Types of Research
The share of private sector funding, relative to public sector funding, for drug, vaccine, and diagnostic research & development (R&D) differs considerably across diseases. Private sector investment in overall health R&D exceeds $150 billion annually, but is largely concentrated on non-communicable chronic diseases with only an estimated $5.9 billion focused on "global health", targeting diseases that primarily affect low and middle-income countries (LMICs). We examine the evidence for five specific disincentives to private sector global health R&D investment: scientific uncertainty, weak policy environments, limited revenues and market uncertainty, high fixed and sunk costs, and downstream rents from imperfect markets. Though all five may affect estimates of net returns from an investment decision, they are worth examining separately as each calls for a different intervention or remediation to change behavior.
In a review of 285 sources published in the past 15 years that discuss private investment in 47 individual diseases, we analyzed and recorded information on which factors are most commonly discussed as either barriers or drivers to private sector global health R&D investment. We find that price, information, and market power are the most commonly discussed key factors. The literature suggests that low or uncertain LMIC product prices relative to prices in the U.S. or other HICs limit private global health R&D investment, and that LMIC market data gaps further hinder revenue forecasting and firm or product market entry. Though expected revenues from global health R&D may be low or uncertain, costs are often high, and incurred upfront with certainty, further deterring private investment in diseases with uncertain revenues. Further, relatively strong downstream market power may make it cheaper to purchase (license) rather than produce innovations (conduct R&D), reducing private sector incentives to invest in upstream global health R&D.
Though a variety of policy tools exist to promote private sector investment in R&D, including push mechanisms (public research funding, R&D tax credits) and pull mechanisms (advance purchase commitments, orphan drug programs, priority review vouchers, and wild-card patent extensions), evidence of effectiveness is mixed. While we find 42 sources suggesting that some combination of policy tools had a positive impact on catalyzing private R&D funding for diseases more prevalent in LMICs, 11 sources report mixed results, and 3 sources report negative impacts of policies.
Proprietary science and LMIC health data gaps represent further barriers to private global health R&D, including data science and bioengineering. To the extent that health data are more limited for global health diseases, there is reason to speculate that as the industry shifts more R&D to biotechnology even less will be directed at diseases prevalent in LMICs. Both industry experts and the literature additionally lament the limited market data available to better assess potential market outcomes – yet despite potential industry-wide gains, there is no clear incentive for any individual firm within this sector to either fund or contribute to such a data service.
Donor countries and multilateral organizations may pursue multiple goals with foreign aid, including supporting low-income country development for strategic/security purposes (national security, regional political stability) and for short-and long-term economic interests (market development and access, local and regional market stability). While the literature on the effectiveness of aid in supporting progress on different indicators of country development is inconclusive, donors are interested in evidence that aid funding is not permanent but rather contributes to a process by which recipient countries develop to a point that they are economically self-sufficient. In this report, we first review the literature on measures of country self-sufficiency as discussed in multilateral and bilateral donor policy documents and in academic studies and gray literature on aid transitions. While self-sufficiency is inconsistently defined in the literature and donor policies, commonly reported measures or indicators do fall into five major categories: economic performance (e.g. GNI per capita), access to non-aid finance (e.g. creditworthiness, ability to raise tax revenue, investment capacity, trade capacity), institutional performance (e.g. quality of country institutions, country policy assessment, absorptive capacity, gaming behavior, policy ownership), aid dependence (e.g. aid to GDP ratio, Aid per capita, aid to government expenditure ratio), and vulnerability (e.g. instability, poverty, population).
The question of whether there is a causal link between receiving aid and transitioning to self-sufficiency is difficult to answer with certainty, as we can never know the counterfactual, i.e., what would have happened to a country’s trajectory in the absence (or presence) of aid. Further, the relationship between aid and self-sufficiency is endogenous, as one key indicator of self-sufficiency is reduced reliance on aid. The existing literature is largely descriptive or non-experimental and does not causally test the impact of aid on measures of self-sufficiency, though some quasi-experimental studies test for associations between aid and particular indicators related to self-sufficiency, such as GDP growth. Much of the literature on international aid focuses on aid effectiveness, rather than the relationship between aid and self-sufficiency, and self-sufficiency is not consistently defined or measured. However, descriptive evidence from illustrative case studies does shed some light on the conditions associated with transitions toward self-sufficiency in certain contexts.
