The recent release of the Sustainable Development Goals reinforces the central role of health as a key element of human development, calling for further investments in health as part of a concerted effort to overcome poverty and inequalities worldwide. Specifically, SDG3 reiterates the importance of investing in policies that favor Universal Health Coverage (UHC), defined in relation to access to quality care and financial protection against the cost of illness. The urge to sustain and increase investments in health as part of an overall development policy is accompanied by the need to ensure that the investments made produce benefits for all groups in a society, contributing to reducing existing inequities in access and health status between the poor and the least poor. Evidence on the equity benefit of recent UHC reforms (ranging from user fee removal to results-based financing) is still limited. Similarly, evidence is lacking on whether investments in these recent reforms have altered spending on health at a national health, increasing the distributional incidence of this spending to benefit the poor rather than the least poor, as indicted by prior research.

This project is part of the first phase of the Research Facility on Inequalities, coordinated by AFD and funded by the European Commission's Directorate-General for International Partnerships over the 2017-2020 period. The first phase of the Facility has led to the conduct of 22 research projects and the publication of around 100 research papers and policy briefs.

This project aims at assessing whether the distributional incidence of total and public spending on health has become more equitable over time, especially as a function of introducing UHC-specific reforms. The research objective is purposely set not only to describe the inequities in access and in health outcomes that may persist in spite of UHC-specific reforms, but also to explore more explicitly the link between the financial investments made and the benefits accrued across socio-economic groups. This choice stems from a wish to generate analytical evidence on the equity impact of the investments made in health, whether these investments are made by African countries themselves or with support from their development partners. The investigators trust that this evidence is much needed to direct and inform future investments in health. Moreover, keeping in mind this wish to inform policy making in a pragmatic manner, they plan to appraise their findings in the light of the different social and political circumstances that have shaped the emergence and implementation of the specific UHC policies and investments under analysis.

The project expands the framework proposed by McIntyre and Ataguba published in 2011 and conducts a quasi-longitudinal benefit incidence analyses to assess the distributional incidence of total, public, and UHC-specific spending (such as user fee removal policies, targeted subsidies, or results-based financing) across all countries over time, measured both at the individual beneficiary level and at the district/health facility level. Traditionally, tables and concentration curves and indexes have been used to display the results of the Benefit Incidence Analysis (BIA). In addition to this traditional approach, the investigators plan to generate maps based on the BIA results to illustrate spatial inequities in the distributional incidence of spending on health.

Furthermore, they will appraise findings in the light of the specific circumstances within which policy decisions on health have been reached in each country, to be able to explain, from a qualitative point of view, what policy elements might have contributed to generate greater or smaller equity.

You may find the research papers here:

• Estimating the distributional incidence of healthcare spending on curative health services in Sub-Saharan Africa: Benefit incidence analysis in Burkina Faso, Malawi and Zambia
• Estimating the distributional incidence of healthcare spending on maternal health services in Sub-Saharan Africa: Benefit incidence analysis in Burkina Faso, Malawi, and Zambia
• Distributional effects of healthcare spending : lessons from Burkina Faso, Malawi, and Zambia
• Assessing inequalities in healthcare spending in Burkina Faso, Malawi, and Zambia: data and methods 
• Inequalities in Maternal Healthcare spending: Evidence from Burkina Faso
• Inequalities in healthcare spending on curative services: evidence from Burkina Faso
• Inequalities in maternal healthcare spending: evidence from Zambia
• Inequalities in healthcare spending on curative services: evidence from Zambia
• Inequalities in maternal healthcare spending: evidence from Malawi
• Inequalities in healthcare spending on curative services: evidence from Malawi

Contact:

Cecilia Poggi, Research Officer, AFD

Social-protection schemes have become a popular form of intervention in developing countries both by governments and within the international-development community, as they are seen as a tool to combat the adverse impacts of natural and economic crises. However, the empirical evidence on the effectiveness of these programs remains mixed. Notwithstanding the wealth of interest from policy makers, donors, and researchers, there is a paucity of evidence about the distributional incidence of these programs. Existing work has often not been able to establish longer-run effects of public-works programs on poverty and inequality. In addition, there is a lack of focus on horizontal and spatial inequalities. This research project intends to fill this evidence gap.

This project is part of the first phase of the Research Facility on Inequalities, coordinated by AFD and funded by the European Commission's Directorate-General for International Partnerships over the 2017-2020 period. The first phase of the Facility has led to the conduct of 22 research projects and the publication of around 100 research papers and policy briefs.

