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12. Costing Healthcare Services Using Time-Driven Activity-Based Costing: A Simple Step-By-Step Guide for Data Collection and Analysis
- Author:
- Lumbwe Chola, Ryan McBain, and Y-Ling Chi
- Publication Date:
- 10-2022
- Content Type:
- Working Paper
- Institution:
- Center for Global Development
- Abstract:
- Cost information is essential for priority setting and optimized resource allocation in the healthcare sector, especially in low- and middle-income countries (LMICs) where resource constraints and opportunity costs are significant. In recent years, a costing approach labelled time-driven activity-based costing (TDABC) has gained prominence, as a means for more closely estimating unit costs. TDABC is a process-based micro-costing methodology that adopts a patient perspective to identify resources that are allocated over the course of service provision, mapping each step of a patient journey. Unlike other activity-based costing methods, TDABC includes the recording of the amount of time that resources are utilized for each activity. The manuscript is developed as a step-by-step guide for researchers, students and policy makers intending to undertake TDABC. While there are many academic resources explaining the theory and steps to conduct TDABC, in this paper, we provide easily accessible descriptions of methods for collecting data, tools that can be adapted to diverse research questions and settings, as well as practical data collection “tips” we learned from applying approaches on the ground.
- Topic:
- Science and Technology, Health Care Policy, Medicine, and Cost-Benefit Analysis
- Political Geography:
- Global Focus
13. Do Cash Transfers Deter Migration?
- Author:
- Michael A. Clemens
- Publication Date:
- 10-2022
- Content Type:
- Working Paper
- Institution:
- Center for Global Development
- Abstract:
- Conditional Cash Transfers are increasingly used by development aid agencies to reduce the incentives for migration from low-income countries. The evidence to date suggests that such transfers typically increase the rate of migration when they are conditional on investment, such as investment in education. They do this primarily by facilitating acquisition of human capital and by lowering capital constraints—increasing both migration aspirations and the means to achieve them. But with certain design features, particular transfer programs have reduced the incentive to migrate. Broadly speaking, migration can be deterred by transfer programs that are conditional on presence in the origin country—provided that the condition is strict, targeted, and lengthy.
- Topic:
- Economics, Migration, Finance, and Investment
- Political Geography:
- Global Focus
14. The ABCs of Sovereign Debt Relief
- Author:
- Rakan Aboneaaj, Jocilyn Estes, and Clemence Landers
- Publication Date:
- 10-2022
- Content Type:
- Policy Brief
- Institution:
- Center for Global Development
- Abstract:
- We are living in a time when many countries face heightened debt vulnerabilities. Already high before the pandemic, debt levels reached a 50-year peak following the growth in government spending to combat COVID-19. Debt is not inherently bad; borrowing can allow countries to finance vital government investment. But unsustainable levels of debt can have devastating consequences for a country’s population, crowding out government spending on even basic necessities including food, medicine, and fuel imports. In Sri Lanka, for example, 71 percent of government revenue was spent on debt service before the country defaulted. Even where the tradeoff is not so dire, unsustainable debt service can limit productive investments in infrastructure, education, healthcare, and other sectors, hampering the economic growth necessary to reduce a country’s debt burden. After a decade-long period of low borrowing costs, a confluence of rising interest rates, inflation, and commodity shocks have raised the likelihood of overlapping debt crises in developing countries. The International Monetary Fund (IMF) now estimates that 30 percent of emerging market countries and 60 percent of low-income countries could face trouble paying down their debts or will soon. There is no international bankruptcy mechanism for countries that default on their external obligations. Instead, countries have historically depended on a patchwork of precedents, contracts, and conventions to bring creditors to the table for debt relief negotiations. The United States has a legacy as the lead architect of large global debt relief initiatives, from the Brady Bond plan for Latin America to the Heavily Indebted Poor Countries (HIPC) Initiative that kickstarted debt relief for poor countries in the 1990s. However, the global creditor landscape has changed significantly over the past decade. Low-income sovereigns’ largest creditors today—China and private bondholders—operate under much different principles than the leading bilateral creditors of the past, making the traditional norms and structures less effective for present debt challenges. The objective of the international financial architecture—historically overseen by the IMF and its shareholders— will be to corral these new creditors into a cooperative arrangement to deliver on debt relief.
