Types of Research
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Many low- and middle-income countries remain challenged by a financial infrastructure gap, evidenced by very low numbers of bank branches and automated teller machines (ATMs) (e.g., 2.9 branches per 100,000 people in Ethiopia versus 13.5 in India and 32.9 in the United States (U.S.) and 0.5 ATMs per 100,000 people in Ethiopia versus 19.7 in India and 173 in the U.S.) (The World Bank 2015a; 2015b). Furthermore, only an estimated 62 percent of adults globally have a banking account through a formal financial institution, leaving over 2 billion adults unbanked (Demirgüç–Kunt et al., 2015). While conventional banks have struggled to extend their networks into low-income and rural communities, digital financial services (DFS) have the potential to extend financial opportunities to these groups (Radcliffe & Voorhies, 2012). In order to utilize DFS however, users must convert physical cash to electronic money which requires access to cash-in, cash-out (CICO) networks—physical access points including bank branches but also including “branchless banking" access points such as ATMs, point-of-sale (POS) terminals, agents, and cash merchants. As mobile money and branchless banking expand, countries are developing new regulations to govern their operations (Lyman, Ivatury, & Staschen, 2006; Lyman, Pickens, & Porteous, 2008; Ivatury & Mas, 2008), including regulations targeting aspects of the different CICO interfaces.
EPAR's work on CICO networks consists of five components. First, we summarize types of recent mobile money and branchless banking regulations related to CICO networks and review available evidence on the impacts these regulations may have on markets and consumers. In addition to this technical report we developed a short addendum (EPAR 355a) which includes a description of findings on patterns around CICO regulations over time. Another addendum (EPAR 355b) summarizes trends in exclusivity regulations including overall trends, country-specific approaches to exclusivity, and a table showing how available data on DFS adoption from FII and GSMA might relate to changes in exclusivity policies over time. A third addendum (EPAR 355c) explores trends in CICO network expansion with a focus on policies seeking to improve access among more remote or under-served populations. Lastly, we developed a database of CICO regulations, including a regulatory decision options table which outlines the key decisions that countries can make to regulate CICOs and a timeline of when specific regulations related to CICOs were introduced in eight focus countries, Bangladesh, India, Indonesia, Kenya, Nigeria, Pakistan, Tanzania, and Uganda.
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 literature on poverty’s causes and cures in developing countries posits a variety of contributing factors. Most researchers acknowledge that a sustained exit from poverty is complex and no single causal pathway from poverty to non-poverty exists. In this review, we present a summary framework for categorizing the various theorized pathways out of poverty, and evaluate the empirical evidence for which interventions and resulting outcomes are most frequently and most strongly associated with poverty alleviation. We conducted a literature review on pathways out of poverty for low-income households in developing countries and identified and categorized general strategies and outcomes demonstrated to be empirically associated with poverty alleviation. We organized the general strategies into four asset groups that could be targeted to alleviate poverty: human, natural, built / financial, and social / political. Much of the literature presents positive results on poverty alleviation, but it is difficult to compare across studies because many of the studies were conducted in different countries and at different scales, and use a variety of outcome measures.
This report reviews and summarizes the existing evidence on the impact of access to financial services/products on measures of production, income and wealth, consumption and food security, and resilience for smallholder farmers and other rural customers and their households in Sub-Saharan Africa. This study covers four main types of financial products/services: 1) credit; 2) savings; 3) insurance; 4) transactional products. We also review the very limited evidence on the effectiveness of bundling these products/services together and of combining them with other offerings such as trainings or support for access to markets, and of providing them via digital channels. We note when financial products/services have been specifically designed to serve the needs of rural customers or smallholder farmers, since the needs of these groups are often very different from those of other stakeholders.
This report provides a summary of findings from six Financial Inclusion Insights (FII) data analysis reports conducted by various agencies for the Bill & Melinda Gates Foundation (BMGF). These reports investigate barriers to financial inclusion and use of digital financial services (DFS) in Bangladesh, India, Kenya, Nigeria, Pakistan, Tanzania, and Uganda. We compile comparable gender-specific statistics, summarize the authors’ findings to determine commonalities and differences across countries, and highlight gender-specific conclusions and recommendations provided in the studies.
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).
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.
Contract farming (CF) is an arrangement between farmers and a processing or marketing firm for the production and supply of agricultural products, often at predetermined prices. This literature review builds on EPAR's review of smallholder contract farming in Sub-Saharan Africa (SSA) and South Asia (EPAR Technical Report #60) by specifically examining the evidence on impacts and potential benefits of contract farming for women in SSA. Key takeaways suggest women’s direct participation in contract farming is limited, with limited access to land and control over the allocation of labor and cash resources key constraints hindering women’s ability to benefit from CF. Further, we find that the impact of contract farming on women is often mediated by their relative bargaining power within the household.