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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.
Donor countries and multilateral organizations may pursue multiple goals with foreign aid, including supporting low-income country development for strategic/security purposes (national security, regional political stability) and for short-and long-term economic interests (market development and access, local and regional market stability). While the literature on the effectiveness of aid in supporting progress on different indicators of country development is inconclusive, donors are interested in evidence that aid funding is not permanent but rather contributes to a process by which recipient countries develop to a point that they are economically self-sufficient. In this report, we review the literature on measures of country self-sufficiency and descriptive evidence from illustrative case studies to explore conditions associated with transitions toward self-sufficiency in certain contexts.
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 provides a summary of background research for future aid-related EPAR projects. We first review prominent measures of aid, examining the definition and scope of Official Development Assistance (ODA) as well as common criticisms and alternatives to this measurement. We also provide a summary of current research on bilateral and multilateral aid allocation trends. The aid allocation literature broadly concludes that donor countries target aid based on both the needs of recipients and on strategic interests, but that aid allocation criteria differ by donor and by type of aid. Finally, we summarize current aid effectiveness literature and key challenges in exploring the impact of aid. A number of challenges in determining the effectiveness of aid were common in the literature, including the micro-macro paradox, difficulties in identifying causal mechanisms and direction of causality, and data limitations.
This report reviews approaches to results measurement used by multilateral and bilateral donor organizations and highlights trends and gaps in how donors measure and report on their performance. Our review consists of assessing donor organizations in terms of their institutional design and levels of evaluation for results measurement, their organizational processes for measuring types of results including coordination and alignment with recipients, outputs and implementation, outcomes and impacts, and costs and effectiveness, and their processes for reporting and using results information. We collect evidence on 12 bilateral organizations and 10 multilateral organizations. The evidence review includes multi-country reviews of aid effectiveness, peer reviews by other donor organizations, donor evaluation plans and frameworks, and donor results and reporting documents. The report is based on an accompanying spreadsheet that contains the coded information from the 22 donor organizations. We find that donors report several types of results, but that there are challenges to measuring certain results at the aggregate donor level, due to challenges with funding and coordination for results measurement at the project, country, portfolio, and donor levels. Approaches to results measurement vary across donor organizations. We identify some trends and differences among groups of donors, notably between bilateral and multilateral donors, but overall there are no clear delineations in how donors approach results measurement.
We review the current body of literature exploring the theories behind holistic human development measurements and the tradeoffs of different methodologies for the construction of human development indices. Through a systematic review of published and grey literature in the fields of human, international, and economic development we identify 22 current indices that aggregate measures from multiple dimensions of human development. We then analyze these indices to identify tradeoffs related to their unique characteristics and construction methodologies, considering ease of calculation, coverage of different measures of human development, ease of interpretation, comparability, and novelty. The report is accompanied by an appendix of summary tables for each index with further details regarding background information, methodology, index components, and evaluation criteria addressed within the report.
Aid results information is often not comparable, since monitoring and evaluation frameworks, information gathering processes, and definitions of “results” differ across donors and governments. This report reviews approaches to results monitoring and evaluation used by governments in developing countries, and highlights trends and gaps in national monitoring and evaluation (M&E) systems. We collect evidence on 42 separate government M&E systems in 23 developing countries, including 17 general national M&E systems and 25 sector-specific national M&E systems, with 14 focused on HIV/AIDS, 8 on health, and 3 on agriculture. The evidence review includes external case studies and evaluations of M&E systems, government M&E assessments, M&E plans, strategic plans with an M&E component, and multi-country reviews of M&E, accountability, and aid effectiveness. We evaluate harmonization of government and development partner M&E systems, coordination and institutionalization of government M&E, challenges in data collection and monitoring, and analysis and use of results information. We also report on key characteristics of M&E systems in different sectors.
Aid donors are interested in the arguments for allocating aid via bilateral versus multilateral channels, and specifically in understanding which channel is more “effective” at supporting positive development and social outcomes. We contribute to the literature on this subject by summarizing recent OECD data on aid flows and reviewing the theoretical arguments from the aid literature on the different characteristics supporting effectiveness of bilateral versus multilateral aid. We then review the empirical literature, analyzing 40 papers that study the effectiveness of different aid channels on various outcomes. Many studies do not directly compare the effectiveness of aid channels, and the studies vary in how aid channels are defined, measured, and evaluated. Further, these studies do not directly test the hypothesized advantages of one channel of aid versus another; rather they test bilateral versus multilateral aid flows associations with development outcomes, assuming some causal mechanism is at work to explain differences in impact. We evaluate studies reporting the impacts of aid on GDP growth, governance, government investment spending, health, the HDI, poverty, and private investment, and find no consistent evidence that either bilateral or multilateral aid is more effective. The lack of conclusive evidence supporting either aid channel is likely related to differences in the methodologies of the studies included in this review, but may also be due to differences in how the theoretical arguments for the effectiveness of either channel apply in different circumstances.
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.