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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 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.
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.
Land tenure refers to a set of land rights and land governance institutions which can be informal (customary, traditional) or formal (legally recognized), that define relationships between people and land and natural resources (FAO, 2002). These land relationships may include, but are not limited to, rights to use land for cultivation and production, rights to control how land should be used including for cultivation, resource extraction, conservation, or construction, and rights to transfer – through sale, gift, or inheritance – those land use and control rights (FAO, 2002). In this project, we review 38 land tenure technologies currently being applied to support land tenure security across the globe, and calculate summary statistics for indicators of land tenure in Tanzania and Ethiopia.
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.
A growing body of evidence suggests that empowering women may lead to economic benefits (The World Bank, 2011; Duflo, 2012; Kabeer & Natali, 2013). Little work, however, focuses specifically on the potential impacts of women’s empowerment in agricultural settings. Through a comprehensive review of literature this report considers how prioritizing women’s empowerment in agriculture might lead to economic benefits. With an intentionally narrow focus on economic empowerment, we draw on the Women’s Empowerment in Agriculture Index (WEAI)’s indicators of women’s empowerment in agriculture to consider the potential economic rewards to increasing women’s control over agricultural productive resources (including their own time and labor), over agricultural production decisions, and over agricultural income. While we recognize that there may be quantifiable benefits of improving women’s empowerment in and of itself, we focus on potential longer-term economic benefits of improvements in these empowerment measures.