Types of Research
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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.
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.
The concept of global public goods represents a framework for organizing and financing international cooperation in global health research and development (R&D). Advances in scientific and clinical knowledge produced by biomedical R&D can be considered public goods insofar as they can be used repeatedly (non-rival consumption) and it is difficult or costly to exclude non-payers from gaining access (non-excludable). This paper considers the public good characteristics of biomedical R&D in global health and describes the theoretical and observed factors in the allocation R&D funding by public, private, and philanthropic sources.
A “new wave” of digital credit products has entered the digital financial services (DFS) market in recent years. These products differ from traditional credit by offering loans to borrowers that can be applied for, approved, and disbursed remotely (often without any brick-and-mortar infrastructure), automatically (generally minimizing or eliminating person-to-person interaction), and instantly (often in less than 72 hours). Digital credit also increasingly considers creditworthiness by using alternative (nontraditional) data—ranging from mobile phone activity to utility payments and social media data—potentially allowing for loans to populations previously unable to access bank credit. Two EPAR reports review the characteristics of digital credit offerings in India, Kenya, Nigeria, Tanzania, and Uganda, and regulations specific to digital credit in Africa and Asia.
Mobile technology is associated with a variety of positive development and social outcomes, and as a result reaching the “final frontier” of uncovered populations is an important policy issue. We use proprietary 2012 data on mobile coverage from Collins Bartholomew to estimate the proportion of the population living in areas without mobile coverage globally and in selected regions and countries, and use spatial analysis to identify where these populations are concentrated. We then compare our coverage estimates to data from previous years and estimates from the most recent literature to provide a picture of recent trends in coverage expansion, considering separately the trends for coverage of urban and rural populations. We find that mobile coverage expansion rates are slowing, as easier to reach urban populations in developing countries are now almost entirely covered and the remaining uncovered populations are more dispersed in rural areas and therefore more difficult and costly to reach. This analysis of mobile coverage trends was the focus of an initial report on mobile coverage estimates. In a follow-up paper prepared for presentation at the 2016 APPAM International Conference, we investigate the assumption that levels of mobile network coverage are related to the degree of market liberalization at the country level.
In Sub-Saharan Africa, 12% of adults now report having a mobile money account, representing over a quarter of the share of those who have any kind of financial account at all. As mobile money expands, there is interest in how regulatory frameworks develop to support digital financial services (DFS) and also support broader financial inclusion. In theory, protecting consumers from risk, and ensuring that they have the information and understanding required to make informed decisions, may increase their confidence and trust in mobile money systems, leading to higher adoption and usage rates. However, consumer protection regulations may also carry certain trade-offs in terms of cost, usage, and innovation. The challenge, according to proponents of consumer protection, is to develop regulations that promote access and innovation, yet still offer an acceptable level of consumer protection. We review the literature on consumer protection institutions and regulatory documents for DFS (particularly mobile money) in 22 developing countries, and identify examples of specific consumer protection regulations relevant to mobile money in each country.
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).
Agriculture and Climate Change: Part I
With estimated global emissions of 5,969-6,615 metric tons (Mt) of carbon dioxide (CO2) per year, agriculture accounts for about 13.5% of total global anthropogenic emissions of greenhouse gases (GHG). Deforestation contributes about 11.8% of total GHG emissions, releasing about 5,800 Mt CO2 per year. Developing countries are largely responsible for emissions from agriculture and deforestation, with the developing countries of South Asia and East Asia accounting for 17% and 25% of global agricultural emissions respectively. Sub-Saharan Africa (SSA) accounts for about 13% of global emissions from agriculture and 15% of emissions from land use change and forestry. This report examines the biophysical and economic potential of mitigating agriculture and land use GHG emissions, and provides a summary on the current and projected impact of global carbon market mechanisms on emission reductions.
Agriculture and Climate Change: Part II
This report covers two topics related to agriculture and climate change in developing countries. The first section discusses the role of agricultural offsets in mitigating greenhouse gas emissions. Recent negotiations around a post-Kyoto Protocol agreement have included debate about whether agricultural carbon sequestration projects should be eligible under the Clean Development Mechanism (CDM). We examine the reasons for supporting or opposing this type of CDM reform and how these reasons relate to impacts on development goals and smallholder farmers, scientific uncertainty about carbon sequestration, and philosophical disagreement about the use of emission offsets. The second section covers proposed agricultural adaptation activities in Africa and other developing countries. While the majority of developing countries have outlined immediate adaptation needs in National Adaptation Programs of Action (NAPAs), few have made progress in implementing adaptation activities. We find that issues related to financial resources, scientific and technical information, and capacity building continue to challenge developing countries in preparing for the impacts of climate change.