Search

You searched for: Content Type Working Paper Remove constraint Content Type: Working Paper Publishing Institution Center for Global Development Remove constraint Publishing Institution: Center for Global Development Topic Health Remove constraint Topic: Health
Number of results to display per page

Search Results

  • Author: Vijaya Ramachandran, Benjamin Leo, Robert Morello
  • Publication Date: 02-2015
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The need for infrastructure improvements is a top-tier economic, political, and social issue in nearly every African country. Although the academic and policy literature is extensive in terms of estimating the impact of infrastructure deficits on economic and social indicators, very few studies have examined citizen demands for infrastructure. In this paper, we draw upon survey data to move beyond topline estimates of national infrastructure access rates towards a more nuanced understanding of service availability and citizen demands at the regional, national, and sub-national level. We find a predictable pattern of infrastructure services across income levels—lower income countries have fewer services. The survey data also allows us to observe the sequencing of infrastructure services. On the demand side, survey respondents are most concerned with jobs and income-related issues, as well as with the availability of infrastructure: specifically transportation and sanitation. These priorities transcend demographic factors, including gender and location (urban/rural).
  • Topic: Health
  • Political Geography: Africa
  • Author: Katharina Hauck, Peter C. Smith
  • Publication Date: 09-2015
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Many health improving interventions in low-income countries are extremely good value for money. So why has it often proven difficult to obtain political backing for highly cost-effective interventions such as vaccinations, treatments against diarrheal disease in children, and preventive policies such as improved access to clean water, or policies curtailing tobacco consumption? We use economic models of public choice, supported by examples, to explain how powerful interests groups, politicians or bureaucrats who pursue their own objectives, or voting and institutional arrangements in countries have shaped health priority setting. We show that it may be perfectly rational for policy makers to accommodate these constraints in their decisions, even if it implies departing from welfare maximizing solutions.
  • Topic: Health, Political Economy, Health Care Policy
  • Author: William Savedoff, Victoria Fan
  • Publication Date: 03-2014
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Almost every country exhibits two important health financing trends: health spending per person rises and the share of out-of-pocket spending on health services declines. We describe these trends as a "health financing transition" to provide a conceptual framework for understanding health markets and public policy. Using data over 1995-2009 from 126 countries, we examine the various explanations for changes in health spending and its composition with regressions in levels and first differences. We estimate that the income elasticity of health spending is about 0.7, consistent with recent comparable studies. Our analysis also shows a significant trend in health spending - rising about 1 percent annually - which is associated with a combination of changing technology and medical practices, cost pressures and institutions that finance and manage healthcare. The out-of-pocket share of total health spending is not related to income, but is influenced by a country's capacity to raise general revenues. These results support the existence of a health financing transition and characterize how public policy influences these trends.
  • Topic: Development, Economics, Health, Governance
  • Political Geography: United States
  • Author: Amanda Glassman, Juan Ignacio Zoloa
  • Publication Date: 10-2014
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: As Latin American countries seek to expand the coverage and benefits provided by their health systems under a global drive for universal health coverage (UHC), decisions taken today–whether by government or individuals-will have an impact tomorrow on public spending requirements. To understand the implications of these decisions and define needed policy reforms, this paper calculates long-term projections for public spending on health in three countries, analyzing different scenarios related to population, risk factors, labor market participation, and technological growth. In addition, the paper simulates the effects of different policy options and their potential knock-on effects on health expenditure.
  • Topic: Health, Governance, Reform
  • Political Geography: Brazil, Latin America, Mexico, Chile
  • Author: Dean Karlan, Pia Raffler, Greg Fischer, Margaret McConnell
  • Publication Date: 11-2014
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: In a field experiment in Uganda, we find that demand after a free distribution of three health products is lower than after a sale distribution. This contrasts with work on insecticide-treated bed nets, highlighting the importance of product characteristics in determining pricing policy. We put forward a model to illustrate the potential tension between two important factors, learning and anchoring, and then test this model with three products selected specifically for their variation in the scope for learning. We find the rank order of shifts in demand matches with the theoretical prediction, although the differences are not statistically significant.
  • Topic: Development, Health
  • Political Geography: Uganda, Africa
  • Author: Amanda Glassman, Denizhan Duran, Rachel Silverman, Victoria Fan
  • Publication Date: 10-2013
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: More than ever, global health funding agencies must get better value for money from their investment portfolios; to do so, each agency must know the interventions it supports and the sub-populations targeted by those interventions in each country.
  • Topic: Foreign Policy, Development, Economics, Health, Humanitarian Aid, Health Care Policy
  • Political Geography: India, Philippines, Ethiopia, Nigeria
  • Author: Amanda Glassman, Denizhan Duran
  • Publication Date: 02-2012
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Health is one of the largest and most complex aid sectors: 16 percent of all aid went to the health sector in 2009. While many stress the importance of aid effectiveness, there are limited quantitative analyses of the quality of health aid. In this paper, we apply Birdsall and Kharas's Quality of Official Development Assistance (QuODA) methodology to rank donors across 23 indicators of aid effectiveness in health. We present our results, track progress from 2008 to 2009, compare health to overall aid, discuss our limitations, and call for more transparent and relevant aid data in the sector level as well as the need to focus on impact and results.