- Topic:
- Debt, Development, Governance, Credit, and Sovereign Debt
- Political Geography:
- Global Focus
15. Reforming the World Bank and MDBs to Meet Shared Global Challenges
- Author:
- Center for Global Development
- Publication Date:
- 10-2022
- Content Type:
- Policy Brief
- Institution:
- Center for Global Development
- Abstract:
- Last July, the Center for Global Development hosted a meeting with other think tanks to exchange perspectives on the multilateral development bank (MDB) system. We shared a common diagnosis that MDBs must more aggressively address the global challenges that defy national borders and threaten human life as we know it. By virtue of its global reach, financial firepower, and expertise, the World Bank is especially well positioned to be a major driver of progress on climate, pandemic preparedness natural resource conservation, and other global public goods. But it is not meeting its full potential. Participants at our meeting agreed to set out a shared “call to action” where we lay out ideas to evolve the World Bank. The central ideas are to make climate mitigation and adaptation a core component of the World Bank’s mandate; greatly expand its financing capacity; create more incentives for countries to invest in climate and health preparedness; and reform the organizational structure of the institution. Together these could help lay the foundation for a modern World Bank that is meeting the defining challenges of our time head on. Unless otherwise noted, we the undersigned support these ideas in our personal capacity. More information on related work underway in our organizations can be found at our respective websites.
- Topic:
- Sovereignty, Reform, Finance, and Banking
- Political Geography:
- Global Focus
16. The Next Game Changers: A Priority Innovation Agenda for Global Health
- Author:
- Cordelia Kenney and Rachel Silverman
- Publication Date:
- 10-2022
- Content Type:
- Working Paper
- Institution:
- Center for Global Development
- Abstract:
- Over the last century, scientific and technological innovation has led to unprecedented improvements in health outcomes—yet research and development (R&D) investments and progress to address health threats has been uneven. Commercial R&D has focused where investors can expect substantial financial returns: rich countries, the diseases that affect them, and high-tech solutions designed for the richest and most sophisticated systems. Despite supplemental funding from philanthropic and government grants, R&D to address many leading causes of death and disability—especially those that primarily affect low- and middle-income countries (LMICs) or insure against future risk—has been consistently underfunded relative to potential health gain. This implies that many untapped opportunities remain to dramatically improve global health and welfare via biomedical innovation. In this paper, we report the results of a horizon-scanning exercise to source opportunities for global health R&D investment—that is, high-value potential biomedical innovations which are currently underfunded but which could be transformative for health, quality of life, and health security in LMICs and around the world. Drawing from a literature review and expert interviews with researchers, economists, funders, advocates, and implementers, we lay out an expansive and high-promise (though non-comprehensive) biomedical innovation agenda for global health spanning the unfinished MDG agenda; non-communicable diseases; and global health security. We conclude with a discussion of implications for research, funding, and practice.
- Topic:
- Development, Health, Science and Technology, Innovation, and Emerging Technology
- Political Geography:
- Global Focus
17. Is There a Better Way to Use Global Reserves?
- Author:
- Mark Plant
- Publication Date:
- 10-2022
- Content Type:
- Working Paper
- Institution:
- Center for Global Development
- Abstract:
- Global reserves can serve as a global public good, facilitating the short-term global recovery from the economic impacts of the pandemic and Russian invasion of Ukraine, as well as the longer-term global transition to a sustainable and equitable economic future. Strategic allocation of Special Drawing Rights (SDRs) could facilitate sharing of global reserves with low- and middle-income countries to the mutual benefit of advanced and developing countries. This will require the development of new SDR sharing mechanisms, in which multilateral development banks could be instrumental. Other SDR reforms should also be pursued.
