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.
This 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. We summarize the public good characteristics of R&D for agriculture in general and for commodity and subsistence crops in particular, as well as R&D for health in general and for neglected diseases in particular, with a focus on Sub-Saharan Africa and South Asia. Finally, we present rationales for which funders are predicted to fund which R&D types based on these funder and R&D characteristics. We then compile available statistics on funding for agricultural and health R&D from private, public and philanthropic sources, and compare trends in funding from these sources against expectations. We find private agricultural R&D spending focuses on commodity crops (as expected). However contrary to expectations we find public and philanthropic spending also goes largely towards these same crops rather than staples not targeted by private funds. For health R&D private funders similarly concentrate on diseases with higher potential financial returns. However unlike in agricultural R&D, in health R&D we observe some specialization across funders – especially for neglected diseases R&D - consistent with funders’ expected relative advantages.
This brief presents an overview of EPAR’s previous research on nutrition and food security and outlines summaries and key findings from 15 technical reports and research briefs. Key findings are drawn from our own original analyses as well as from other sources, which are cited in the individual reports. We also include appendices briefly summarizing EPAR’s research on health and climate change, topics somewhat related to nutrition and food security, and EPAR’s confidential work on nutrition and food security.
Household survey data are a key source of information for policy-makers at all levels. In developing countries, household data are commonly used to target interventions and evaluate progress towards development goals. The World Bank’s Living Standards Measurement Study - Integrated Surveys on Agriculture (LSMS-ISA) are a particularly rich source of nationally-representative panel data for six Sub-Saharan African countries: Ethiopia, Malawi, Niger, Nigeria, Tanzania, and Uganda. To help understand how these data are used, EPAR reviewed the existing literature referencing the LSMS-ISA and identified 415 publications, working papers, reports, and presentations with primary research based on LSMS-ISA data. We find that use of the LSMS-ISA has been increasing each year since the first survey waves were made available in 2009, with several universities, multilateral organizations, government offices, and research groups across the globe using the data to answer questions on agricultural productivity, farm management, poverty and welfare, nutrition, and several other topics.
This brief reviews the various definitions of global public goods (GPGs) and regional public goods (RPGs) found in the literature and provides examples of each in six frequently discussed sectors: environment, health, knowledge, security, governance, and infrastructure. We identify multiple alternative definitions that have gained some traction in the literature, but GPGs are generally agreed to exhibit publicness in consumption, distribution of benefits, and decision-making. Because policy choices determine what is and what is not a GPG, there cannot be a fixed list of such goods; some always have the property of global publicness, while others have over time changed from being local or national to being global in terms of benefits and costs. GPGs are thus redefined as goods that are in the global public domain. GPG and RPG financing mechanisms include payments by users and beneficiaries, taxes, fees, and levies, private funding by non-profit corporations, profit-making firms, and philanthropic individuals and organizations, national and international public resources, and partnerships between several sources of financing. We conclude with an analysis of trends in GPG and RPG financing through Official Development Assistance (ODA) using time series data from the OECD’s Creditor Reporting System and other sources. We find that 14% of ODA in 2014 was allocated to sub-sectors labelled by Reiner et al. as GPGs, while 15% of ODA was allocated to RPGs, and that GPG and RPG spending has steadily increased from 2002-2014.
This report reviews the current body of peer-reviewed scholarship exploring the impacts of morbidity on economic growth. This overview seeks to provide a concise introduction to the major theories and empirical evidence linking morbidity – and the myriad different measures of morbidity – to economic growth, which is defined primarily in terms of gross domestic product (GDP) and related metrics (wages, productivity, etc.). Through a systematic review of published manuscripts in the fields of health economics and economic development we further identify the most commonly-used pathways linking morbidity to economic growth. We also highlight the apparent gaps in the empirical literature (i.e., theorized pathways from morbidity to growth that remain relatively untested in the published empirical literature to date).
This brief analyzes the indicators used by the World Bank in its Project Appraisal Documents (PAD) to measure the outputs and outcomes of 44 Water, Sanitation and Hygiene projects in Africa and Asia from 2000-2010. This report details the methods used to collect and organize the indicators, and provides a brief analysis of the type of indicators used and their evolution over time. A searchable spreadsheet of the indicators used in this analysis accompanies this summary. We find that some patterns emerge over time, though none are very drastic. The most common group of indicators used by the World Bank are “management” oriented indicators (28% of indicators). Management indicators are disproportionately used in African projects as compared to projects in Asia. Several projects in Africa incorporate indicators relating to legal/regulatory/policy outcomes, while projects in Asia do not. In recent years, the World Bank has used fewer indicators that measure service delivery, health, and education and awareness.
Water supply and sanitation is the responsibility of sub-national state governments under the Indian Constitution. At present, the national government sets water supply and sanitation policy while states plan, design, and execute water supply schemes accordingly. Furthermore, while state governments are in charge of operation and maintenance, they may pass the responsibility to village or district levels. Given the highly decentralized provision of water and sanitation services, there is no autonomous regulatory agency for the water supply and sanitation sector in India at the state or national level. This report reviews literature on India’s urban sanitation policy. The methodology includes Google, Lexis-Nexis, and University of Washington Library searches, searches of two major Indian newspapers, and searches of websites and blogs sponsored by non-governmental organizations. Sources also include the India Sanitation Portal, a forum on sanitation in India used by governmental and nongovernmental organizations, and WASH Sanitation Updates, a sanitation news feed with considerable material on India. We find that urban sanitation policy, as embodied in the National Urban Sanitation Plan of 2008, remains focused on decentralized approaches. Our research reveals no evidence of a change in official policy, nor evidence suggesting that government sanitation programs conflict with official policy.
Limited sanitation infrastructure, poor hygienic practices, and unsafe drinking water negatively affect the health of millions of people in the developing world. Using sanitation interventions to interrupt disease pathways can significantly improve public health. Sanitation interventions primarily benefit public health by reducing the prevalence of enteric pathogenic illnesses, which cause diarrhea. Health benefits are realized and accrue to the direct recipients of sanitation interventions and also to their neighbors and others in their communities. In a report to the United Nations Development Programme (UNDP), Hutton et al. (2006) estimate that the cost-benefit ratio of sanitation interventions in all developing countries worldwide is 11.2. This literature review summarizes the risks of inadequate sanitation to public health and presents the empirical evidence on the public health benefits of complete, intermediate and multiple factor sanitation interventions. We find that complete or improved sanitary systems can offer concrete public health benefits by reducing exposure pathways to a variety of infectious diseases contained in human feces and wastewater. Substantial complementary economic gains are also predicted to accrue as a result of providing increased sanitation. In addition, community-wide sanitation interventions seem to offer the greatest promise for reducing pathogenic health risks from feces.
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.