This research project proposes to investigate the distributional impact of three large-scale social-protection schemes - the Productive Safety Net Program (PSNP) in Ethiopia, the Mahatma Gandhi National Rural Employment Guarantee Scheme (NREGS) in India, and the Juntos conditional cash-transfer program in Peru. These programs were chosen because they are large-scale projects involving a coordinated effort by governments, donors, local authorities and individual households. The programs cover three countries with diverse social, cultural, political, and economic contexts from which to draw lessons for future policy initiatives.

The researchers propose to go beyond measuring the direct intended impacts of the programs and rather focus on their indirect, and not necessarily intended, consequences. In particular, they first consider the effect of these programs on the income and wealth of program participant households over both the shorter- and longer-run. They then turn to the programs’ impact on horizontal and spatial inequalities, as well as their effect on household social relations and the distribution of resources within households.

Unlike traditional benefit-incidence studies, the researchers exploit policy differences across time and space, both within and across the countries, to provide causal estimates of the social-policy impacts. They use the Young Lives cohort study that collected data both pre-and post-program implementation between 2002 and 2014 in all three countries. They exploit a number of aspects of the Young Lives cohort study and the roll-out of the social-protection schemes in each country to produce estimates that deal with non-random program placement.

The researchers planned to begin by conducting an individual-specific pre- and post-program comparison of income and wealth. Then to exploit the staggered rollout of the social-protection programs across districts to causally identify the impact of the schemes on a set of indicators. They intend to compare changes in districts that received the program earlier to changes in districts that received the program later in a difference-in-differences approach. Last but not least, they will further assess the impact of the program on individual outcomes, taking advantage of administrative boundaries to separate treated and control areas in a geographic regression discontinuity.

You may find the research papers here :

• Social protection and inequality: Evidence from Ethiopia, India and Peru
• Social protection and multidimensional poverty: Lessons from Ethiopia, India and Peru 
• Social protection and intrahousehold resource allocation: Evidence from three large-scale programs 

You may find the policy briefs here:

• Policy Dialogues No. 1 | Social Protection: The Impact on Inequality in Ethiopia, India, and Peru
• Policy Dialogues No. 2 | Social Protection: The Impact on Multidimensional Poverty in Ethiopia, India, and Peru
• Policy Dialogues No. 3 | Social protection: impact on household resource allocation and child undernutrition

Contact:

Conchita d’Ambrosio, Professor of Economics, Université du Luxembourg

Cecilia Poggi, Research Officer, AFD

 

An upturn in growth in Côte d'Ivoire since 2012 has been observed, with average growth rates in real GDP surpassing 8%. However, this renewed vitality in the economy has not yet been felt by all of Ivorian society. The level of poverty remains high (46.3%), as does that of inequalities. (The Gini index for 2015 is estimated at 0.402 by the National Statistics Institute and 0.415 by the World Bank). We can thus see that, while the Ivorian economy seems to be doing well, a very large proportion of its population is excluded from the benefits of this economic upturn. 

This project is part of the first phase of the Research Facility on Inequalities, coordinated by AFD and funded by the European Commission's Directorate-General for International Partnerships over the 2017-2020 period. The first phase of the Facility has led to the conduct of 22 research projects and the publication of around 100 research papers and policy briefs.

This research program on inequalities in Côte d’Ivoire will first take stock of the inequalities there, and then it will carry out scientific studies on three themes:

• the impact of shocks on inequalities;
• the inequalities of access to education and to quality health services;
• the impacts of public policies on inequalities. 

The study will also focus on the perception of inequalities by Ivorians.

 

The research on inequalities will take stock of the Ivorian situation and will review the initiatives of public authorities to fight monetary and non-monetary inequalities. Using the data available on the living conditions of the households, the main indicators for the measurement of inequalities will be calculated and a representation of the spatial distribution of the inequalities will be carried out in the form of maps. Subsequently, an analysis will be carried out on inequalities in opportunities (measured by the effect on opportunities from parents’ education, their occupation, place of birth, and gender) with regard to access to property and assets, as well as on the sources and the perceptions of these inequalities. 

The study on the shocks will be based on statistical analysis and modeling methods (in particular, a linear regression model and a panel data model will be applied). Access to basic services will be covered mainly with the help of micro-econometric models. The study of the effects of public policies will be considered with a microsimulated inter-industry model, then by impact evaluation models.