  • Topic: Development, Health, Human Welfare, Humanitarian Aid, Foreign Aid
  • Author: Victoria Fan, Anup Karan, Ajay Mahal
  • Publication Date: 06-2012
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: In 2007, the state of Andhra Pradesh in southern India began rolling out the Aarogyasri health insurance to reduce catastrophic health expenditures in households “below the poverty line.” We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that, within the first year of implementation, Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population.
  • Topic: Health, Poverty, Health Care Policy
  • Political Geography: India, Asia, Andhra Pradesh
  • Author: Kevin Ummel
  • Publication Date: 08-2012
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The Carbon Monitoring for Action (CARMA) database provides information about the carbon dioxide emissions, electricity production, corporate ownership, and location of more than 60,000 power plants in over 200 countries. Originally launched in 2007, CARMA is provided freely to the public at www.carma. org and remains the only comprehensive data source of its kind. This paper documents the methodology underpinning CARMA v3.0, released in July, 2012. Comparison of CARMA model output with reported data highlights the general difficulty of precisely predicting annual electricity generation for a given plant and year. Estimating the rate at which a plant emits CO2 (per unit of electricity generated) generally faces fewer obstacles. Ultimately, greater disclosure of plant-specific data is needed to overcome these limitations, particularly in major emitting countries like China, Russia, and Japan. For any given plant in CARMA v3.0, it is estimated that the reported value is within 20 percent of the actual value in 85 percent of cases for CO2 intensity, 75 percent for annual CO2 emissions, and 45 percent for annual electricity generation. CARMA's prediction models are shown to offer significantly better estimates than more naïve approaches to estimating plant-specific performance.
  • Topic: Climate Change, Environment, Health, Industrial Policy
  • Political Geography: Russia, Japan, China
  • Author: Nora Lustig
  • Publication Date: 11-2012
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: We apply a standard tax-and-benefit-incidence analysis to estimate the impact on inequality and poverty of direct taxes, indirect taxes and subsidies, and social spending (cash and food transfers and in-kind transfers in education and health). The extent of inequality reduction induced by direct taxes and transfers is rather small (2 percentage points on average), especially when compared with that found in Western Europe (15 percentage points on average). What prevents Argentina, Bolivia, and Brazil from achieving similar reductions in inequality is not the lack of revenues but the fact that they spend less on cash transfers—especially transfers that are progressive in absolute terms—as a share of GDP. Indirect taxes result in that net contributors to the fiscal system start at the fourth, third, and even second decile on average, depending on the country. When in-kind transfers in education and health are added, however, the bottom six deciles are net recipients. The impact of transfers on inequality and poverty reduction could be higher if spending on direct cash transfers that are progressive in absolute terms were increased, leakages to the nonpoor reduced, and coverage of the extreme poor by direct transfer programs expanded.
  • Topic: Development, Economics, Education, Health, Poverty
  • Political Geography: Brazil, Argentina, Latin America, Mexico, Peru, Bolivia
  • Author: Rachel Nugent, Andrea B. Feigl
  • Publication Date: 01-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Health conditions in developing countries are becoming more like those in developed countries, with non-communicable diseases (NCDs) predominating and infectious diseases declining. The increased awareness of changing health needs, however, has not translated into significant shifts in resources or policy-level attention from international donors or governments in affected countries. Driven by changes in lifestyle related to nutrition, physical activity, and smoking, the surging burden of NCDs in poor countries portends painful choices, particularly for countries with weak health systems that are struggling to manage persistent infectious disease burdens and to protect the poor from excessive out-of-pocket expenses.
  • Topic: Development, Health, Poverty, Third World, Foreign Aid
  • Author: Todd Moss, Benjamin Leo
  • Publication Date: 03-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Even under conservative assumptions, IDA will likely face a wave of country graduations by 2025. We project that it will lose more than half of its client countries and that the total population living in IDA-eligible countries will plunge by two-thirds. The remaining IDA-eligible countries will be significantly smaller in size and overwhelmingly African, and a majority are currently considered fragile or post-conflict. This drastically altered client base will have significant implications for IDA's operational and financial models. We conclude with three possible options for IDA and recommend that World Bank shareholders and management begin frank discussions on its future sooner rather than later.
  • Topic: Demographics, Development, Health, World Bank, Health Care Policy
  • Political Geography: Africa
  • Author: Amanda Glassman, Lisa Carty, J. Stephen Morrison, Margaret Reeves
  • Publication Date: 06-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: On June 13, the GAVI Alliance convenes its first pledging conference in London with the aim of securing $3.7 billion to immunize an additional 250 million children by 2015. Founded in 2000, GAVI is an innovative partnership that combines donors, partner governments, UNICEF, WHO, civil society, and the private sector. It is designed to accelerate the financing and delivery of selected vaccines and related health services to the world's most disadvantaged populations. As GAVI enters its second decade of operations, it has established itself as a quiet success. And as it strives to sustain and expand its model of operations, it simultaneously strives to make itself better known and understood; better led, managed, and resourced; better assured of essential high-level political and financial support; and better served by well-functioning relations with its many essential partners.
  • Topic: Development, Economics, Health, Foreign Aid
  • Author: Charles Kenny, Ursula Casabonne
  • Publication Date: 05-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Casabonne and Kenny argue that two major factors underlie improved global health outcomes: first, the discovery of cheap technologies that can dramatically improve outcomes; second, the adoption of these technologies, thanks to the spread of knowledge. Other factors have played a role. Increased income not only allows for improved nutrition, but also helps to improve access to more complex preventative technologies. Institutional development is a second key to the spread of such complex technologies. Nonetheless, evidence of dramatic health improvements even in environments of weak institutions and stagnant incomes suggests that the role of these factors may be secondary.
