Disease Control, Demographic Change and Institutional Development in Africa

Margaret S. McMillanDepartment of Economics, Tufts University

http://margaretsmcmillan.com/

William A. MastersDepartment of Food and Nutrition Policy, Tufts University

http://sites.tufts.edu/willmasters

Harounan KaziangaDepartment of Economics, Oklahoma State University

http://www.hkazianga.org/

Revised version of NBER Working Paper No. 17718, entitled “Rural Demography, Public Services and Land Rights in Africa:

A Village-Level Analysis in Burkina Faso”

Abstract: Our paper in 150 wordsThis paper addresses the role of tropical disease in rural demography, land use rights and public amenities, using data from Onchocerciasis (river blindness) control in Burkina Faso. We combine a new survey of village elders with historical census data for 1975-2006 and geocoded maps of treatment under the regional Onchocerciasis Control Program (OCP). The OCP ran from 1975 to 2002, first spraying rivers to stop transmission and then distributing medicine to help those already infected. Controlling for time and village fixed effects, we find that villages in treated areas acquired larger populations and also had more cropland transactions, fewer permits required for cropland transactions, and more regulation of common property pasture and forest. Treated villages also acquired closer access to electricity and telephone service, markets, wells and primary schools, with no difference in several other variables. These results are consistent with both changes in productivity and effects of population size on public institutions.

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Abstract: Our paper in 150 wordsThis paper addresses the role of tropical disease in rural demography, land use rights and public amenities, using data from Onchocerciasis (river blindness) control in Burkina Faso. We combine a new survey of village elders with historical census data for 1975-2006 and geocoded maps of treatment under the regional Onchocerciasis Control Program (OCP). The OCP ran from 1975 to 2002, first spraying rivers to stop transmission and then distributing medicine to help those already infected. Controlling for time and village fixed effects, we find that villages in treated areas acquired larger populations and also had more cropland transactions, fewer permits required for cropland transactions, and more regulation of common property pasture and forest. Treated villages also acquired closer access to electricity and telephone service, markets, wells and primary schools, with no difference in several other variables. These results are consistent with both changes in productivity and effects of population size on public institutions.

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Abstract: Our paper in 150 wordsThis paper addresses the role of tropical disease in rural demography, land use rights and public amenities, using data from Onchocerciasis (river blindness) control in Burkina Faso. We combine a new survey of village elders with historical census data for 1975-2006 and geocoded maps of treatment under the regional Onchocerciasis Control Program (OCP). The OCP ran from 1975 to 2002, first spraying rivers to stop transmission and then distributing medicine to help those already infected. Controlling for time and village fixed effects, we find that villages in treated areas acquired larger populations and also had more cropland transactions, fewer permits required for cropland transactions, and more regulation of common property pasture and forest. Treated villages also acquired closer access to electricity and telephone service, markets, wells and primary schools, with no difference in several other variables. These results are consistent with both changes in productivity and effects of population size on public institutions.

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Abstract: Our paper in 150 wordsThis paper addresses the role of tropical disease in rural demography, land use rights and public amenities, using data from Onchocerciasis (river blindness) control in Burkina Faso. We combine a new survey of village elders with historical census data for 1975-2006 and geocoded maps of treatment under the regional Onchocerciasis Control Program (OCP). The OCP ran from 1975 to 2002, first spraying rivers to stop transmission and then distributing medicine to help those already infected. Controlling for time and village fixed effects, we find that villages in treated areas acquired larger populations and also had more cropland transactions, fewer permits required for cropland transactions, and more regulation of common property pasture and forest. Treated villages also acquired closer access to electricity and telephone service, markets, wells and primary schools, with no difference in several other variables. These results are consistent with both changes in productivity and effects of population size on public institutions.

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Abstract: Our paper in 150 wordsThis paper addresses the role of tropical disease in rural demography, land use rights and public amenities, using data from Onchocerciasis (river blindness) control in Burkina Faso. We combine a new survey of village elders with historical census data for 1975-2006 and geocoded maps of treatment under the regional Onchocerciasis Control Program (OCP). The OCP ran from 1975 to 2002, first spraying rivers to stop transmission and then distributing medicine to help those already infected. Controlling for time and village fixed effects, we find that villages in treated areas acquired larger populations and also had more cropland transactions, fewer permits required for cropland transactions, and more regulation of common property pasture and forest. Treated villages also acquired closer access to electricity and telephone service, markets, wells and primary schools, with no difference in several other variables. These results are consistent with both changes in productivity and effects of population size on public institutions.

