Setting the Weights: The Women's Capabilities Index for Malawi

Developing a Comprehensive Multidimensional Wellbeing Index Based on What People Value: An Application to a Middle-Income Country

We introduce a comprehensive policy-relevant measure of multidimensional wellbeing conceptually rooted in Amartya Sen's capability approach and applied to a middle-income country: the Multidimensional Wellbeing Index for Peru (MWI-P). We design and collect a specialized survey in Peru in late 2018, which included data on wellbeing achievements across 12 dimensions, on the value that respondents place upon each of these dimensions, and on self-perceived freedom. Then, we utilize this information to set the weighting structure and select a wellbeing sufficiency threshold for the MWI-P, which we estimate using the capability-inspired Alkire-Foster method. Our results show that only 45.9% of the sample population live above the wellbeing threshold, which involves achieving sufficiency in at least seven out of the 12 weighted dimensions of the MWI-P. Subgroup analyses reveal that rural populations, women, and older adults are at a disadvantage compared with urban populations, men, and younger adults, respectively. These subgroups' disparities hold valid if we introduce changes in the weighting structure or in the wellbeing sufficiency threshold. We argue that the MWI-P can inspire other low- and middle-income countries to reorient post-pandemic recovery policies from a focus on economic growth to a human flourishing approach based on what people value.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11482-022-10064-w.

Measuring and valuing broader impacts in public health: Development of a sanitation-related quality of life instrument in Maputo, Mozambique

Two billion people globally lack access to a basic toilet. While improving sanitation reduces infectious disease, toilet users often identify privacy, safety and dignity as more important. However, these outcomes have not been incorporated in sanitation-related economic evaluations. This illustrates the general challenge of outcome measurement and valuation in the economic evaluation of public health interventions, and risks misallocating the US$ 20 billion invested in sanitation in low- and middle-income countries every year. In this study in urban Mozambique, we develop an instrument to measure sanitation-related quality of life (SanQoL). Applying methods from health economics and the capability approach, we develop a descriptive system to measure five attributes identified in prior qualitative research: disgust, health, shame, safety and privacy. Sampling individuals from the intervention and control groups of a sanitation intervention trial, we elicit attribute ranks to value a SanQoL index and assess its validity and reliability. In combination with a measure of time using a sanitation service, SanQoL can quantify incremental benefits in a sanitation-focused cost-effectiveness analysis. After monetary valuation based on willingness to pay, QoL benefits could be summed with health gains in cost-benefit analysis, the most common method in sanitation economic evaluations.

Challenges in developing capability measures for children and young people for use in the economic evaluation of health and care interventions

Methods for measuring outcomes suitable for economic evaluations of health and care interventions have primarily focused on adults. The validity of such methods for children and young people is questionable in areas including the outcome domains measured and how they are measured and valued, with most existing measures narrowly focusing on health. Novel methods for assessing benefits beyond health by focusing on a person's capability have also concentrated on adults to date. This paper aims to set out the rationale for capability measures in children and young people. It argues for the need to expand the evaluative space beyond health functioning towards broader capabilities, with children and young people playing an integral role in capability measure development. Drawing from existing literature, specific challenges related to the identification, measurement, and valuation of capabilities in children and young people are also discussed. Finally, the practical implications for conducting economic evaluation when measuring and valuing capabilities at different stages across the life-course are illustrated. We develop an alternative framework based on conceiving capabilities as evolving across the life-course. This framework may also be helpful in thinking about how to model health outcomes across the life-course.

Development, Validity, and Reliability of the Women's Capabilities Index

We report the results of a series of validity and reliability tests performed during the development of the Women's Capabilities Index (WCI) in Malawi. The WCI is a multidimensional measure based on Sen's capability framework for assessing women's quality of life. Construct validity was assessed by investigating the expected relationships of the dimensions with key socioeconomic characteristics. The majority of hypothesized associations were found to be statistically significant in the expected direction. This provides evidence that the index is measuring quality of life as intended in the conceptual model. Further evidence in support of the index's validity was given by the high degree of correlation between the WCI and another scale measuring comparable (but not identical) domains of quality of life. The results from the internal consistency and the test-retest repeatability also offered encouraging evidence on the reliability of the instrument. This is the first study to rigorously and comprehensively test for validity and reliability a capabilities index for a low-income setting. The results of the validity and reliability tests provide supportive evidence that a locally developed measure of capabilities can be used as a robust tool for the assessment of women's quality of life.