1. Disease Control, Demographic Change and Institutional Development in Africa Margaret S. McMillan Department of Economics, Tufts University http://margaretsmcmillan.com/ William A. Masters Department of Food and Nutrition Policy, Tufts University http://sites.tufts.edu/willmasters Harounan Kazianga Department 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”

2. Do deep determinants matter? Timing of historical transitions and demographic change Conditioning production response and investment returns Conditioning policy response and institutional development Tropical disease control as natural experiments Geographic endemicity overcome with postwar technologies Control of river blindness (Onchocerciasis) offers: Magnitude and variance (Africa-wide, 60% of Burkina Faso) Speed and timing (1975-2002, between census years) Exogeneity (foreign technology, uniform treatment) Disease, Demography and Institutional Development Motivation | Data | Method | Results

3. How river blindness works A species of blackfly (Simulium damnosum) breed in rivers, bite people and pick up Onchocerca larva transmits 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 Development Motivation | Data | Method | Results

4. Disease, Demography and Institutional Development Motivation | 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.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.http://www.who.int/apoc/onchocerciasis/control/en

5. Disease, Demography and Institutional Development Motivation | Data | Method | Results The West Africa Onchocerciasis Control Program (OCP) Step 1: Spray larvacide in rivers, to stop blackfly reproduction Step 2: Distribute deworming meds, to kill microfilaria Source: Merck (2012), www.mectizan.orgwww.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

6. Disease, Demography and Institutional Development Motivation | 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)

7. Disease, Demography and Institutional Development Motivation | Data | Method | Results OCP Results in West Africa Burkina Faso Estimated Onchocerciasis Prevalence in West Africa Prior to control (1974)After control (2002) Source: WHO, Onchocerciasis Control Programme ( www.who.int/apoc/onchocerciasis/ocp). www.who.int/apoc/onchocerciasis/ocp How did people respond?

8. Disease, Demography and Institutional Development Motivation | Data | Method | Results Demographic change Migration and settlement in previously Oncho-affected areas Private investment in farm and nonfarm activity Institutional development Land rights over cropland, grazing and forest areas Public and private investment in local amenities If treatment helped people improve oncho locations Then historical endemicity helps explain historical poverty and such programs can still help other disadvantaged locations How did people respond?

9. Disease, Demography and Institutional Development Motivation | Data | Method | Results Villages’ Location, Population Growth 1975-85 and Oncho Status

10. Survey Method From the Burkina Faso Office of Agricultural Statistics – Sample of 747 villages, nationally representative – Drop 118 subject to central planning (AVV) – Drop 14 missing from census data – We use 615 villages, representing non-AVV areas We asked focus groups 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 Development Motivation | Data | Method | Results

11. Questionnaire design: land rights Disease, Demography and Institutional Development Motivation | Data | Method | Results N°QuestionsRéponse 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 ? |____||____|____|____|____|

12. Questionnaire design: distance to services Disease, Demography and Institutional Development Motivation | Data | Method | Results N°QuestionsRéponse Distance (en km)Année d’établissement V.1Distance 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.2Distance 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|____|____|____||____|____|____|____|

13. 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 Development Motivation | Data | Method | Results

14. 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 Development Motivation | Data | Method | Results Distance (km) from village to nearest:

15. Descriptive statistics: property rights in census years Disease, Demography and Institutional Development Motivation | Data | Method | Results Source: Table 1: Mean, standard deviation, and sample size for all variables in each year

16. Descriptive statistics: distance to amenities Disease, Demography and Institutional Development Motivation | Data | Method | Results Source: Table 1: Mean, standard deviation, and sample size for all variables in each year

17. Descriptive statistics: distance to amenities (cont’d) Disease, Demography and Institutional Development Motivation | Data | Method | Results Source: Table 1: Mean, standard deviation, and sample size for all variables in each year

18. Do treated and control villages differ at baseline? Disease, Demography and Institutional Development Motivation | Data | Method | Results Population and land rights Table 2: Mean, standard deviation and difference between treated and control areas in 1975

19. Do treated and control villages differ at baseline? Disease, Demography and Institutional Development Motivation | Data | Method | Results Transport and infrastructure Table 2: Mean, standard deviation and difference between treated and control areas in 1975

20. Do treated and control villages differ at baseline? Disease, Demography and Institutional Development Motivation | Data | Method | Results Markets and water sources Table 2: Mean, standard deviation and difference between treated and control areas in 1975

21. Do treated and control villages differ at baseline? Disease, Demography and Institutional Development Motivation | Data | Method | Results Schooling, health and religious services Table 2: Mean, standard deviation and difference between treated and control areas in 1975

22. 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 Development Motivation | Data | Method | Results Regression specification

23. Disease, Demography and Institutional Development Motivation | Data | Method | Results OLS estimates of equation (1) Dependent variable:Post-75Post-85Annual 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 19850.24*** Treated X 19960.39*** Treated X 20060.39*** Post-75 (1985-2006)0.09 Post-85 (1996-2006)-0.09* Year = 19850.21*** Year = 19960.17** Year = 2006-0.11 Constant6.68***6.88***6.68*** R-squared0.470.450.48 Table 3: OLS results for village population on Onchocerciasis treatment status and time

24. Disease, Demography and Institutional Development Motivation | 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)0.020.04***0.020.03*-0.04*** Time = 1985-20060.02**0.000.11***0.04*** Constant0.39***0.84***0.23***0.08***0.34*** R-squared0.960.920.83 0.96 Panel B: Post-1985 Treated X Post-85 (1996-2006)0.02**0.04***0.05***0.02*-0.05*** Time = 1996-20060.02***0.00*0.09***0.05***0.04*** Constant0.39***0.85***0.26***0.09***0.34*** R-squared0.960.930.84 0.96 Main results for land rights only Table 4: OLS results for property rights on Onchocerciasis treatment status and time

25. Disease, Demography and Institutional Development Motivation | 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)-0.000.02***-0.01-0.000.00 Time = 1985-20060.03*** 0.13***0.05***0.01** Constant0.39***0.74***0.29***0.10**0.34*** R-squared0.960.930.83 0.95 Panel B: Post-1985 Population (log)0.000.02***-0.000.00 Time = 1996-20060.03*** 0.12***0.06***0.02*** Constant0.38***0.74***0.27***0.09**0.34*** R-squared0.960.930.84 0.96 Panel 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

26. Disease, Demography and Institutional Development Motivation | 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)0.050.13***0.060.08*-0.13** Time = 1985-20060.01-0.010.11***0.03*0.05*** Panel B: Post-1985 Population (log)0.08*0.15***0.19**0.09-0.19*** Time = 1996-20060.03***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

27. Conclusions Disease, Demography and Institutional Development Motivation | 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) Methodologically, villagers’ recall data can work for recent history