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

• What are the “deep determinants” of global poverty?• Why are some still so poor, long after others got so rich?• The most visible variation is explained by social choices

especially institutional rules and government policies• Those differences can in turn be traced to physical geography

especially tropical climate and landlocked isolation • Do geographic factors still matter today?

• Do yesterday’s obstacles still limit peoples’ choices?• We might look where a new technology has helped overcome

an old geographic obstacle, and see how people respond…

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

• Tropical disease control as natural experiment• Tropical diseases are location-specific, often “endemic” in a

particular place • In the 20th century, especially after World War II, there were

many breakthroughs against tropical disease…• The particular tropical disease control we study was unusual:

• Big enough to matter, but varied enough to measure (All across Africa, including about 60% of Burkina Faso)

• Suddenly brought under control in recent decades(From 1975 to 2002, between census years)

• Clearly exogenous to Burkina Faso’s own choices(Same treatment across almost all of West Africa)

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

• The details of Onchocerciasis • A species of blackfly (Simulium damnosum)

• breed in rivers, bite people and pick up Onchocerca larva• transmit the Onchocerca to its next victim

• A species of worm (Onchocerca volvulus)• grow in nodules under your skin, live for about 14 years• release millions of microfilarial larva that live or up to 2 years

in the human host, who they maim and blind, and viable for 6-8 days in the blackfly during transmission to next victim

= > Endemic in hot, tropical places near to rivers (up to 40 km?), with low population density (under 35-50 people/km2)

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Source: Carter Center (2010), River Blindness Programs. http://www.cartercenter.org/health/river_blindness.

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

The West Africa Onchocerciasis Control Program (OCP)Step 1: Spray larvacide in rivers, to stop blackfly reproduction

In the late 1950s, French researchers mapped the blackfly larva and showed that killing them would stop transmission

From 1975, World Bank and other donors paid for helicopters to spray larvacide over rivers in Oncho areas across Africa

Source: IRD (2010), Onchocerciasis. http://en.ird.fr/all-the-current-events/news/onchocerciasis-an-exemplary-control-programme.

Source: WHO (n.d.), African Programme for Onchocerciasis Control. http://www.who.int/apoc/onchocerciasis/control/en.

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

The West Africa Onchocerciasis Control Program (OCP)Step 1: Spray larvacide in rivers, to stop blackfly reproductionStep 2: Distribute deworming meds, to kill microfilaria

Source: Merck (2012), www.mectizan.org

• In the 1980s, a veterinary deworming drug called ivermectin (Mectizan) was found to control Onchocerciasis symptoms in people

• Since 1987, Merck has given the drug freely for distribution by aid agencies in affected areas

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

The West Africa Onchocerciasis Control Program (OCP)• spraying stopped in 1989, after 14 years (no new transmission)• ivermectin distribution stopped in 2002 (and continues elsewhere)

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

OCP Results in West Africa

Burkina FasoBurkina Faso

Estimated Onchocerciasis Prevalence in West AfricaPrior to control (1974) After control (2002)

Source: WHO, Onchocerciasis Control Programme (www.who.int/apoc/onchocerciasis/ocp).

How did people respond?

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

• How might people have responded to Oncho control?• Move into and invest in previously Oncho-affected areas• Improve institutions and public policies in those areas

• If we observe this in response to the OCP during 1975-2002…• Then the presence of Oncho can help explain why these

locations stayed poor• …which in turn implies that OCP-type programs to overcome

other geographic problems can help disadvantaged locations• because their “deep determinants” of historical

underdevelopment might still be operative today

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Villages’ Location, Population Growth 1975-85 and Oncho Status

Survey Method• Universe is 747 villages in the national farm survey of

the Office of Agricultural Statistics in Burkina Faso, minus 118 subject to AVV planning, and 14 missing from census data, for a sample of 615 villages

• Survey asks a focus group of elders to recall:– the status of the village’s land rights and distance to

various public amenities,– now and in the past, – recording the year of each change.