 

The project is expected to produce a review describing the state of public interventions designed to eradicate inequalities in Côte d'Ivoire. The study on the perception of inequalities will also make it possible to measure the extent to which households are conscious of the need for greater social justice and identify possible measures at the individual level. This research will also help identify the mechanisms of intergenerational transmission of inequalities and will propose policy measures for social mobility in Côte d'Ivoire. 

This research will give rise to conferences and workshops. Various publications are also expected: a report, policy briefs, and research articles.

You may find the report and the research papers linked to this project here (in French) :

• Etat des lieux des inégalités en Côte d'Ivoire
• D'où proviennent les inégalités en Côte d'Ivoire? 
• Analyse de l'impact de la crise de 2002 sur les inégalités en Côte d'Ivoire 
• Impacts des dépenses publiques sur les inégalités en Côte d'Ivoire: le cas des secteurs sociaux

You may find the policy briefs linked to this projet here (in French) :

• Impacts de la crise militaro-politique de 2002 sur les inégalités en Côte d’Ivoire
• D’où proviennent les inégalités sociales en Côte d’Ivoire ?
• Les effets des dépenses publiques sociales sur les inégalités en Côte d’Ivoire

Contacts:

Linda Zanfini, Research Officer, AFD.

Anda David, Research Officer, AFD.

The world has seen a significant reduction in the extreme poverty levels in the past decades, led by strong economic growth from emerging economies. Despite the economic growth, the incomes of the poorest people all over the world are not keeping up. Eight out of ten people in developing countries live in nations where the income of the bottom 40% has grown slower than the rest of the economy (Hoy & Samman, 2015) and 7 out of 10 people live in a country where inequality has risen in the last 30 years.

Regarding Latin American and the Caribbean, although the region achieved considerable success in reducing extreme poverty over the last decade, its still-high levels of income and wealth inequality have damaged sustainable growth and social inclusion.

In West Africa, the sub-region had the largest average economic growth at 6.2 percent between 2010 and 2014 among Africa's regions, and compared with 4.4 percent for Africa during the period. However, there is growing concern that the benefits of this impressive growth have not been inclusive and equitably shared. The combination of high economic growth and stubbornly high income inequality rates remains a puzzle.

This project is part of a European facility for a research program on inequalities in developing and emerging countries which is coordinated by the AFD. Financed by the Development Cooperation Instrument of the European Union, this facility enables to implement 20 research projects over the period 2017-2020, in partnership with donors and research centers from the South to the North.

 

This project is part of the first phase of the Research Facility on Inequalities, coordinated by AFD and funded by the European Commission's Directorate-General for International Partnerships over the 2017-2020 period. The first phase of the Facility has led to the conduct of 22 research projects and the publication of around 100 research papers and policy briefs.

Even if we know less unequal societies are desirable given their beneficial economic, social and political outcomes, there is still uncertainty on which are the best routes to understand and tackle inequalities through a multidimensional perspective. To contribute to this global conversation on inequalities, Oxfam, the International Inequalities Institute at the London School of Economics and the School of Oriental and African Studies of the University of London, are joining efforts to develop a conceptual and measurement framework on inequalities. The purpose of the framework is to provide analysts and practitioners with a theoretically-grounded means by which to gain a clear understanding of the nature of inequality and to use this information to develop and devise effective policy responses with the long-term goal of reducing inequalities, tackling deprivation and improving well-being.

The framework is designed to capture the multidimensional nature of inequality, which is experienced across a number of 7 life domains, and given that there are many different forms of inequality (such as concentrations of wealth, pay gaps, dispersion of income, social gradients in mortality, and greater social isolation experienced by the elderly). The framework is based on Amartya Sen's capability approach. The focus of this approach is an assessment on what life we lead and what we can or cannot do, and can or cannot be; the quality of life that individuals are able to achieve. Equally important, this framework should enlighten the discussion on inequalities in a way that allows for context-specific diagnosis and policy recommendations, so that it can support the strategic work of practitioners and key stakeholders of the development arena.

See this project's 2 minutes pitch from Ana Claver, Project Manager on Inequalities at Oxfam Intermón:

Evidence from more than 150 countries, rich and poor alike, spanning more than 30 years, shows that overall, investment in health, education and social protection reduces inequality. Nevertheless, we still need to know more about what are the concrete mechanisms that make these inequality reductions happen, and how certain policies should be designed so that they tackle spatial, gender and ethnic inequalities in an effective manner. We expect to draw lessons from those different scenarios by this comparative research.

