Diarrhea and malaria are two of the most devastating public health threats in the developing world, resulting in millions of childhood deaths each year. Part of the challenge in addressing these threats arises from the fact that many of the causes of and potential remedies for these diseases lie squarely at the intersection of environment, development, and health. In addition, while many environmental, economic, and health-related policies focus on expanding access to new technologies (e.g., latrines, mosquito nets), inadequate attention to factors that affect the use of these technologies often leads to disappointing policy outcomes. This dissertation applies an economic framework to explore the drivers of households' environmental health decisions in two specific contexts. The first study examines sanitation behaviors and child health outcomes in Orissa, India, while the second case involves malaria-related knowledge, prevention, and treatment behaviors in Mvomero, Tanzania. In both cases, theoretical models are developed that focus on the perceived costs and benefits households consider in their decisions to adopt certain behaviors. A key insight is that technologies targeting diarrhea and malaria have characteristics of both private and public goods. For both epidemiological and social reasons, the payoffs to adopting behavior changes such as using a latrine or a mosquito net will depend in part on the behavior of other households in the village or neighborhood. This motivates an examination of the role of social networks and social interactions in influencing households' environmental health choices in both empirical studies. The first empirical case involves a study of a randomized community-level sanitation intervention in Orissa, India. Household survey data were collected before and after the sanitation campaign in 1050 households in 40 rural villages. Impact evaluation analyses indicate that the campaign resulted in large increases in latrine use in the randomly selected "treatment" villages. In addition, some analyses suggest that child health outcomes may have improved as a result of the campaign. To examine the drivers of the observed behavior change, econometric models are run including household and village characteristics as well as indicators of social interactions. Results indicate that households were more likely to adopt latrines when they observed more adoption among their peers. Thus, part of the sanitation campaign's success was likely due to its emphasis on targeting villages rather than individuals and strengthening social pressure to adopt latrines. The second empirical case examines indicators of households' malaria-related knowledge, prevention, and treatment behaviors in Mvomero, Tanzania. Survey data from 408 households in 10 villages shed light on a number of malaria control behaviors, including use of bed nets and anti-malarial medications. Findings suggest that the majority of households (over 80%) in this area own and use mosquito nets. At the same time, malaria continues to impose a significant burden on the study population. Data collected in Mvomero also provide unique information on the patterns of social interaction among households within and across different villages, and additional analyses explore the role of social interactions in influencing households' malaria-related decisions. Results suggest that patterns of interaction are influenced by a number of factors, including physical proximity as well as tribe, religion, and wealth. In addition, social effects may play an important role in influencing households' malaria prevention and treatment decisions. Together, these studies help to shed light on the ways households perceive and respond to two specific environmental health threats. More generally, this study illustrates the potential benefits of applying economic tools and analyses to problems like sanitation and malaria, and expanding the definition of "environmental problems" beyond the typical set of first-world issues (e.g., industrial pollution) to include these pressing issues facing the world's most vulnerable populations. / Dissertation

Introduction: Women’s household decision autonomy is a significant part of women’s empowerment and has, in previous studies, been shown to affect the possibility of negotiating for safe sex practices. Women in sub-Saharan Africa face difficulties in refusing sex from their partners due to stigmatization, which puts them at risk for both unwanted pregnancies and STIs. The aim of this thesis is to assess the association between participation in household decision-making and married women’s ability to refuse sex in Mali. Methods: It is a cross-sectional study using data from the 2018 Mali Demographic and Health Survey. The final study sample included 7681 married or women living in union, and the analysis used descriptive statistics and univariate- and multivariate logistic regression. Results: This study found that women who participate in household decisions are significantly more likely to be able to refuse sexual intercourse with their partners. Additionally, uneducated women and women living in rural areas were significantly less likely to be able to refuse sex, while women who have access to some sort of media on a weekly basis were more likely to be able to refuse. Age, sex of head of household, and partner’s education showed no impact on the ability to refuse sex. Conclusion: The results corroborate with existing literature and highlight the need for improved efforts to specifically address social and cultural barriers that may aid women’s ability to practice safe sex negotiations in their relationships.