• Responses permit construction of 3-step time series– we use only the situation in 1975, 1985, 1996 and 2006– some villages did not report some data, so samples vary

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Questionnaire design: land rights

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

N° Questions Réponse

VIII.1 Type de droit appliquée pour les terres de culture(si la réponse est non, mettre des croix à année de début d’application)

Type de droit appliquée (1=Oui ; 0=Non)

Année de début d’application

VIII.1.1 Propriété individuelle |____| |____|____|____|____|

VIII.1.2 Propriété collective-familiale |____| |____|____|____|____|

VIII.1.3 Propriété collective-communautaire |____| |____|____|____|____|VIII.2 Location, vente et prêts de terres de culture

(si la réponse est non, mettre des croix à année de début d’application)

Possibilité de transaction(1=Oui ; 0=Non)

Année de début d’application

VIII.2.1 Est-ce que la terre peut-être louée ? |____| |____|____|____|____|

VIII.2.2 Est-ce que la terre peut-être vendue ? |____| |____|____|____|____|

VIII.2.3 Est-ce que la terre peut-être prêtée ? |____| |____|____|____|____|

Questionnaire design: distance to services

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

N° Questions RéponseDistance (en km) Année d’établissement

V.1 Distance entre le village et l’administration centrale (pour les registres des naissances)

V.1.1 La situation actuelle |____|____|____| |____|____|____|____|

V.1.2 La situation précédente |____|____|____| |____|____|____|____|

V.1.3 La situation antécédente |____|____|____| |____|____|____|____|

V.2 Distance entre le village et la route praticable par car ou camion toute l’année

V.2.1 La situation actuelle |____|____|____| |____|____|____|____|

V.2.2 La situation précédente |____|____|____| |____|____|____|____|

V.2.3 La situation antécédente |____|____|____| |____|____|____|____|

Our measures of property rights

– Are (or were) land rights assigned to individuals?– Do (or did) cropland transactions occur?– Is (or was) pasture access regulated?– Is (or was) forest access regulated?– Do (or did) cropland transactions require a permit?

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Our measures of public amenities

– Road– Bus Stop

– Bank– Electricity– Telephone

– Public Market– Livestock Market– Private Shop

– Water Well– Borehole – Dam

– Primary School– Secondary Sch.– Health Clinic

– Church – Mosque – Temple

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Distance (km) from village to nearest:

Descriptive statistics: property rights in census years

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Village population

(from census)

Land rights assigned to individuals

Land transactions

occurred

Pasture access is regulated

Forest access is regulated

Land transactions

require permit

Year = 1975 1,266 0.378 0.846 0.228 0.075 0.335

(1,248) (0.485) (0.361) (0.420) (0.263) (0.473)

Year = 1985 1,637 0.400 0.862 0.293 0.096 0.348

(1,561) (0.490) (0.346) (0.456) (0.294) (0.477)

Year = 1996 1,659 0.409 0.868 0.350 0.135 0.352

(1,413) (0.492) (0.339) (0.477) (0.342) (0.478)

Year = 2006 1,414 0.435 0.889 0.425 0.173 0.371

(2,597) (0.496) (0.314) (0.495) (0.378) (0.484) Observations 2,307 2,307 2,307 2,307 2,307 2,307 Villages 615 615 615 615 615 615 Source:Table 1: Mean, standard deviation, and sample size for all variables in each year

Descriptive statistics: distance to amenities

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Transport . Services . Markets . Road Bus Stop Bank Electricity Telephone Public Livestock Private Year = 1975 3.79 17.60 49.03 57.17 40.84 7.85 20.67 5.63 (7.21) (22.86) (47.49) (43.69) (35.48) (16.80) (30.26) (10.08) Year = 1985 4.34 13.93 39.29 51.12 37.11 5.73 22.46 5.18 (13.92) (18.55) (35.52) (36.07) (31.71) (8.10) (29.82) (8.90) Year = 1996 4.91 12.99 35.12 46.91 28.28 5.28 20.55 4.68 (14.21) (17.43) (30.91) (33.86) (24.64) (8.12) (26.01) (9.02) Year = 2006 4.32 10.64 25.81 36.73 21.34 4.85 17.07 2.09 (13.44) (15.82) (24.21) (26.39) (19.67) (7.52) (20.57) (5.25) Observations 1,433 1,719 1,084 1,227 1,589 2,216 1,042 1,228 Villages 449 518 559 462 557 601 339 549

Source:Table 1: Mean, standard deviation, and sample size for all variables in each year

Descriptive statistics: distance to amenities (cont’d)