  • Topic: Development, Health, Poverty, Foreign Aid
  • Author: Nemat Shafik
  • Publication Date: 05-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Development finance is at a turning point. There is talk about a "triple revolution of goals, actors and tools." As much of Asia grows its way out of poverty, aid will increasingly be focused on Africa and on countries plagued by instability, or with governments unable to meet the basic needs of their populations. A growing share of development finance will be directed to tackling global public goods-like climate change, conflict prevention, and public health. Responsibility for addressing global challenges will increasingly be borne by coalitions that cut across states, the private sector, and civil society. These networks to address poverty and global issues will become a feature of the international architecture in a multipolar world. The rules of the game and the tools of development assistance need to evolve to focus on transparency, results, accountability, a market-driven division of labor and flexible partnerships for the future development finance system to become an effective tool of global problem solving.
  • Topic: Conflict Prevention, Climate Change, Development, Environment, Health
  • Author: Nancy Birdsall, Benjamin Leo
  • Publication Date: 04-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The global community faces a number of critical challenges ranging from climate change to crossborder health risks to natural-resource scarcities. Many of these so-called global commons problems carry grave risks to economic growth in the developing world and to the livelihoods and welfare of their people. Climate change is the classic example. Despite the risks involved, donor governments have funded programs addressing global challenges such as climate change at far lower levels than traditional programs of country-based development assistance. The prospects for dealing with such global challenges will depend at least in part on new collective financing mechanisms.
  • Topic: Climate Change, Development, Health, Humanitarian Aid, Foreign Aid
  • Author: Amanda Glassman, William Savedoff
  • Publication Date: 07-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Global health aid is exceedingly complex. It encompasses more than one hundred bilateral agencies, global funds, and independent initiatives that interact with an equally complex and diverse set of institutions involved in financing and providing health care in developing countries. Numerous efforts have been made to better coordinate these activities in the interest of making them more effective. The Health Systems Funding Platform (the Platform) is one of the most recent of these initiatives. Established in 2009, the Platform has advanced farthest in two countries, Ethiopia and Nepal, and is currently expanding to several others. This paper briefly assesses the Platform and argues that the way the initiative is proceeding differs little from prior initiatives, such as sector- wide approaches and budget support. However, the initiative does represent an opportunity to make global health aid more effective if it were to deepen its commitment to improving information for policy, link funding explicitly to well-chosen independently verified indicators, and establish an evaluation strategy to learn from its experience.
  • Topic: Development, Health, International Cooperation, International Organization, Foreign Aid
  • Political Geography: Nepal, Ethiopia
  • Author: Amanda Glassman, Andy Sumner, Denizhan Duran
  • Publication Date: 10-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: After a decade of rapid growth in average incomes, many countries have attained middle-income country (MIC) status. At the same time, the total number of poor people hasn't fallen as much as one might expect and, as a result, most of the world's poor now live in MICs. In fact, there are up to a billion poor people or a 'new bottom billion' living not in the world's poorest countries but in MICs. Not only has the global distribution of poverty shifted to MICs, so has the global disease burden. This paper examines the implications of this 'new bottom billion' for global health efforts and recommends a tailored middle-income strategy for the Global Fund and GAVI. The paper describes trends in the global distribution of poverty, preventable infectious diseases, and health aid response to date; revisits the rationale for health aid through agencies like GAVI and the Global Fund; and proposes a new MIC strategy and components, concluding with recommendations.
  • Topic: Development, Globalization, Health, Poverty
  • Author: Thomas Bollyky
  • Publication Date: 06-2010
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: There has been tremendous progress over the last decade in the development of health products for neglected diseases. These include drugs, vaccines, and diagnostics for malaria and tuberculosis, which kill millions of people annually, plus other diseases like chagas and dengue fever, which may less familiar, but nonetheless exact a large and often lethal toll in the world's poorest communities. Led by product development public private partnerships (PDPs) and fueled by the support of the Bill Melinda Gates Foundation, the National Institutes of Health, and other donors, there are now dozens of candidate products in the pipeline.
  • Topic: Development, Health, Humanitarian Aid, Infectious Diseases
  • Author: Michael Kremer, Alaka Holla
  • Publication Date: 01-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: This paper surveys evidence from recent randomized evaluations in developing countries on the impact of price on access to health and education. The debate on user fees has been contentious, but until recently much of the evidence was anecdotal. Randomized evaluations across a variety of settings suggest prices have a large impact on take-up of education and health products and services. While the sign of this effect is consistent with standard theories of human capital investment, a more detailed examination of the data suggests that it may be important to go beyond these models. There is some evidence for peer effects, which implies that for some goods the aggregate response to price will exceed the individual response. Time-inconsistent preferences could potentially help explain the apparently disproportionate effect of small short-run costs and benefits on decisions with long-run consequences.