The researchers involved in this project anticipate that active citizenship is a means to achieve development, because it enables women and men living in poverty to raise their voice in defence of their rights (health, education, jobs, dignity). Moreover, they presuppose that public policies amplify their effectiveness when citizens are involved in their cycle. They also presume that women and girls plus youth are the groups especially impacted by multidimensional inequality and thus, they should be carefully considered in the research.

Find the presentation of the research paper "Multidimensional inequality in Western Africa" by Ana Claver Muñoz and Cristina Rovira Izquierdo, project manager on inequalities and inequality programme advisor at Oxfam Intermón during the fifth webinar of the Research Facility on Inequalities:

You may find the deliverables linked to this project here: 

West Africa Report: 

- Analysis of multidimensional inequalities in West Africa and a strategy for inequality reduction (in English)

- Análisis de las desigualdades multidimensionales en el Africa Occidental y sus consecuencias en la estrategia regional contra la desigualdad (in Spanish)

 

Central America and Dominican Republic Report:

- Analysis of multidimensional inequalities in Central America and Dominican Republic, and a strategy for inequality reduction (in English)

- Análisis de la desigualdad multidimensional en Centroamérica y República Dominicana (card) y de una estrategia política regional para reducir las desigualdades (in Spanish)

 

Policy briefs:

- A strategy for reducing inequalities in West Africa (in English)

- A strategy for reducing inequalities in Central America and the Dominican Republic (in English)

You may also find a short presentation video of the Multidimension Inequality Framework (MIF) used in this research project (in English):

 

Contact:

Anda David, Research Officer, AFD

Despite a significant progress in Vietnam in terms of growth, poverty reduction and even inequality reduction, efforts on inequality and human development issues still need to be done.

In Vietnam, nearly 30 million people have been lifted above the official poverty line over the last three decades, and the country's human development index (HDI) has risen significantly. However, data shows that income inequality in Vietnam has increased over the last two decades. According to the World Bank, the Gini index rose from 35.7 to 38.7 from 1992 to 2012. Besides, in 2014, there were 210 super-rich individuals in the country whose combined wealth stood around $20bn, which is equivalent to 12% of the country's GDP. In fact, according to Oxfam-Vietnam calculations, the richest man in Vietnam earns more in a day than the poorest Vietnamese earns in 10 years.

This project is part of the first phase of the Research Facility on Inequalities, coordinated by AFD and funded by the European Commission's Directorate-General for International Partnerships over the 2017-2020 period. The first phase of the Facility has led to the conduct of 22 research projects and the publication of around 100 research papers and policy briefs.

The goal is to adopt a multidimensional approach to provide convincing analysis on inequality. This will focus especially on inequality of opportunities and voice in order to use this as a process to engage with relevant stakeholders, especially in the debates on policy options to tackle inequality, and in mid-term to use the MIF as a way to influence monitoring of SDG 10 in the country.

The specific goals are as follows:

• The "Oxfam Vietnam Inequality Framework" is developed, piloted and adopted to the Vietnamese context;
• The OVIF is used as a tool to enhance in-depth understanding on multiple dimensions of inequality (paying special attention to inequality in voices and opportunity) and identify concrete policy gaps to tackle inequality in Vietnam;

The OVIF research findings and methodology are shared with policy makers, research institutes, and other development institutions.

The Multidimensional Inequality Framework is designed to capture the multidimensional nature of inequality, which is experienced across a number of 7 life domains, and that there are many different forms of inequality (such as concentrations of wealth, pay gaps, dispersion of income, social gradients in mortality, and greater social isolation experienced by the elderly). Within each of the 7 life domains, the framework offers a series of sub-domains and a number of indicators and measures which can be used to measure and monitor multidimensional inequality in a given context. Many of the indicators and measures suggested under each subdomain are related to the SDGs framework, which governments are already committed to monitor. This can be a useful element to guarantee at least a minimum level of data availability in all countries. Besides, the Oxfam Inequality Toolkit, which is a key companion for the practical implementation of the MIF in a given context, suggests several global databases, aside from national household surveys, to be used by teams willing to implement the framework.

The research findings point at persisting, critical inequalities across several life domains.  After conducting quantitative and qualitative analysis, the research identifies large gaps between subpopulation groups across spatial, socio-economic, and ethnic axes of inequality in their capability to enjoy the right to a proper, quality education and to experience a life free of illness and access to quality healthcare facilities. People belonging to ethnic minorities (EM), women, and people living in rural provinces are more affected by inequalities in health and education than the Kihn, men, and higher-income households living in predominantly urban areas. 

Furthermore, inequality in the capability to participate, raise one’s voice, and influence public matters is extremely acute between men and women and the poorest households, with a lower level of education, compared to the richest, urban, highly educated households. 