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Water . Schooling and Health . Religious Services . Well Borehole Dam Primary Secondary Clinic Church Mosque Temple Year = 1975 1.11 1.52 18.59 10.73 51.74 16.30 8.95 5.46 9.48 (4.69) (4.95) (21.76) (12.84) (39.86) (17.33) (13.55) (11.40) (12.14) Year = 1985 0.74 0.63 18.12 6.94 40.14 12.70 4.88 3.92 5.09 (3.42) (2.90) (20.10) (11.74) (33.60) (13.83) (9.73) (7.30) (8.85) Year = 1996 0.89 0.57 16.91 3.73 26.07 8.79 4.97 3.88 5.09 (3.33) (2.69) (19.02) (8.46) (24.02) (10.56) (9.84) (7.29) (8.95) Year = 2006 0.30 0.33 15.41 1.14 17.32 5.91 3.55 2.63 3.01 (1.30) (2.07) (18.15) (4.43) (16.66) (6.76) (8.65) (5.73) (6.42) Observations 1,041 1,062 753 2,025 1,681 2,055 1,694 1,777 1,410 Villages 322 414 249 573 528 574 471 505 411

Source:Table 1: Mean, standard deviation, and sample size for all variables in each year

Do treated and control villages differ at baseline?

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Treated Control Difference Village population 1130.703 1468.08 -337.378***

[70.242] [90.799] [114.797]

Indicators of agricultural land-use rights

Land rights assigned to individuals 0.328 0.452 -0.125***

[0.027] [0.035] [0.045]

Land transactions occurred 0.834 0.864 -0.030

[0.022] [0.024] [0.033]

Pasture access is regulated 0.206 0.261 -0.055

[0.024] [0.031] [0.039]

Forest access is regulated 0.084 0.06 0.024

[0.016] [0.017] [0.023]

Land transactions require permit 0.389 0.256 0.132***

[0.028] [0.031] [0.042]

Population and land rights

Table 2: Mean, standard deviation and difference between treated and control areas in 1975

Do treated and control villages differ at baseline?

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Distance from village to nearest public amenity (km)

Road 4.196 3.192 1.004

[0.618] [0.639] [0.889]

Bus Stop 18.354 16.408 1.946

[1.627] [2.160] [2.704]

Bank 66.361 31.200 35.161***

[9.633] [3.998] [10.429]

Electricity 73.061 39.800 33.261***

[4.903] [4.133] [6.412]

Telephone 45.46 32.862 12.598***

[3.165] [2.934] [4.316]

Treated Control Difference Village population 1130.703 1468.08 -337.378***

Transport and infrastructure

Table 2: Mean, standard deviation and difference between treated and control areas in 1975

Do treated and control villages differ at baseline?

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Distance from village to nearest public amenity (km)

Road 4.196 3.192 1.004

Treated Control Difference Village population 1130.703 1468.08 -337.378***

Markets and water sources

Distance from village to nearest public amenity (km) Public Market 9.092 5.934 3.158**

[1.194] [0.713] [1.390]

Livestock Market 25.140 15.013 10.127**

[3.584] [2.253] [4.233]

Private Shop 6.231 4.750 1.481

[1.470] [1.011] [1.784]

Water Well 1.658 0.429 1.230*

[0.694] [0.143] [0.709]

Borehole 0.833 2.154 -1.321

[0.833] [1.764] [1.951]

Dam 24.96 8.625 16.335***

[3.490] [1.823] [3.937]

Primary School 11.818 9.068 2.750**

Table 2: Mean, standard deviation and difference between treated and control areas in 1975

Do treated and control villages differ at baseline?

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Distance from village to nearest public amenity (km)

Road 4.196 3.192 1.004

Treated Control Difference Village population 1130.703 1468.08 -337.378***

Schooling, health and religious services

[3.490] [1.823] [3.937]

Primary School 11.818 9.068 2.750**

[0.820] [1.112] [1.382]

Secondary Sch. 56.294 44.958 11.335**

[3.221] [4.190] [5.284]

Health Clinic 16.603 15.828 0.775

[1.086] [1.440] [1.803]

Church 9.692 8.000 1.692

[1.052] [1.146] [1.556]

Mosque 6.236 4.200 2.036*

[1.006] [0.657] [1.201]

Temple 10.189 8.580 1.610

[1.263] [1.119] [1.687] Table 2: Mean, standard deviation and difference between treated

and control areas in 1975

Our regressions are:

Where:I is the institutional outcome of interest for the village,Pop is population of the village, are fixed effects for all villages, and β is the “difference-in-difference” estimator of treatment effects.

In Equation (3), Pop is endogenous so we instrument it with the predicted value from equation (1), using 2SLS.