  • Topic: Development, Economics, Education, Health, Human Welfare, Markets
  • Author: Mead Over
  • Publication Date: 02-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The slower spread of AIDS in South Asian countries, combined with the fact that most South Asian countries have higher per capita incomes than the most severely affected countries of other regions imply that the various impacts of the disease will be smaller in South Asia than in the worst affected countries in other regions. While justified with respect to the impact of the disease on economic output, on poverty, or on orphanhood, this conclusion does not follow with respect to the health sector, where the relatively minor public role in health care delivery and the entrepreneurial and heterogeneous private health and pharmaceutical sectors combine to magnify the potential impact of the epidemic.
  • Topic: Health, Humanitarian Aid
  • Political Geography: South Asia, Asia
  • Author: Tom Slayton
  • Publication Date: 03-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The world rice market was aflame last spring and for several months it looked as if the trading edifice that had exhibited such resilience over the last two decades was going to burn to the ground. World prices trebled within less than four months and reached a 30- year inflation-adjusted high. Many market observers thought the previous record set in 1974 would soon be toast. The fire was man-made, not the result of natural developments. While the governments in India, Vietnam, and the Philippines did not to set the world market on fire, that was the unintended result of their actions which threatened both innocent bystanders (low-income rice importers as far away as Africa and Latin America) and, ultimately, poor rice consumers at home. This paper describes what sparked the fire and the accelerants that made a bad situation nearly catastrophic. Fortuitously, when the flames were raging at peak intensity, rain clouds appeared, the winds [market psychology] shifted, and conditions on the ground improved, allowing the fire to die down. It remains to be seen, however, if the trading edifice has been seriously undermined by the actions of decision makers in several key Asian rice exporting and importing countries. In describing the cascading negative effects of these seemingly rational domestic policies, this paper aims to help policy makers in the rice exporting and importing nations to avoid a repeat of the disastrous price spike of 2008.
  • Topic: Agriculture, Economics, Health, Humanitarian Aid, Markets, Political Economy
  • Political Geography: Africa, India, Asia, Latin America
  • Author: Ethan B. Kapstein, Josh Busby
  • Publication Date: 08-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: This paper examines the role of policy entrepreneurs and global activists in shaping the international market for antiretroviral drugs to combat HIV/AIDS. When ARVs first came on the market in the 1990s they were exceedingly expensive; the cost of treatment was upwards of $10,000 per year. These drugs were thus accessible only to those patients who had high incomes. But in 2006, the “international community,” meeting at a United Nations General Assembly Special Session (UNGASS), made an astonishing pledge to those who were infected with HIV. It proclaimed that there should be universal access to ARV treatment. This UNGASS, following up on an earlier historic UN special session devoted entirely to AIDS in 2001, marked the first time in history that the international community pledged itself to chronic care for the ill, which in this case includes the approximately 30 million people around the world estimated to be HIV positive. How do we explain the transformation of ARVs from private goods, which only a few could afford, into merit goods that were (at least declaratively) to be made available to everyone? In other words, how does a norm of “universal access to treatment”—that no person should be denied these life-extending drugs—become the ethical basis for global public policy with respect to pharmaceutical allocation? What are the lessons of the ARV story for other global issues? These are the primary questions we explore in this paper. Briefly, we argue that the policy entrepreneurs and activists who promoted the creation of a universal access to treatment regime—of the transformation of ARVs into global merit goods—relied on a combination of moral arguments and ideas with favorable material circumstances. From the ethical perspective, the task of these entrepreneurs was to convince the “international community” that access to ARVs was a “human right,” or conversely to convince decision-makers that it was morally wrong to allocate these life-enhancing drugs solely on the basis of ability to pay. But from a material standpoint, these arguments were greatly facilitated by the lowering prices of ARVs caused by a combination of differential pricing (that is, lower prices for drugs in the developing world than in the advanced welfare states) and competition from generics producers, coupled with increases in foreign aid spending devoted to HIV/AIDS and other diseases.
  • Topic: Globalization, Health, Markets
  • Political Geography: United Nations
  • Author: Prashant Yadav
  • Publication Date: 09-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The emergence and spread of drug resistance is draining available resources and threatening our ability to treat infectious diseases in developing countries. Countering drug resistance requires pharmaceutical companies, government regulators, doctors, and patients to make difficult choices about drug treatment in order to balance efficacy, cost, safety, and sustainability of drugs. These complex tradeoffs are faced along the drug supply chain from the development of new products, procurement of drugs for donor and government distribution, distribution steps to ensure treatment heterogeneity along with quality and availability, and dispensing and use that requires affordability, patient adherence and rational use of drugs and diagnostics. An analysis of the incentives and risks in the drug supply chain reflects that many stakeholders who can influence optimal prescribing of existing drugs; affect higher patient compliance; and ensure the quality of drugs have weak incentives to carry out these activities optimally. This implies a high potential for drug resistance to accelerate. This paper recommends specific measures to better align the incentives of these stakeholders with resistance- countering activities.