You may find the research paper and the policy brief here:

• Research paper: Multidimensional inequality in Vietnam
• Policy brief: Multidimensional inequality in Vietnam

 

Please find the presentation of the report "Multidimensional Inequalities in Vietnam” by Vu Thi Quynh Hoa (Head of Campaign & Advocacy in Oxfam Vietnam) and Dr. Phuong Duc Tung (Director of the Mekong Development Research Institute) during the second webinar of the AFD Research Conversations:

Contact:

• Anda David, Research Officer, AFD

The picture within Africa is more complex, and often obscured by problems with unreliable and non-comparable data, both over time and across countries. The most careful African data analysis suggests that, measured in monetary terms, African inequality is very high, Africa being the most unequal continent. There is, however, huge variation in the magnitude, changes and texture of this inequality across the continent.

This implies a double danger. Africa first needs to ensure that it is included in the international measurements. At least as importantly, the continent must also ensure that the particular contexts of its societies are considered in the analysis both of the factors causing inequality and the consequences of inequality. This analysis is absolutely crucial because it is the basis for policy interventions and civil society action, which are necessary to reverse the trend. 

Given this context, a research project focusing on the development of diagnostic tools and capacity building was launched in partnership with the African Center of Excellence on Inequality Research (ACEIR) in the framework of the first phase of the Research Facility on Inequalities. The initial study (2018-2020) led to an in-depth analysis of inequalities in four countries: South Africa, Ghana, Kenya and Cote d’Ivoire. A Handbook on Inequality Measurement, which serves as a foundational guide for multidimensional inequality analysis, was also developed by ACEIR. The Handbook outlines key dimensions and indicators of inequality and provides guildelines for measuring income and beyond income inequalities.

Following the success of this research project:

• A fifth analysis was launched in Mozambique over the 2022-2024 period;
• A research project aming to expand and update the Handbook by incorporating methodologies for assessing vulnerabilities related to climate change and ecological transitions has also been launched over the 2024-2025 period.

The main objective of this research project was to advance the analysis of African inequality and the policy discussion on strategies to overcome inequality in Africa through a series of country-level engagements. The project was given structure and impetus through the development of a diagnostic tool that was implemented in a limited number of pilot countries. This diagnostic tool consists of a thorough analysis of the various inequalities in a given country which enables the government to identify the priorities and policy options in order to reduce them.

In order to build the diagnostic tool, a Handbook was also developed to set up a common base which enabled country comparisons. To extend its use and improve accountability, it was backed with a central data hub and strong data centres in each partner country that allowed and facilitated further inequality analysis.

Existing multidimensional inequality analyses primarily concentrate on examining inequalities within the social and economic domains. While many low-income countries are severely impacted by climate change, there is a notable research gap in the analysis of inequalities related to climate vulnerabilities and their interactions with other socio-economic and environmental factors. The extension and updating of the Handbook, carried out over the period 2024-2025, aims to address this gap and provide the guidelines for integrating the analysis of climate-related inequalities in future diagnostics.

The diagnostic tool is based on three pillars :

1. a conceptual and empirical review of the studies on inequality in Africa, allowing us to have a baseline for the development of future projects, as well as a better comprehension of the specificities of inequalities in Africa and of their measurement;
2. a Handbook which contains the framework proposed for the country inequality diagnostics, the methodological issues around the measurement of inequalities and their analysis and the important issues linked to policies;
3. the support to the implementation of the country diagnostic, in collaboration with the pilot countries’ local research teams and the creation of the data hub.

In order to expand and update the Handbook, researchers will thoroughly examine and synthesise existing literature that addresses the measurement and analysis of climate-related vulnerabilities. This approach will help identify gaps in current research and propose a minimal set of indicators for measuring vulnerabilities linked to climate change and the imperatives of the ecological transition and detail appropriate data and measurement methods to enable their inclusion as part of an inequality diagnostic report.  

In practical terms, the country diagnostic takes the form of a report which overviews the inequality within a country, across all relevant dimensions, for a given time and over time. Alongside this, it summarises the main policies passed, or in place, expected to have an impact on inequalities. Each country will use their diagnostic as a platform:

• for policy engagements on strategies to overcome inequality,
• for the stimulation of national dialogue and a national research focus on inequality,
• to lead the national discussion through further, high impact research papers from the country node on inequality.

• Anda David, Research Officer, AFD
• Rawane Yasser, Junior Research Officer, AFD