We analyze trends in aid and indicators of self-sufficiency for Botswana, India, Indonesia, Ghana, and Rwanda, all countries highlighted in the literature on self-sufficiency as presenting examples of success or challenges in transitions toward self-sufficiency as measured by various indicators. For each case study we evaluate the conditions under which increased self-sufficiency was realized (or not) in each country, and summarize evidence from the literature on the role of aid in this process. These case studies reveal six main areas of ongoing debate in published and gray literature: whether or not aid negatively impacts a country’s progress toward self-sufficiency; whether transitioning countries off of aid should be the assumed goal of donors; whether tax capacity can positively impact transitions toward self-sufficiency; whether technical assistance and capacity-building programs can strengthen institutional characteristics associated with self-sufficiency; whether a “missing middle” of government funding status can threaten self-sufficiency of countries as they transition out of aid; and whether emerging donors may impact the aid landscape, especially in terms of government aid policy ownership
A large and growing body of scholarship now suggests that many household outcomes, including children’s education and nutrition, are associated with a wife’s bargaining power and control over household decision-making. In turn, bargaining power in a household is theorized to be driven by a wife’s financial and human capital assets – in particular the degree to which these assets contribute to household productivity and/or to the wife’s exit options. This paper draws on the detailed Farmer First dataset in Tanzania and Mali to examine husband and wife reports of a wife’s share of decision-making authority in polygynous households, where multiple wives jointly contribute to household productivity, and where exit options for any single wife may be less credible. We find that both husbands and wives assign less authority to the wife in polygynous households relative to monogamous households. We also find that a wife’s assets are not as strongly associated with decision-making authority in polygynous versus monogamous contexts. Finally, we find that responses to questions on spousal authority vary significantly by spouse in both polygynous and monogamous households, suggesting interventions based on the response of a single spouse may incorrectly inform policies and programs.
Access to financial services can enhance low-income households’ ability to invest in their livelihoods, safeguard their assets, manage risks, smooth income, and escape poverty (Cull, Ehrbeck & Holle, 2014; Dupas & Robinson, 2013). Yet worldwide 35% of men and 42% of women remain unbanked (Demirgüç-Kunt et al., 2015). Approximately half of the financially excluded population has access to a mobile phone, which may facilitate access to new digital financial services (DFS) such as mobile money (GSMA, 2015). Increasing access to and adoption of DFS-based technologies such as mobile money may therefore represent a significant opportunity for increasing financial inclusion. This potential may be especially great among the poor, and among rural, low-income women in particular, who in the past have been under-served by conventional bank-based financial services.
In this report we analyze three waves of the Intermedia Financial Inclusion Insights (FII) Survey, a nationally-representative household survey conducted in 2013/14, 2014, and 2015 in Kenya, Uganda, Tanzania, Nigeria, Pakistan, Bangladesh, India, and Indonesia. We run multiple logistic regressions using pooled survey data and country and wave fixed-effects to explore sociodemographic and economic factors associated with mobile money adoption, awareness, and use across countries and over time.
We find that rural respondents and respondents below the Progress out of Poverty Index (PPI) score have statistically significant negative associations with awareness and adoption for each survey wave and for most countries, consistent with less reach of mobile money in these populations. Indicators of education, including level of education acquired and literacy, have a positive association with awareness and adoption across countries and across survey waves. Phone ownership and having a bank account are consistently strongly associated with awareness, adoption, and use of mobile money; and the effects of these factors are the largest in terms of magnitude for mobile money adoption and use.
Women have consistently lower levels of awareness, adoption, and use than men across countries. Even controlling for other sociodemographic and economic factors, we find that being female is associated with an overall lower likelihood of awareness of mobile money. Across all countries, women who are aware of mobile money are also less likely to adopt mobile money than are aware men, with the negative effect of gender increasing in each wave. Gender does not have a significant association with the use of mobile money among those that have adopted it, however, which suggests that barriers to first-time use may be the most important for women’s access to mobile money.
These findings indicate that to realize the potential of DFS to reach currently unbanked populations and increase financial inclusion, particular attention needs to be paid to barriers faced by women in accessing mobile money. While policies and interventions to promote education, employment, phone ownership, and having a bank account may broadly help to increase mobile money adoption and use, potentially bringing in currently unbanked populations, specific policies targeting women may be needed to close current gender gaps.
Cash transfer programs are interventions that directly provide cash to target specific populations with the aim of reducing poverty and supporting a variety of development outcomes. Low- and middle-income countries have increasingly adopted cash transfer programs as central elements of their poverty reduction and social protection strategies. Bastagli et al. (2016) report that around 130 low- and middle-income countries have at least one UCT program, and 63 countries have at least one CCT program (up from 27 countries in 2008). Through a comprehensive review of literature, this report primarily considers the evidence of the long-term impacts of cash transfer programs in low- and lower middle-income countries. A review of 54 reviews that aggregate and summarize findings from multiple studies of cash transfer programs reveals largely positive evidence on long-term outcomes related to general health, reproductive health, nutrition, labor markets, poverty, and gender and intra-household dynamics, though findings vary by context and in many cases overall conclusions on the long-term impacts of cash transfers are mixed. In addition, evidence on long-term impacts for many outcome measures is limited, and few studies explicitly aim to measure long-term impacts distinctly from immediate or short-term impacts of cash transfers.