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

Regression specification

)1()()( 1112111 jtjttjjt TimeTimeTreatPop

)2()()( 2222212 kjtkjtktjkkkjt TimeTimeTreatI

)3()()( 3332313 kjtkjtkjtkkkjt TimePopI

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

OLS estimates of equation (1)Dependent variable: Post-75 Post-85 Annual Data log of village population (1) (2) (3)

Treated X Post-75 (1985-2006) 0.33***Treated X Post-85 (1996-2006) 0.25***Treated X 1985 0.24***Treated X 1996 0.39***Treated X 2006 0.39***Post-75 (1985-2006) 0.09Post-85 (1996-2006) -0.09*Year = 1985 0.21***Year = 1996 0.17**Year = 2006 -0.11Constant 6.68*** 6.88*** 6.68***R-squared 0.47 0.45 0.48

Table 3: OLS results for village population on Onchocerciasis treatment status and time

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

OLS estimates of equation (2)

Dependent variable:

Land rights assigned to individuals

Land transactions occurred

Pasture access is regulated

Forest access is regulated

Land transactions require permit

    (1) (2) (3) (4) (5)Panel A: Post-1975 Treated X Post-75 (1985-2006) 0.02 0.04*** 0.02 0.03* -0.04***Time = 1985-2006 0.02** 0.00 0.11*** 0.04*** 0.04***Constant 0.39*** 0.84*** 0.23*** 0.08*** 0.34***

  R-squared 0.96 0.92 0.83 0.83 0.96Panel B: Post-1985 Treated X Post-85 (1996-2006) 0.02** 0.04*** 0.05*** 0.02* -0.05***Time = 1996-2006 0.02*** 0.00* 0.09*** 0.05*** 0.04***Constant 0.39*** 0.85*** 0.26*** 0.09*** 0.34***

 R-squared 0.96 0.93 0.84 0.84 0.96Panel C: Annual Data (reported in paper - not shown here)

Main results for land rights only

Table 4: OLS results for property rights on Onchocerciasis treatment status and time

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

OLS estimates of equation (3)

Dependent variable:

Land rights assigned to individuals

Land transactions occurred

Pasture access is regulated

Forest access is regulated

Land transactions require permit

    (1) (2) (3) (4) (5)Panel A: Post-1975 Population (log) -0.00 0.02*** -0.01 -0.00 0.00Time = 1985-2006 0.03*** 0.03*** 0.13*** 0.05*** 0.01**Constant 0.39*** 0.74*** 0.29*** 0.10** 0.34***

 R-squared 0.96 0.93 0.83 0.83 0.95Panel B: Post-1985          Population (log) 0.00 0.02*** -0.00 0.00 0.00Time = 1996-2006 0.03*** 0.03*** 0.12*** 0.06*** 0.02***Constant 0.38*** 0.74*** 0.27*** 0.09** 0.34***

 R-squared 0.96 0.93 0.84 0.84 0.96Panel C: Annual Data (reported in paper - not shown here)

Main results for land rights only

Table 5: OLS results for property rights on village population and time

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

2SLS estimates of equation (3)

Dependent variable:

Land rights assigned to individuals

Land transactions occurred

Pasture access is regulated

Forest access is regulated

Land transactions require permit

    (1) (2) (3) (4) (5)Panel A: Post-1975        

Population (log) 0.05 0.13*** 0.06 0.08* -0.13**Time = 1985-2006 0.01 -0.01 0.11*** 0.03* 0.05***

Panel B: Post-1985 Population (log) 0.08* 0.15*** 0.19** 0.09 -0.19***Time = 1996-2006 0.03*** 0.02*** 0.11*** 0.06*** 0.03***

Panel C: Annual Data (reported in paper - not shown here)

Main results for land rights only

Table 6: 2SLS results for property rights on predicted village population and time

Conclusion

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

• Oncho-affected villages had been smaller, with similar or less market-oriented institutions before 1975

• After OCP treatment (after 1975-1985) treated villages: • expanded population by 25-33% faster than other villages, • became 4-5% more likely to assign property rights to individuals,

and 4-5% less likely to require permit before transactions• some of that may have been due to population growth alone, in

addition to increased productivity for those already there• treated villages also came to be more closely served by rural

amenities, especially public markets and also primary schooling and telephone service (results not shown in slides)

So what?

Disease, Demography and Institutional DevelopmentMotivation | Data | Method | Results

We hope this paper will lead to:• Methodological improvements

• Other papers using villagers’ recall data to measure social changes

• Replication of results• Other papers testing whether disease (control)

explains poor (better) social choices• Policy change

• More evidence to guide those willing to help geographically impaired places get richer