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Im Zuge der rasanten Verbreitung von Mikrokrediten und Mikrosparprodukten werden seit etwa einem Jahrzehnt auch Mikroversicherungen an einkommensschwache Haushalte in Entwicklungsländern verkauft. Sie stellen für diese Haushalte eine Möglichkeit dar, mit den Folgen von Risiken besser umzugehen und somit ihren Wohlstand zu steigern. Diese Arbeit verwendet quantitative und qualitative Analysemethoden – basierend auf eigenen Haushaltsumfragen und Fokusgruppendiskussionen –, um die Aufnahmebedingungen von Mikroversicherung in Ghana zu untersuchen. Die Ergebnisse zeigen erstens, dass über Standarddeterminanten der Versicherungsnachfrage hinaus Faktoren informeller Vertrauensbildung und die subjektive Risikoeinschätzung eine entscheidende Rolle spielen. Dies begründet sich in bestehenden Informationsasymmetrien und einer geringen Erfahrung mit dem Versicherungsprodukt und dem Versicherer. Ferner steht die Nutzung von Mikrolebensversicherung in einer sich verstärkenden Beziehung zu der Nutzung anderer formaler Finanzdienstleistungen. Zweitens wird deutlich, dass der Wert (Client Value), den die Zielgruppe in Mikroversicherung sieht, nicht allein auf Kosten- und Nutzenerwägungen basiert. Vielmehr spielen auch emotionale- und soziale Aspekte eine Rolle. Der Kundenwert wird dabei von Faktoren wie (geringen) Finanz- und Versicherungskenntnissen, der Beeinflussung durch die soziale Gruppe und dem Vergleich mit alternativen Risikomanagementstrategien beeinflusst. Drittens bestehen genderspezifische Muster in der Aufnahme von Mikrolebensversicherung, die mit dem Haushaltstyp und regional unterschiedlichen soziokulturellen Bedingungen zusammenhängen. Die Ergebnisse weisen darauf hin, dass Präferenzen bezüglich Lebensversicherung innerhalb von Haushalten variieren und die Wahrscheinlichkeit eines Versicherungskaufs mit wachsender Verhandlungsstärke der Frau zunimmt. Die Ergebnisse legen nahe, dass Frauen eine besonders wichtige Zielgruppe für Mikrolebensversicherungen sind. / Microinsurance has been the third financial service – following microcredit and microsavings - to enter emerging financial markets in the developing world. It is widely regarded as a promising innovation that could provide high welfare gains, given that low-income people often lack efficient strategies to manage and cope with risks. This thesis applies quantitative econometric and qualitative methods – based on own household and individual survey data and focus group discussions – to investigate participation patterns and perceived value in micro life insurance in Ghana. The results of this thesis show that household, first, uptake of micro life insurance does not entirely follow the predictions made by standard insurance theories. Informal trust-building mechanisms and subjective risk perceptions turn out to play an important role in the context of information asymmetries and limited experience with formal insurance. Furthermore, there is a mutually reinforcing relationship between micro life insurance and other formal financial services available in the rural and semi-urban study areas in Ghana. Second, the perceived value of microinsurance consists not only of the expected or experienced benefits and costs, but also of quality, emotional and social dimensions. Perceptions of high or low value are driven by large discrepancies between expectations and experiences, clients’ knowledge about insurance, their interaction with peers, and the availability and effectiveness of alternative risk management options. Third, there are gender-specific patterns of market participation between and within households that are intertwined with the household type and regionally varying sociocultural conditions. Spousal preferences on insurance differ and women with a higher bargaining power are more likely to purchase insurance on their own. The results suggest that women are an important target group for the provision of micro life insurance.