Although the programs reported on in the reviews include 37 cash transfer programs from Sub-Saharan Africa, 36 from Latin America, 18 from South Asia, ten from East Asia and the Pacific, three from Europe and Central Asia, five from North America, and four from the Middle East and North Africa, much of the evidence comes from multiple studies evaluating the most prominent cash transfer programs, especially Latin American programs. More evidence on the long-term impacts of cash transfer programs and on how these impacts might differ by context and program design will emerge as more of the existing global cash transfer programs mature and are evaluated. The available evidence indicates that cash transfer programs can be cost-effective, depending on the context and program design. Evidence of the cost-effectiveness, scalability, and sustainability of these programs is limited, but a few studies present initial findings on factors that appear to support or hinder cost-effectiveness, scalability, and sustainability. Several reviews suggest that design characteristics of cash transfer programs, including conditionality, targeting, and payment size, timing, frequency, and duration may all affect the impacts of the programs. Evidence on whether CCTs or UCTs are more effective at improving particular outcomes is mixed and may depend on the outcome measure of interest, but the reviews indicate that programs generally have greater impacts when targeting poorer or more marginalized populations and when providing transfers of larger size. Few reviews compare outcomes between cash transfer programs and other types of programs or interventions, though there is some limited evidence indicates that cash transfer programs might be more effective than alternatives to improve outcome measures related to poverty under specific circumstances.
According to AGRA's 2017 Africa Agriculture Status Report, smallholder farmers make up to about 70% of the population in Africa. The report finds that 500 million smallholder farms around the world provide livelihoods for more than 2 billion people and produce about 80% of the food in sub-Saharan Africa and Asia. Many development interventions and policies therefore target smallholder farm households with the goals of increasing their productivity and promoting agricultural transformation. Of particular interest for agricultural transformation is the degree to which smallholder farm households are commercializating their agricultural outputs, and diversifying their income sources away from agriculture. In this project, EPAR uses data from the World Bank's Living Standards Measurement Study - Integrated Surveys on Agriculture (LSMS-ISA) to analyze and compare characteristics of smallholder farm households at different levels of crop commercialization and reliance on farm income, and to evaluate implications of using different criteria for defining "smallholder" households for conclusions on trends in agricultural transformation for those households.
Crop yield is one of the most commonly used partial factor productivity measures. It is used to estimate the ratio of quantity of crop output, generally measured in kilograms or tons, to a sole input, land area. Ongoing EPAR research explores the policy implications of measuring yield by area planted versus area harvested. In this brief, we consider implications for crop yield estimates of other decisions in how to construct yield measures from household survey microdata. Using data from three waves of the Tanzania National Panel Survey (TNPS) and two waves of the Ethiopia Socioeconomic Survey (ESS), both part of the World Bank’s Living Standards Measurement Study-Integrated Surveys on Agriculture (LSMS-ISA), we calculate separate crop yield estimates across survey waves following different decisions on disaggregating yield by gender(s) of the plot decision-maker(s) and for pure-stand and mixed stand (intercropped) plots, on including crop production from multiple growing seasons, and on how to treat outlier observations.
Our technical brief helps to illustrate some of the potential effects of decisions of how to construct and report yield estimates, focus on maize yield estimates. We observe large differences in maize yields between pure stand and mixed stand plots, though the differences vary between Tanzania and Ethiopia and depending on how outliers are treated. We observe strong patterns in maize yields by gender of the plot decision-maker in Tanzania, but the patterns differ in Ethiopia again depending on how outliers are treated. Conclusions around maize yield do not seem to vary across sub-populations of plots when short rainy season production is added to long rainy season production in Tanzania, though these yield estimates are larger. These findings demonstrate that interpretations of crop yield estimates should pay particular attention to the decisions made in arriving at those estimates and the directions of bias potentially introduced by those decisions.
An ongoing stream of EPAR research considers how public good characteristics of different types of research and development (R&D) and the motivations of different providers of R&D funding affect the relative advantages of alternative funding sources. For this project, we seek to summarize the key public good characteristics of R&D investment for agriculture in general and for different subsets of crops, and hypothesize how these characteristics might be expected to affect public, private, or philanthropic funders’ investment decisions.
Land tenure refers to a set of land rights and land governance institutions which can be informal (customary, traditional) or formal (legally recognized), that define relationships between people and land and natural resources (FAO, 2002). These land relationships may include, but are not limited to, rights to use land for cultivation and production, rights to control how land should be used including for cultivation, resource extraction, conservation, or construction, and rights to transfer – through sale, gift, or inheritance – those land use and control rights (FAO, 2002). Land tenure security – i.e., the level of confidence landholders have in their land rights – depends on the ability of informal and formal institutions to enforce those land rights and prevent others from challenging them (Feder & Feeny, 1991). In low and middle income countries land tenure security has been linked to improved land management including greater investments to improve land and agricultural productivity (Deininger & Jun, 2006; Deininger, Ali, & Alemu, 2011; Ali, Deininger, & Goldstein, 2014; Lawry et al., 2017). Having legal documentation in particular has been associated with a greater sense of ownership over land, increases in land productivity and capital investments associated with land, and in some cases additional financial opportunities such as access to credit for landholders with formal land titles (Deininger, Ali, & Alemu, 2011). But in spite of the widely recognized benefits of land tenure security more than 70 percent of the world’s population – and in particular many poor and vulnerable populations including ethnic minorities, smallholder farmers, and women – still lack access to formal systems to register their property and receive legally recognized land titles (Place, 2009; Enemark et al., 2014; Mitchell et al. 2016).