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.
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.
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 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).
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.
Anderson, C. L., Gugerty, M. K., Biscaye, P., True, Z., Clark, C., & Harris, K. P. (2014). Self-Help Groups in Development: A Review of Evidence from South Asia and Sub-Saharan Africa. EPAR Technical Report #283. Evans School of Public Policy & Governance, University of Washington. Retrieved <Day Month Year> from https://epar.evans.uw.edu/sites/default/files/epar_283_shg_evidence_review_brief_10.23.20.pdf
This report draws on past and present peer-reviewed articles and published reports by institutions including the World Health Organization (WHO), the UK Department for International Development (DFID), and others to provide a scoping summary of the household-level spillovers and broader impacts of a select group of health initiatives. Rather than focusing on estimates of the direct health impacts of investments (e.g., reductions in mortality from vaccine delivery), we focus on estimates of the less-often reported spillover effects of specific health investments on household welfare or the broader economy. The brief is designed to give a concise overview of major theories linking health improvements to broader social and economic outcomes, followed by more in-depth summaries of available local- and country-level estimates of broader impacts, defined as project spillovers offering local, regional and national social and economic benefits not typically reported in project evaluations.
The commercial alcohol industry in Africa may provide opportunities to increase market access and incomes for smallholder farmers by increasing access to agriculture-alcohol value chains. Despite the benefits of increased market opportunities, the high costs to human health and social welfare from increased alcohol use and alcoholism could contribute to a net loss for society. To better understand the tradeoffs between increased market access for smallholders and societal costs associated with harmful alcohol consumption, this paper provides an inventory of the societal costs of alcohol in Sub-Saharan Africa (SSA). We examine direct costs associated with addressing harmful effects of alcohol and treating alcohol-related illnesses, as well as indirect costs associated with the goods and services that are not delivered as a consequence of drinking and its impact on personal productivity. We identified resources using Google Scholar and the University of Washington libraries, and utilized the Global Burden of Disease (GBD) database by the Institute for Health Metrics and Evaluation (IHME) and the World Health Organization’s Global Information System on Alcohol and Health (GISAH) database. We also utilized FAOSTAT to retrieve raw data on national-level alcohol production and export statistics. We find that hazardous alcohol use contributes to early mortality and morbidity, loss of productivity, property damage, and other social costs and harms for drinkers and those around them. Drinking also affects vulnerable segments of the population disproportionately. Policymakers, local authorities, and donor agencies can use the information presented in this paper to plan and prepare for the higher consumption levels and subsequent social costs that may follow through agricultural development and economic growth in the region.