associated with unemployment in Ghana. The findings underscore the importance of addressing mental health issues, particularly in low-income countries, where employment is critical for economic growth.

Objectives: To study the impact of a new franchise health clinic model (The HealthStore Foundation's CFWShops) on access to vaccinations and treatment for acute illnesses in a nationally representative sample of children in Kenya.

Design: We used multivariate linear and count regressions to examine associations between receipt of vaccinations or treatment and proximity to a franchise health clinic, adjusting for individual, household and clinic attributes as well as region fixed effects.

Setting: Demographic and Health Survey data from Kenya, 2008-2009.

Participants: 6079 Kenyan children under 5 years old, out of which 2310 reported recent acute illness.

Main outcome measures: Outcomes for all children were number of polio doses received, number of DPT doses received, receipt of BCG vaccine, receipt of measles vaccine, and number of total vaccinations received. Outcomes for acutely ill children were receipt of any medical treatment, treatment for fever, treatment for malaria, and treatments specifically stocked by CFWShops.

Results: Children living within 30 km of a CFWShop received .129 (p=.017) and .113 (p=.025) more DPT and polio doses, respectively; and .285 more total vaccinations (p=.023). Among acutely ill children, CFWShop proximity was associated with significant increases in the probabilities of receiving any medical treatment (.142; p<.001), treatment for fever (.117; p=.007), and treatments specifically stocked by CFWShops (.064; p=.015). Use of CFWShop services was not significantly different for lower-income vis-a-vis higher-income households.

Conclusions: The franchise health clinic model could substantially increase access to essential vaccinations and treatments in low-income countries. Moreover, the model's benefits may accrue to lesser- and higher-income households alike.