- Topic:
- Development, Multilateralism, Sustainability, and Banking
- Political Geography:
- Global Focus
18. What’s the Best Way to Bolster the IMF’s Capacity to Lend to Low-Income Countries?
- Author:
- David Andrews
- Publication Date:
- 09-2022
- Content Type:
- Working Paper
- Institution:
- Center for Global Development
- Abstract:
- The IMF’s concessional lending to low-income countries through its Poverty Reduction and Growth Trust (PRGT) has risen dramatically since the start of the pandemic and demand for the PRGT resources is expected to remain above pre-pandemic levels for quite some time. But the surge in lending has strained the PRGT's finances—loan resources have dwindled, subsidy costs have risen sharply, and reserves need bolstering. Projections show the risks to PRGT financing are accentuated given the Russian invasion of Ukraine and rising global interest rates. A multi-pronged decade-long effort is needed to ensure sound PRGT financing: (1) reinforce current fundraising efforts for loan and subsidy resources; (2) promote the use of the PRGT's deposit investment account; (3) terminate the reimbursement of PRGT administrative resources to the IMF's General Resources Account and (4) begin a discussion on IMF gold sales to take place in the out years. Each prong of the effort should start immediately, given the time lags involved in reaching consensus and implementation.
- Topic:
- Development, International Cooperation, Finance, and IMF
- Political Geography:
- Global Focus
19. Why and How Development Agencies Facilitate Labor Migration
- Author:
- Helen Dempster and Beza Tesfaye
- Publication Date:
- 08-2022
- Content Type:
- Working Paper
- Institution:
- Center for Global Development
- Abstract:
- Development agencies in high-income countries spend a large amount of both official development assistance (ODA) and other forms of financing on migration programming. While most of this spending is aimed at deterring migration, increasingly more is being focused on facilitating migration: to the high-income country itself; within and between low- and middle-income countries; and supporting people on the move and the diaspora. This paper, written by the Center for Global Development and Mercy Corps, aims to explore why and how development agencies in high-income countries facilitate labor, or economic, migration, and how they have been able to justify and expand their mandate in this area. Based on interviews with nine development agencies, we find that development agencies use a range of arguments to justify their work in this area, including supporting economic development and poverty reduction in partner countries while also meeting labor market demands at home or other countries. Yet expanding a mandate in this area requires substantial cross-government coordination and political buy-in, both of which are difficult to achieve. It also requires the ability to be able to use ODA to facilitate labor migration, which is currently up for debate. As development agencies seek to expand their work on labor migration, it will be necessary to define shared goals and start with pilot projects that focus on low-hanging fruit, while maintaining a focus on development and poverty reduction.
- Topic:
- Development, Migration, Diaspora, and Labor Issues
- Political Geography:
- Global Focus
20. Healthier Firms for a Stronger Recovery: Policies to Support Business and Jobs in Latin America and the Caribbean
- Author:
- Andrew Powell and Liliana Rojas-Suarez
- Publication Date:
- 08-2022
- Content Type:
- Special Report
- Institution:
- Center for Global Development
- Abstract:
- This report—the product of a joint working group convened by the Center for Global Development and the Inter-American Development Bank—focuses on firms and labor markets in Latin America and the Caribbean during the COVID-19 crisis and the highly uncertain recovery phase now underway. The ongoing Russian war in Ukraine, volatility in international financial markets, and fears of global stagflation (low growth and high inflation) combine with the impacts of the pandemic to make the economic environment particularly challenging. Through a balance sheet analysis, the report describes how larger firms have navigated the crisis by cutting back on variable costs and investment. It also focuses on small and medium-size enterprises (SMEs), which appear to have suffered more in terms of closures and restrictions on credit access. The impacts on labor markets were unprecedented, with steep falls in employment and participation rates. A key question is whether the reallocation of resources, favoring firms in sectors that were hit less hard and able to take advantage of digital technologies, will persist. Key dangers are that informality is higher than ever, that productive resources remain trapped in small and less productive or ultimately unviable enterprises, and that firms are not rebuilding their capital stocks quickly. Drawing on an analysis of firms and labor markets, the report provides a set of recommendations for policymakers in the region and suggestions for international financial institutions to assist productive firms to invest, support the growth of new firms, and enhance labor market performance.
- Topic:
- Development, Economics, Finance, and Banking
- Political Geography:
- South America, Latin America, Caribbean, and North America