1. Reaching the Poor Conference, February 24, 2004 1 Achievement Index: Immunization in India Abdo Yazbeck Lead Health Economist World Bank Institute

2. 2 Wagstaff, Adam. (2002). Inequality aversion, health inequalities and health achievement. Journal of Health Economics, 21(4), pp. 627-41 Combines levels and distribution Allows for different levels of inequality aversion (v=0 is the same as level, V=8 means the values of the lowest income groups dominate) Achievement Index

3. 3 Immunization Levels are very important for immunization (Herd immunity factor) But distribution also matters The Wagstaff (Achievement) index allows us to combine the two to compare among states in India and to trank progress over time

4. 4 Data Two household Surveys 6 years apart: NFHS India 1992/93 NFHS India 1998/99 16 states and territories Rural and Urban done separately 32 points in total

5. 5 Steps 1.Calculated the Wagstaff Index for each state rural and urban samples for both point in time 2.Rank states/subsamples in each period (urban and rural separately) for v = 0 and v = 8 3.Identify movers (winners and losers)

6. 6 Winners and Losers