Le capital social est un concept de plus en plus populaire en économie mais des ambiguïtés persistent quant à la manière de saisir l'aspect "social" de la vie humaine et d'interpréter le terme "capital". Par rapport aux précédents travaux, cette thèse fournit des outils analytiques nouveaux pour identifier et mesurer le capital social et étudier son rôle dans le bien-être individuel. Dans une perspective théorique, ces outils apportent un éclairage sur les raisons de ses différentes interprétations. Nous définissons d'abord le capital social comme l'ensemble des attentes et obligations que les individus accumulent lors des interactions et identifions trois dimensions le composant: l'homogénéité entre individus, la fréquence des contacts et la hiérarchisation des relations. Ces dimensions sont responsables de la fonction de coordination, attribuée au capital social, et du vaste éventail d'effets observés jusqu'à présent. Ce cadre est opérationnalisé à l’aide d’une mesure d’un index multidimensionnel au niveau individuel en Indonésie et un lien avec l'approche des capabilités est établi avec pour objectif de mieux identifier les canaux à travers lesquels le capital social impacte le bien être d’individus. Dans une perspective empirique, une étude des déterminants de l'empowerment des femmes est ensuite proposée avec, comme principale variable explicative, le capital social. Cette thèse démontre que le capital social est, tout d’abord, un concept fondamental dans la compréhension de la capacité à agir et dans le bien-être d’individus et que, de plus, celui-ci peut générer des effets négatifs sur l'empowerment des femmes, simultanément à ses effets positifs et prépondérants. / In the last decades, the concept of social capital has gained increasing popularity in economics. Yet substantial ambiguity exists about how to assess the "social" aspect of human life and what meaning to attribute to the term "capital". To shed a new light on the concept, I develop a new conceptual framework and I make it operational for analysis and policy in the context of development by investigating issues of gender empowerment. From a theoretical perspective, this conceptual framework defines social capital as the amount of expectations and obligations that individuals accumulate when they interact and identifies its constituting dimensions: homogeneity among individuals, frequency of contacts and hierarchization of relationships. These dimensions are responsible for the function of coordination, attributed to social capital, as well for the wide range of outcomes observed in the literature. This framework is then operationalized through an index of social capital at the individual level in Indonesia. A connection with the capability approach to welfare economics is established to better understand those channels through which social capital affects individual well-being. At the empirical level, an investigation of the determinants of women empowerment in the household is consequently proposed, with social capital as the main explanatory variable. This work shows that the concept of social capital is fundamental to explore individuals' agency and well-being and that it has both positive and negative effects on women empowerment.

Cette thèse traite des mesures à prendre afin d'assurer le succès de projets de développement exécutés par des firmes privées, et plus particulièrement les Organisations Non Gouvernementales (ONGs). Les ONGs sont des firmes à but non lucratif qui sont semblables aux gouvernements dans leur préoccupation pour le bien-être des bénéficiaires et aux firmes privées standard sur le plan organisationnel. Leur participation aux projets de développement soulève la question de savoir si elles sont plus efficaces que ces entités similaires. Malgré la croissance rapide du secteur ONG, surtout des multinationales basées dans les pays riches avec des branches implantées dans les pays pauvres, peu de recherches en économie de développement se sont intéressées à comment la nature d’une organisation peut affecter son comportement dans l’implémentation des projets de développement. Les trois chapitres de cette thèse soulignent des différences entre Les ONG, les firmes privées et les gouvernements et examinent comment la nature même de chaque type d'organisation affecte sa fourniture de services publics. Les deux questions-clés sont donc pourquoi et sous quelles des conditions choisir une ONG comme fournisseur de biens et services dans le cadre d'un projet de développement, et comment s’assurer que les normes culturelles des bénéficiaires n’affectent négativement la réussite desdits projets. / This thesis addresses the question of how to ensure the success of development projects executed by private firms, especially Non-Governmental Organizations (NGOs). NGOs are non-profit firms that are similar to governments in their concern about beneficiaries' welfare and to standard private firms in their organizational form. Their involvement in development projects raises the issue of how well they perform in service provision compared to alternative entities. Despite the rapid growth of the non-profit sector, especially international firms based in high-income countries that operate in low-income countries, the existing literature on economic development has hardly investigated the issue of non-profit performance and regulation. The three chapters of this thesis emphasize differences between NGOs and either private for-profit firms or governements, and examine how the very nature of each type of organization affects service provision. The two key questions are why and under which conditions to choose an NGO as goods or services provider in the framework of a development project, and how to ensure beneficiaries' cultural norms do not undermine the success of development projects.