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1. Introduction 1. - 1.1. Context & relevance 1. - 1.2. Research questions 7. - 1.3. Methods 8. - 1.4. Structure of the study 9. - 2. Risk and risk structure 11. - 2.1. Risk characteristics and vulnerability to risks 12. - 2.2. Sources of risk 19. - 2.3. Health risks and exposure to health risks 21. - 2.4. The dual economic burden of health risks 27. - 3. Social risk management 32. - 3.1. The social risk management framework 32. - 3.2. Criticism and recent developments of the SRM framework 37. - 3.3. Adaptation of the social risk management framework 42. - 3.4. Social risk management strategies in the adaptation of the SRM framework 48. - 4. Risks and social risk management in Sub-Saharan Africa 62. - 4.1. Introduction to country focus on Ghana and Malawi 62. - 4.2. Risks, risk exposure and vulnerability in Sub-Saharan Africa 65. - 4.3. Social risk management in Sub-Saharan Africa 72. - 5. Methods 123. - 5.1. Background of the study 123. - 5.2. Household survey 124. - 5.3. Statistical methods used in analysis 130. - 6. Analytical framework and hypotheses 134. - 6.1. Analytical framework and structure of analysis 134. - 6.2. Hypotheses 137. - 6.3. Operationalization of variables 140. - 7. Analysis 150. - 7.1. Descriptive analysis 150. - 7.2. Household exposure to general risks 155. - 7.3. Exposure of individuals and households to high health risks and high health care costs 168. - 7.4. Application of social (health) risk management strategies 194. - 7.5. Health insurance as SRM strategy and demand for health insurance 240

Risk exposure is a major cause of poverty, deprivation and persistent vulnerability worldwide. This volume analyzes individuals' and households' responses to a variety of risks, with an emphasis on health risks. The study adapts the Social Risk Management (SRM) conceptual framework and extends it considerably for academic inquiry. Using household data from Ghana and Malawi, empirical evidence is provided on the complex relationship between high risk exposure and the application of proactive and reactive SRM strategies (incl. health insurance), showing their specific contributions to risk management. // The PhD thesis has been published as monography in the series "Social Protection in Health - Challenges, Needs and Solutions in International Health Care Financing" at LIT-publisher. URL: http://lit-verlag.de/isbn/3-643-90642-7 // Die Dissertation ist als Monographie in der Reihe "Social Protection in Health - Challenges, Needs and Solutions in International Health Care Financing" des LIT-Verlages erschienen. URL: http://lit-verlag.de/isbn/3-643-90642-7

Abstract: Losses and damages in the context of the climate crisis pose major challenges for development cooperation. They result from residual climate risks, i.e. risks that remain after risks have been reduced through mitigation and adaptation. As part of the evaluation of climate change adaptation interventions, DEval examined the instruments of German development cooperation for managing residual climate risks (Leppert et al., 2021). This Policy Brief shows how their relevance and effectiveness can be increased

Abstract: Schäden und Verluste im Kontext der Klimakrise stellen die Entwicklungszusammenarbeit (EZ) vor große Herausforderungen. Sie sind Folgen residualer Klimarisiken, also Risiken, die nach Risikoreduzierung durch Klimaschutz und Maßnahmen zur Anpassung an den Klimawandel verbleiben. Das DEval untersuchte im Rahmen der Evaluierung von Maßnahmen zur Anpassung an den Klimawandel die Instrumente der deutschen EZ im Umgang mit residualen Klimarisiken (Leppert et al., 2021). Dieser Policy Brief zeigt, wie ihre Relevanz und Wirkungen erhöht werden können

Abstract: Die deutsche Entwicklungszusammenarbeit (EZ) verfügt im internationalen Vergleich über ein großes Portfolio, um Entwicklungs- und Schwellenländer im umfassenden Umgang mit Klimarisiken zu unterstützen. Im Rahmen der Evaluierung von Maßnahmen zur Anpassung an den Klimawandel hat das DEval die Instrumente der deutschen EZ zum Umgang mit residualen Klimarisiken untersucht (Leppert et al., 2021). Dieser Policy Brief fasst die zentralen Ergebnisse dieser Evaluierung zusammen

By international comparison, German development cooperation has a large portfolio to support developing and emerging countries in managing climate risks comprehensively. As part of the
evaluation of climate change adaptation interventions, DEval examined the instruments of German development cooperation for managing residual climate risks (Leppert et al., 2021). This policy brief summarises the key findings of this evaluation.

Schäden und Verluste im Kontext der Klimakrise stellen die Entwicklungszusammenarbeit (EZ) vor große Herausforderungen. Sie sind Folgen residualer Klimarisiken, also Risiken, die nach Risikoreduzierung durch Klimaschutz und Maßnahmen zur Anpassung an den Klimawandel verbleiben. Das DEval untersuchte im Rahmen der Evaluierung von Maßnahmen zur Anpassung an den Klimawandel die Instrumente der deutschen EZ im Umgang mit residualen Klimarisiken (Leppert et al., 2021). Dieser Policy Brief zeigt, wie ihre Relevanz und Wirkungen erhöht werden können.