  • Topic: Development, Health, Human Welfare, Third World
  • Author: Ethan Kapstein, Josh Busby
  • Publication Date: 08-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: This paper examines the role of policy entrepreneurs and global activists in shaping the international market for antiretroviral drugs to combat HIV/AIDS. When ARVs first came on the market in the 1990s they were exceedingly expensive; the cost of treatment was upwards of $10,000 per year. These drugs were thus accessible only to those patients who had high incomes. But in 2006, the “international community,” meeting at a United Nations General Assembly Special Session (UNGASS), made an astonishing pledge to those who were infected with HIV. It proclaimed that there should be universal access to ARV treatment. This UNGASS, following up on an earlier historic UN special session devoted entirely to AIDS in 2001, marked the first time in history that the international community pledged itself to chronic care for the ill, which in this case includes the approximately 30 million people around the world estimated to be HIV positive. How do we explain the transformation of ARVs from private goods, which only a few could afford, into merit goods that were (at least declaratively) to be made available to everyone? In other words, how does a norm of “universal access to treatment”—that no person should be denied these life-extending drugs—become the ethical basis for global public policy with respect to pharmaceutical allocation? What are the lessons of the ARV story for other global issues? These are the primary questions we explore in this paper. Briefly, we argue that the policy entrepreneurs and activists who promoted the creation of a universal access to treatment regime—of the transformation of ARVs into global merit goods—relied on a combination of moral arguments and ideas with favorable material circumstances. From the ethical perspective, the task of these entrepreneurs was to convince the “international community” that access to ARVs was a “human right,” or conversely to convince decision-makers that it was morally wrong to allocate these life-enhancing drugs solely on the basis of ability to pay. But from a material standpoint, these arguments were greatly facilitated by the lowering prices of ARVs caused by a combination of differential pricing (that is, lower prices for drugs in the developing world than in the advanced welfare states) and competition from generics producers, coupled with increases in foreign aid spending devoted to HIV/AIDS and other diseases.
  • Topic: Health, Human Welfare, Humanitarian Aid, Political Economy
  • Author: Carsten Fink
  • Publication Date: 06-2008
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Over the past fifteen years, the United States and other developed countries have employed trade agreements to substantially strengthen the protection of intellectual property rights for pharmaceutical products in the developing world. The associated rules changes have already had an effect on pharmaceutical prices in developing countries, prompting conflicts between developing country governments seeking to promote drug access and Western pharmaceutical companies wishing to protect their exclusive rights. If anything, such conflicts are bound to intensify as more patent protected drugs enter pharmaceutical markets outside rich countries. This paper describes the global shift in intellectual property policies and employs economic analysis to evaluate its consequences for developing countries. It also puts forward several recommendations for policymakers in developing countries and in the United States, seeking to better reconcile innovation incentives and access needs.
  • Topic: Economics, Health, Science and Technology
  • Political Geography: United States
  • Author: Ferdinando Regalía, Leslie Castro
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Nicaragua's Red de Protección Social (RPS) is one of the first conditional cash transfer (CCT) programs implemented in a low-income country. Demand-side incentives, in the form of monetary transfers, are provided to poor households on condition that their children attend school and visit preventive health care providers. The design of the program is unique among CCT programs because these demand-side incentives are complemented by supply-side incentives aimed at improving the provision of health care. Health care providers are paid on the basis of their performance against predetermine d targets. Both private and nonprofit health care providers contracted by the government extend the coverage of services to previously underserved areas.
  • Topic: Education, Health, Non-Governmental Organization, Poverty
  • Political Geography: Nicaragua
  • Author: Amanda Glassman, Jessica Todd, Marie Gaarder
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: In order to support poor families in the developing world to seek and use health care, a multi-pronged strategy is needed on both the supply and the demand side of health care. A demand-side program called Conditional Cash Transfer s (CCTs) strives to reduce poverty and also increase food consumption, school attendance, and use of preventive health care. Since 1997, seven countries in Latin America have implemented and evaluated CCT programs with health and nutrition components. The core of the program is based on encouraging poor mothers to seek preventive health services and attend health education talks by providing a cash in centive for their healthy behavior (with healthy behavior representing performance). Evaluations of these programs measured outputs in the utilization of services; health knowledge, attitudes, and practice; food consumption; the supply and quality of services; as well as outcomes in vaccination rates; nutritional status; morbidity; mortality; and fertility.
  • Topic: Education, Health, Poverty
  • Political Geography: South America, Latin America, Central America, Caribbean
  • Author: Rena Eichler, Paul Auxila, Uder Antoine, Bernateau Desmangles
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: USAID launched a project in 1995 to deliver basic health services in Haiti. The project began by reimbursing contracted NGOs for documented expenditures or inputs. In 1999, payment was changed to being based partly on attaining performance targets or outputs. The project also provided technical assistance to the NGOs, along with opportunities to participate in an NGO network and other cross-fertilization activities. Remarkable improvements in key health indicators have been achieved in the six years since payment for performance was phased in. Although it is difficult to isolate the effects of performance-based payment on these improved indicators from the efforts aimed at strengthening NGOs and other factors, panel regression results suggest that the new payment incentives were responsible for considerable improvements in both immunization coverage and attended deliveries. Results for prenatal and postnatal care were less significant, perhaps suggesting a strong patient behavioral element that is not under the influence of provider actions.
  • Topic: Development, Education, Health, Poverty
  • Political Geography: Haiti
  • Author: Rena Eichler, Diana Weil, Alexandra Beith
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Tuberculosis is a public health emergency in Africa, Eastern Europe, and Central Asia. Of the estimated 1.7 million deaths from TB, 98 percent are in the developing world, the majority being among the poor. In order to reach the MDG and the Stop TB partnership targets for 2015, TB detection rates need to double, treatment success rates must increase to more than 7075 percent, and strategies to address HIV-associated TB and multi-drug resistant TB must be aggressively expanded. DOTS, the internationally-recommended TB control strategy is the foundation of TB control efforts worldwide. A standard recording and monitoring system built on routine service-based data allows nearly all countries in the world to track progress in case detection and treatment completion through routine monitoring. This provides a good base for measuring the impact of different strategies for improving TB control outcomes.
