Types of Research
The private sector is the primary investor in health research and development (R&D) worldwide, with investment annual investment exceeding $150 billion, although only an estimated $5.9 billion is focused on diseases that primarily affect low and middle-income countries (LMICs) (West et al., 2017b). Pharmaceutical companies are the largest source of private spending on global health R&D focused on LMICs, providing $5.6 billion of the $5.9 billion in total private global health R&D per year. This report draws on 10-K forms filed by Pharmaceutical companies with the U.S. Securities and Exchange Commission (SEC) in the year 2016 to examine the evidence for five specific disincentives to private sector investment in drugs, vaccines and therapeutics for global health R&D: scientific uncertainty, weak policy environments, limited revenues and market uncertainty, high fixed costs for research and manufacturing, and imperfect markets. 10-K reports follow a standard format, including a business section and a risk section which include information on financial performance, investment options, lines of research, promising acquisitions and risk factors (scientific, market, and regulatory). As a result, these filings provide a valuable source of information for analyzing how private companies discuss risks and challenges as well as opportunities associated with global health R&D targeting LMICs.
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.
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.
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.
This brief summarizes the literature on caloric and lipid deficiencies and their contribution to nutritional outcomes, and identifies key studies and pieces of literature related to this topic.
Cereals and pulses are important food and cash crops for farmers and rural households in Ethiopia. Despite the economic and food security importance of these crops, data and opinion suggest a yield gap: actual smallholder farm yields do not achieve estimated potential yields for wheat, sorghum, maize, lentils and peas. Furthermore, cereal prices in Ethiopia fall between import and export parity prices, limiting their international trading prospects. Although there are significant wheat imports, these reflect the influx of food aid, rather than competitive trade on the international market. The purpose of this brief is to estimate yield gaps in important Ethiopian crops in order to identify potential areas for productivity gains. We find that wheat, sorghum and maize all exhibit the potential for yield gains to increase domestic food availability. Additionally, all three crops experienced significant spikes in yield in the 2006 season. Further investigation into the climate conditions and policy in place that year may generate potential strategies to increase future yields. Analysis of Ethiopian lentil and pea yields suggest that productivity gains may be possible to increase food availability. Limited access to improved technologies appears to be the main constraint to pulse productivity in Ethiopia. Opportunities to increase lentil and pea yields appear to exist through increasing cultivation of improved varieties.
Without availability and access to a variety of foods, populations in the developing world are suffering from deficiencies in iron, zinc, iodine, vitamin A, and other micronutrients in addition to deficiencies in energy and protein. Supplementation and fortification programs have demonstrated effectiveness, but there is an increasing interest in potentially more sustainable solutions via agricultural interventions. The review examines the literature regarding agricultural interventions and pathways to diet diversification and whether desired nutritional outcomes are achieved. We find a strong sentiment that agricultural interventions can improve dietary diversity, and that dietary diversity can improve nutrition and related health outcomes. The programs with demonstrated ability to improve nutrition outcomes are most often cross-cutting interventions, borrowing from the agriculture, nutrition, and public health traditions. While these multi-platform programs can be costly to evaluate and difficult to implement, the evidence supports their potential to create sustainable quality-of-life improvements in target regions. The pathways by which agricultural interventions achieve impact are not fully clear, however. The greatest knowledge gaps are directly related to the lack of integration between program design and evaluation. Many evaluations are based on small sample sizes, lack control groups or baseline data, are subject to selection bias, or face other challenges to rigorous statistical analysis.
The purpose of this literature review is to examine research and decision-making tools that model the impacts of agricultural interventions. We begin with a short explanation of what model features are being described. We then review decision-support tools and user-end modeling tools (menu-driven tools with an interface designed for easy use), as well as academic and professional research models for assessing the potential impacts of agricultural interventions. This review also includes decision tools and models for analyzing agricultural and environmental policies outside of technology impacts in Sub-Saharan Africa and South Asia. The other tools mentioned here, for example a tool that considers nutritional intervention impacts, are included to help provide a broader understanding of the structure and availability of user-end, decision-making tools. In the final section of this brief, we review the most complex models used more in academic research than for in-field decision-making.
Ecosystem services are the benefits people obtain from ecosystems, such as provisioning of fresh water, food, feed, fiber, biodiversity, energy, and nutrient cycling. Agricultural production can substantially affect the functioning of ecosystems, both positively and negatively. The purpose of this report is to provide an overview of the impacts of agricultural technologies and practices on ecosystem services such as soil fertility, water, biodiversity, air, and climate. The report describes the environmental impacts of different aspects of intensive cropping practices and of inputs associated with intensification. We further explore these impacts by examining intensive rice systems and industrial crop processing. Although this report focuses on the impacts of agricultural practices on the environment, many of the practices also have implications for plant, animal, and human health. Farmers and others who come in contact with air, water, and soils polluted by chemical fertilizers and pesticides may face negative health consequences, for instance. By impacting components of the ecosystem, these practices affect the health of plants and animals living within the ecosystem. We find that the unintended environmental consequences of intensive agricultural practices and inputs are varied and potentially severe. In some cases, sustaining or increasing agricultural productivity depends upon reducing impacts to the environment, such as maintaining productive soils by avoiding salinization from irrigation water. However, in other cases, eliminating negative environmental impacts may involve unacceptable trade-offs with food provision or other development goals. Determining the appropriate balance of costs and benefits from intensive agricultural practices is a location-specific exercise requiring knowledge of natural, economic, and social conditions.