Losses and damages in the context of the climate crisis pose major challenges for development cooperation. They result from residual climate risks, i.e. risks that remain after risks have been reduced through mitigation and adaptation. As part of the evaluation of climate change adaptation interventions, DEval examined the instruments of German development cooperation for managing residual climate risks (Leppert et al., 2021). This Policy Brief shows how their relevance and effectiveness can be increased.

Die deutsche Entwicklungszusammenarbeit (EZ) verfügt im internationalen Vergleich über ein großes Portfolio, um Entwicklungs- und Schwellenländer im umfassenden Umgang mit Klimarisiken zu unterstützen. Im Rahmen der Evaluierung von Maßnahmen zur Anpassung an den Klimawandel hat das DEval die Instrumente der deutschen EZ zum Umgang mit residualen Klimarisiken untersucht (Leppert et al., 2021). Dieser Policy Brief fasst die zentralen Ergebnisse dieser Evaluierung zusammen.

Background: Street-level workers play a key role in public health policies in Africa, as they are often the ones to ensure their implementation. In Burkina Faso, the State formulated two different user-fee exemption policies for indigents, one for deliveries (2007), and one for primary healthcare (2009). The objective of this study was to measure and understand the determinants of street-level workers' knowledge and application of these exemption measures. Methods: We used cross-sectional data collected between October 2013 and March 2014. The survey targeted 1521 health workers distributed in 498 first-line centres, 18 district hospitals, 5 regional hospitals, and 11 private or other facilities across 24 districts. We used four different random effects models to identify factors associated with knowledge and application of each of the above-mentioned exemption policies. Results: Only 9.2% of workers surveyed knew of the directive exempting the worst-off, and only 5% implemented it. Knowledge and application of the delivery exemption were higher, with 27% of all health workers being aware of the delivery exemption directive and 24.2% applying it. Mobile health workers were found to be consistently more likely to apply both exemptions. Health workers who were facility heads were significantly more likely to know about the indigent exemption for primary health care and to apply it. Health workers in districts with higher proportions of very poor people were significantly more likely to know about and apply the delivery exemption. Nearly 60% of respondents indicated either 5% or 10% as the percentage of people they would deem adequate to target for exemption. Conclusion: This quantitative study confirmed earlier qualitative results on the importance of training and informing health workers and monitoring the measures targeting equity, to ensure compliance with government directives. The local context (e.g., hierarchy, health system, interventions) and the ideas that street-level workers have about the policy instruments can influence their effective implementation. Methods for remunerating health workers and health centres also need to be adapted to ensure equity measures are applied to achieve universal healthcare.

This evaluation report investigates the impact of ten years of comprehensive
land-use planning in the Philippines. Characterized by fundamental
developmental challenges associated with scarce land resources,
environmental degradation, natural hazards and persistent poverty,
land-use planning plays a crucial role in finding answers to these pressing
challenges.
The impact evaluation assesses a technical approach to enhanced land-use
planning and capacity development from community to national level,
supporting decentralized planning, natural resource governance, and
resilience to natural hazards and climate change. The so-called SIMPLE
(Sustainable Integrated Management and Planning for Local Government
Ecosystems) approach by the Philippine-German cooperation, managed
by the Deutsche Gesellschaft für internationale Zusammenarbeit (GIZ),
was implemented in two regions of the Visayas. The ambitious intervention
operated in a challenging environment with multiple stakeholders,
overlapping mandates, and imprecise legal frameworks. In cooperation
with GIZ, the Housing and Land Use Regulatory Board (HLURB) rolled
out the related enhanced Comprehensive Land Use Planning (eCLUP)
guidelines nationwide.
Based on a mixed-methods and quasi-experimental design, the evaluation
generates relevant findings for the improvement of land-use planning and
local governance interventions, for sustainable natural resource management,
disaster risk management, and for welfare improvements of communities
and beneficiaries. It shows relevant factors for the successful implementation.
The report draws important lessons for local planning and the national
framework, and suggests solutions to the fundamental gap between
planning and plan implementation, improved innovation diffusion and
efficient processes, effective community participation, and public
accountability.

A systematic use of Remote Sensing (RS) data opens a door for evaluators to better address evaluation questions by adding a spatial dimension. This policy brief highlights DEval's methodological approach to the analysis of high-resolution RS data through the application of image classification and machinelearning (ML) techniques. DEval has been developing this approach in close cooperation with RS experts from the Faculty of Geo-information Science and Earth Observation (ITC) at the University of Twente in the Netherlands.

Eine systematische Nutzung von RS-Daten ermöglicht durch Hinzunahme einer räumlichen Dimension eine bessere Beantwortung der Evaluierungsfragen. In diesem Policy Brief wird der methodische Ansatz von DEval zur Analyse von hochauflösenden RS-Daten unter Anwendung von Bildklassifizierungstechniken und Techniken des maschinellen Lernens (ML) vorgestellt. DEval hat den Ansatz in enger Zusammenarbeit mit RS-Fachleuten der Fakultät für Geoinformationswissenschaften und Erdbeobachtung (ITC) an der Universität Twente in den Niederlanden entwickelt.