Research Topics

EPAR Technical Report #346
Publication Date: 04/23/2018
Type: Literature Review
Abstract

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.

EPAR Technical Report #345
Publication Date: 12/01/2017
Type: Literature Review
Abstract

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.

EPAR Technical Report #359
Publication Date: 11/13/2017
Type: Literature Review
Abstract

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.

EPAR Technical Report #329
Publication Date: 05/31/2017
Type: Literature Review
Abstract

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.

EPAR Technical Report #338
Publication Date: 05/19/2017
Type: Literature Review
Abstract

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.

EPAR Technical Report #293
Publication Date: 03/31/2015
Type: Literature Review
Abstract

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).

EPAR Technical Report #283
Publication Date: 12/11/2014
Type: Literature Review
Abstract

Donors and governments are increasingly seeking to implement development projects through self-help groups (SHGs) in the belief that such institutional arrangements will enhance development outcomes, encourage sustainability, and foster capacity in local civil society – all at lower cost to coffers. But little is known about the effectiveness of such institutional arrangements or the potential harm that might be caused by using SHGs as ‘vehicles’ for the delivery of development aid.  This report synthesizes available evidence on the effectiveness of Self-Help Groups (SHGs) in promoting health, finance, agriculture, and empowerment objectives in South Asia and Sub-Saharan Africa. Our findings are intended to inform strategic decisions about how to best use scarce resources to leverage existing SHG interventions in various geographies and to better understand how local institutions such as SHGs can serve as platforms to enhance investments. 

EPAR Technical Report #130
Publication Date: 01/29/2011
Type: Literature Review
Abstract

The purpose of this literature review is to provide qualitative and quantitative examples of technologies, constraints and incentives for efficient waste treatment and reuse in Sub-Saharan Africa and Southeast Asia.  We present relevant case studies and expert observations and experiences on the nutrient content in urine and feces, contaminants frequently found in untreated sludge and wastewater, waste treatment technologies that may be relevant for low-income countries, risks associated with waste reuse, benefits to resource recovery in agriculture. We further discuss reasons for waste treatment failures, including urbanization, observations on challenges with market-driven reuse in less developed countries, and examples of net-positive energy facilities in Europe and the United States. Much of the evidence presented in the literature relates to wastewater treatment processes or the sludge produced from wastewater treatment as opposed to untreated fecal sludge.  However, examples of risks, failures, and opportunities for raw sludge treatment and reuse are discussed when available.  In some cases, empirical evidence or case studies were not available for developing countries and alternatives are presented.  Overall we found the empirical evidence on waste treatment and reuse in developing countries is quite thin. 

EPAR Research Brief #113
Publication Date: 12/20/2010
Type: Portfolio Review
Abstract

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.

EPAR Research Brief #116
Publication Date: 12/13/2010
Type: Literature Review
Abstract

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.