  • Topic: Health, International Organization, Poverty
  • Political Geography: Africa, Europe, Asia
  • Author: Jeremy Shiffman, Stephanie Smith
  • Publication Date: 10-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Why do some global health initiatives receive priority from international and national political leaders while others receive minimal attention? We propose a framework for analyzing this question consisting of four categories of factors: the strength of the actors involved in the initiative, the power of the ideas they use to frame the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself.
  • Topic: Health, International Cooperation, Politics
  • Author: Jeremy Shiffman
  • Publication Date: 05-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Why do some serious health issues—such as HIV/AIDS—get considerable attention and others—such as malaria and collapsing health systems—get very little? Why and under what conditions do political leaders consider an issue worthy of sustained attention, and back up that attention with money and other resources? In this CGD Brief, visiting fellow Jeremy Shiffman, an associate professor of public administration at the Maxwell School of Syracuse University, discusses nine factors that influenced the degree to which national leaders in five countries made one public health issue—maternal mortality—a political priority. Pregnancy-related complications are the leading cause of mortality globally among adult women of reproductive age, with more than half a million deaths annually. But in some countries maternal health has become a priority and maternal deaths have fallen, while in other countries this has not yet occurred. Drawing on his comparison of these countries, Shiffman offers recommendations for public health priority-setting in developing countries. His bottom line: attaining public health goals is as much a political as it is a medical or technical challenge; success requires not only appropriate technical interventions but also effective political strategies.
  • Topic: Globalization, Health, Political Economy, Third World
  • Publication Date: 05-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Today's global health programs will attain their objectives only if products appropriate to the health problems in low-and middle income countries are developed, manufactured and made available when and where they are needed. Achieving this requires mobilizing public and charitable money for more and better products to diagnose, prevent and treat HIV/AIDS, tuberculosis, malaria, reproductive health problems and childhood killers. But more money is only one part of the story. Weak links in the global health value chain—from research and development (R) through service delivery—are constraining on-the ground access to essential products. The consequences of those weak links are many: supply shortages, inefficient use of scarce funding, reluctance to invest in R for developing country needs and, most important, the loss of life among those who need essential products.
  • Topic: Globalization, Health, Political Economy, Poverty
  • Author: Michael Kremer, Alix Peterson Zwane
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: This paper critically reviews the existing research on the cost-effective prevention and treatment of diarrheal diseases, and identifies research priorities in this area aimed at finding ways to reduce the diarrheal disease burden. In contrast to the empirical knowledge base that exists for traditional child health programs to reduce diarrheal morbidity and mortality, evidence on the relative effectiveness and cost-effectiveness of various environmental health interventions is limited and subject to significant methodological concerns. There is a limited understanding of the determinants of long-term water and sanitation technology adoption and behavior change at the individual level. Even less is known about how collective action problems in water and sanitation infrastructure maintenance can be overcome. An agenda for future research includes evaluating alternative transmission interruption mechanisms, improving understanding of the determinants of individual-level technology adoption in the water and sanitation sector, and assessing the quality of infrastructure maintenance under different management schemes.
  • Topic: Health, Human Welfare, Humanitarian Aid, Poverty
  • Author: Ferdinando Regalía, Leslie Castro
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Nicaragua's Red de Protección Social (RPS) is one of the first conditional cash transfer (CCT) programs implemented in a low-income country. Demand-side incentives, in the form of monetary transfers, are provided to poor households on condition that their children attend school and visit preventive health care providers. The design of the program is unique among CCT programs because these demand-side incentives are complemented by supply-side incentives aimed at improving the provision of health care. Health care providers are paid on the basis of their performance against predetermined targets. Both private and nonprofit health care providers contracted by the government extend the coverage of services to previously underserved areas.
  • Topic: Development, Health, Humanitarian Aid
  • Political Geography: Latin America
  • Author: Amanda Glassman, Jessica Todd, Marie Gaarder
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: In order to support poor families in the developing world to seek and use health care, a multi-pronged strategy is needed on both the supply and the demand side of health care. A demand-side program called Conditional Cash Transfers (CCTs) strives to reduce poverty and also increase food consumption, school attendance, and use of preventive health care. Since 1997, seven countries in Latin America have implemented and evaluated CCT programs with health and nutrition components. The core of the program is based on encouraging poor mothers to seek preventive health services and attend health education talks by providing a cash incentive for their healthy behavior (with healthy behavior representing performance). Evaluations of these programs measured outputs in the utilization of services; health knowledge, attitudes, and practice; food consumption; the supply and quality of services; as well as outcomes in vaccination rates; nutritional status; morbidity; mortality; and fertility.
  • Topic: Development, Health, Humanitarian Aid
  • Political Geography: Latin America
  • Author: Amanda Glassman, Jessica Todd, Marie Gaarder
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: USAID launched a project in 1995 to deliver basic health services in Haiti. The project began by reimbursing contracted NGOs for documented expenditures or inputs. In 1999, payment was changed to being based partly on attaining performance targets or outputs. The project also provided technical assistance to the NGOs, along with opportunities to participate in an NGO network and other cross-fertilization activities. Remarkable improvements in key health indicators have been achieved in the six years since payment for performance was phased in. Although it is difficult to isolate the effects of performance-based payment on these improved indicators from the efforts aimed at strengthening NGOs and other factors, panel regression results suggest that the new payment incentives were responsible for considerable improvements in both immunization coverage and attended deliveries. Results for prenatal and postnatal care were less significant, perhaps suggesting a strong patient behavioral element that is not under the influence of provider actions.
