_54_ _Policy, Planning, and Research Working Paper_ **_Series_**

# 155. **Measuring** Adult Mortality In Developing **Countries:** A Review and Assessment of Methods

# Ian Timaeus and Wendy Graham

_In countries where full death registration is a distant goal, the best way to collect data on adult mortality is probably to combine sample community-based health reporting systems and single-round surveys inwhich respondents areasked about the survival of various relatives -including parents, first spouses, and siblings._ Reliable information about adult mortal- ity ideally, by age and cause for populationsubgroups-isimportantforpopulation and health care planningand as an indicatorof changesinhumanwelfare. In most developing countries, data collection methods in the civil registration system and health services are woefully inadquate and methods for adjusting them apply only at the national level.

In the many developing countries where deaths are not fully registered, the best way tocollect data on adult mortality is probably to combine sample community-based health reporting systems and single-round surveys in which respondents are asked about the survival of various relatives, including parents, first spouses, and siblings.

The authors argue that a few reliable indicators that cover the whole population are not only more affordable but more useful for health planning than a mass of information of doubtful accuracy and completeness.

One should not make inferences about adult mortality by extrapolating from information on child deaths. Only genuine measures of adult mortality are useful for planning. Several approaches - active sample registration systems, multi-round demographic surveys, sentinel site reporting, and demographic surveillance systems - have been fairly successful but expensive. Questions put tohouseholdheads aboutrecent deathsin the household seldom yield useful data and should not be used in their present form.

Demographic research shows that age patterns ofmortality are similar in all populations, so it is possible to estimate mortality rates with reasonable reliability from simple data on the proportions of surviving relatives reported by survey respondents. More research is needed to determine whether indices of mortality by cause can be similarly inferred from general proportionate measures of death from particular causes. Single-round surveys asking about family survivors have not always worked well, but they often yield good estimates of adult mortalityatrelativelylowcost,areefficientin sample size, and based on straightforward questions about the respondents' lifetime experience.

The method's main limitation is that it provides rather broad, nonspecific measures of mortality - but these are adequate for allocation of resources, which is likely to be affected only by large differences. (Methods to elicit more specific information are still in the experimental stage.) Certain questions need further investigation:

* Canadditionalinformationimportant for health planning be gathered in the context of surveys designed to measure levels, trends, and differentials in adult mortality?

* Can the indirect questions used in single-round surveys be used to investigate causes of death, on the one hand, and some of the social and economic consequences of adult deaths on the other?

* Can the measurement of adult mortality be integrated with efforts to improve our understanding ofill health in the surviving adult population?

This paper is a product of the Population, Health, and Nutrition Division, Population and Human Resources Department. Copies are available free from the World Bank, 1818 H Street NW, Washington DC 20433. Please contact Sonia Ainsworth, room S6-065, extension 31091 (58 pages with figures).

# 156. Credit Cooperatives In **Israeli** Agriculture

# YoavKislev, Zvi Lerman, and Pinhas Zusman

_Many businesses suffered with the introduction of anti-inflationary policies in 1985. Only in agriculture did a whole sector - cooperatives - collapse financially. The reasons for this failure lie in the character and operating mode of Israeli cooperative credit._ In the last two to three decades, moshavim and kibbutzim developed intensively, adopted new technologies, reacted quickly to changes in market conditions, and established a network of farm services owned and operated by farmers and their representatives.

Financial cooperation helped make this intensive development possible and was effective when appropriate conditions prevailed. But in its strength lay dangers.

Cooperation in credit - together with a government policy of easy money and broad public support - also caused overexpansion and overinvestment. Warnings from within the government about overcapacity were overruled by political decisionmakers eager to show progress, however shortsighted. Debt grew to crisis proportions. When macroeconomic conditions changed and the expansion of credit slowed down, the sector found itself trappedinfinancialimpossibilities. Now cooperation ties farmers and organizations together and intensifies the dimensions of the crisis.

The authors recommend:

* Minimizing the extension of agricultural credit under preferential terms and reducing subsidies.

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* Continued (but limited) government commitment to aid farmers in financial distress caused by environmental fluctuations or temporarily depressed markets but not by other factors.

* Government participation in the creation of institutional structures (e.g., the revival of concentrated credit) to control overborrowing by farmers and farmer associations.

* Changes in cooperative laws and regulations thatimprove control over the cooperatives' financial integrity and strengthen the credit cooperatives' governance structure. Thispaperisaproductof theAgricultural Policies Division, Agriculture and Rural Development Department. Please contact Cicely Spooner, room J2-074, extension 37570.

# 157. A Policy **Model** for Tunisia with **Real and Financial Flows**

Martha de Melo, Marc Leduc, and Setareh Razmara _Country economists and developing country decisionmakers can use this model to analyze fiscal, debt, and incomes policies_

- _and to derive implications for the exchange rate and for the availability of credit to the private sector. The exdended_