  • Topic: Development, Health, Humanitarian Aid
  • Political Geography: Caribbean, Haiti
  • Author: Rena Eichler, Diana Weil, Alexandra Beith
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Tuberculosis is a public health emergency in Africa, Eastern Europe, and Central Asia. Of the estimated 1.7 million deaths from TB, 98 percent are in the developing world, the majority being among the poor. In order to reach the MDG and the Stop TB partnership targets for 2015, TB detection rates need to double, treatment success rates must increase to more than 7075 percent, and strategies to address HIV-associated TB and multi-drug resistant TB must be aggressively expanded. DOTS, the internationally-recommended TB control strategy is the foundation of TB control efforts worldwide. A standard recording and monitoring system built on routine service-based data allows nearly all countries in the world to track progress in case detection and treatment completion through routine monitoring. This provides a good base for measuring the impact of different strategies for improving TB control outcomes.
  • Topic: Development, Health, Human Welfare, Humanitarian Aid
  • Political Geography: Africa, Central Asia, Eastern Europe
  • Author: Michael Clemens
  • Publication Date: 03-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The emigration of highly skilled workers can in theory lower social welfare in the migrant-sending country. If such workers produce a good whose consumption conveys a positive externality—such as nurses and doctors in a very poor country—the loss can be greater, and welfare can even decline globally. Policies to impede emigration thus have the potential to raise sending-country and global welfare. This study uses a new database of health worker emigration from Africa to test whether exogenous decreases in emigration raise the number of domestic health professionals, increase the mass availability of basic primary care, or improve a range of public health outcomes. It identifies the effect through two separate natural quasi-experiments arising from the colonial division of the African continent. These produce exogenous changes in emigration comparable to those that would result from different immigration policies in principal receiving countries. The results suggest that Africa's generally low staffing levels and poor public health conditions are the result of factors entirely unrelated to international movements of health professionals. A simple model proposes that such results would be explained by segmentation of health workforce labor markets in the sending countries. The results further suggest that emigration has caused a greater production of health workers in Africa.
  • Topic: International Relations, Health, Migration
  • Political Geography: Africa
  • Author: Markus Goldstein, Joshua Graff Zivin, Harsha Thirumurthy
  • Publication Date: 01-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The provision of life-saving antiretroviral (ARV) treatment has emerged as a key component of the global response to HIV/AIDS, but very little is known about the impact of this intervention on the welfare of children in the households of treated persons. We estimate the impact of ARV treatment on children's schooling and nutrition outcomes using longitudinal household survey data collected in collaboration with a treatment program in western Kenya. We find that children's weekly hours of school attendance increase by over 20 percent within six months after treatment is initiated for the adult household member. For boys in treatment households, these increases closely follow their reduced market labor supply. Similarly, young children's short-term nutritional status—as measured by their weight-for-height Z-score—also improves dramatically. We also present evidence that the impact of treatment is considerably larger when compared to the counterfactual scenario of no ARV treatment. The results illustrate how intrahousehold allocations of time and resources are altered in response to significant health improvements. Since the improvements in children's schooling and nutrition at these critical early ages will affect their socio-economic outcomes and wellbeing in adulthood, the widespread provision of ARV treatment is likely to generate significant long-run welfare benefits.
  • Topic: Health, Human Welfare
  • Political Geography: Kenya, Africa
  • Author: Rachel Glennerster, Heidi Williams, Georg Weizsacker, Ruth Levine, Jean Lee, Michael R. Kremer, Ernst R. Berndt
  • Publication Date: 08-2006
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The G8 is considering committing to purchase vaccines against diseases concentrated in low-income countries (if and when desirable vaccines are developed) as a way to spur research and development on vaccines for these diseases. Under such an “advance market commitment,” one or more sponsors would commit to a minimum price to be paid per person immunized for an eligible product, up to a certain number of individuals immunized. For additional purchases, the price would eventually drop to close to marginal cost. If no suitable product were developed, no payments would be made. We estimate the offer size which would make revenues similar to the revenues realized from investments in typical existing commercial pharmaceutical products, as well as the degree to which various model contracts and assumptions would affect the cost-effectiveness of such a commitment. We make adjustments for lower marketing costs under an advance market commitment and the risk that a developer may have to share the market with subsequent developers. We also show how this second risk could be reduced, and money saved, by introducing a superiority clause to a commitment. Under conservative assumptions, we document that a commitment comparable in value to sales earned by the average of a sample of recently launched commercial products (adjusted for lower marketing costs) would be a highly cost-effective way to address HIV/AIDS, malaria, and tuberculosis. Sensitivity analyses suggest most characteristics of a hypothetical vaccine would have little effect on the cost-effectiveness, but that the duration of protection conferred by a vaccine strongly affects potential cost-effectiveness. Readers can conduct their own sensitivity analyses employing a web-based spreadsheet tool.
  • Topic: Development, Economics, Health, Markets
  • Author: Gunilla Petterson, Michael A. Clemens
  • Publication Date: 08-2006
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The migration of doctors and nurses from Africa to developed countries has raised fears of an African medical brain drain. But empirical research on the causes and effects of the phenomenon has been hampered by a lack of systematic data on the extent of African health workers' international movements. We use destination-country census data to estimate the number of African-born doctors and professional nurses working abroad in a developed country circa 2000, and compare this to the stocks of these workers in each country of origin. Approximately 65,000 African-born physicians and 70,000 African-born professional nurses were working overseas in a developed country in the year 2000. This represents about one fifth of African-born physicians in the world, and about one tenth of African-born professional nurses. The fraction of health professionals abroad varies enormously across African countries, from 1% to over 70% according to the occupation and country. These numbers are the first standardized, systematic, occupation-specific measure of skilled professionals working in developed countries and born in a large number of developing countries.
  • Topic: Development, Health, Migration
  • Political Geography: Africa
  • Author: Owen Barder
  • Publication Date: 07-2006
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: It is sometimes claimed that an increase in aid might cause Dutch Disease—that is, an appreciation of the real exchange rate which can slow the growth of a country's exports— and that aid increases might thereby harm a country's long-term growth prospects. This essay argues that it is unlikely that a long-term, sustained and predictable increase in aid would, through the impact on the real exchange rate, do more harm than good, for three reasons. First, there is not necessarily an adverse impact on exports from Dutch Disease, and any impact on economic growth may be small. Second, aid spent in part on improving the supply side—investments in infrastructure, education, government institutions and health—result in productivity benefits for the whole economy, which can offset any loss of competitiveness from the Dutch Disease effect. Third, the welfare of a nation's citizens depends on their consumption and investment, not just output. Even on pessimistic assumptions, the additional consumption and investment which the aid finances is larger than any likely adverse impact on output. However, the macroeconomic effects of aid can cause substantial harm if the aid is not sustained until its benefits are realized. The costs of a temporary loss of competitiveness might well exceed the benefits of the short-term increase in aid. To avoid doing harm, aid should be sustained and predictable, and used in part to promote economic growth. This maximizes the chances that the long-term productivity and growth benefits will offset the adverse effects—which may be small if they exist at all—that big aid surges may pose as a result of Dutch Disease.
  • Topic: Economics, Health, Humanitarian Aid
  • Political Geography: Europe
  • Author: Owen Barder, Ethan Yeh
  • Publication Date: 02-2006
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: How can the international community save more children's lives faster and more effectively in the 21st century? This Working Paper analyzes the extent to which “frontloading” and predictable vaccine funding, as proposed by the International Finance Facility for Immunization (IFFIm), is more effective in impacting vaccine coverage than spending vaccine funds equally throughout the lives of projects. The IFFIm is an initiative of the Global Alliance for Vaccines and Immunization (GAVI), and supported by the governments of the United Kingdom, France, Sweden, Italy, Spain and Norway. An initial IFFIm investment of $4 billion is expected to prevent 5 million child deaths by 2015, and more than 5 million future adult deaths. Using a stylized model, the authors quantify the positive and negative effects of predictable vaccine funds and frontloading, and finds IFFIm's approach can increase the impact of vaccine coverage by 22%. This is because stable and long-term financing allows vaccine manufacturers and countries to plan for long periods of time, knowing that resources will be available. Front-loading helps to reduce the spread of disease and to immunize large groups of people faster.
  • Topic: Economics, Health, Human Welfare, International Cooperation
  • Political Geography: United Kingdom, Norway, France, Spain, Italy, Sweden
  • Author: Maureen Lewis
  • Publication Date: 01-2006
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: What factors affect health care delivery in the developing world? Anecdotal evidence of lives cut tragically short and the loss of productivity due to avoidable diseases is an area of salient concern in global health and international development. This working paper looks at factual evidence to describe the main challenges facing health care delivery in developing countries, including absenteeism, corruption, informal payments, and mismanagement. The author concludes that good governance is important in ensuring effective health care delivery, and that returns to investments in health are low where governance issues are not addressed.
  • Topic: Corruption, Government, Health, Third World
  • Author: Vijaya Ramachandran, Manju Kedia Shah, Ginger Turner
  • Publication Date: 01-2006
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: This paper analyzes the determinants of firms' decision to provide HIV/AIDS prevention activities. Using data from 860 firms and 4,955 workers in Uganda, Tanzania, and Kenya, it shows that larger firms, and firms with higher skilled workers tend to invest more in AIDS prevention. Firms where more than 50 percent of workers are unionized are also more likely to do more prevention activity. Finally, these characteristics are also significant in determining whether or not a firm carries out pre-employment health checks of its workers. The results shed light on the likelihood of private sector intervention and the gaps that will require public sector assistance.
  • Topic: Health, Human Welfare, Humanitarian Aid, Non-Governmental Organization
  • Political Geography: Uganda, Kenya, Tanzania
  • Author: Maureen Lewis
  • Publication Date: 01-2006
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: What factors affect health care delivery in the developing world? Anecdotal evidence of lives cut tragically short and the loss of productivity due to avoidable diseases is an area of salient concern in global health and international development. This working paper looks at factual evidence to describe the main challenges facing health care delivery in developing countries, including absenteeism, corruption, informal payments, and mismanagement. The author concludes that good governance is important in ensuring effective health care delivery, and that returns to investments in health are low where governance issues are not addressed.
  • Topic: Corruption, Development, Health, Human Welfare