Types of Research
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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.
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.
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.
The literature on poverty’s causes and cures in developing countries posits a variety of contributing factors. Most researchers acknowledge that a sustained exit from poverty is complex and no single causal pathway from poverty to non-poverty exists. In this review, we present a summary framework for categorizing the various theorized pathways out of poverty, and evaluate the empirical evidence for which interventions and resulting outcomes are most frequently and most strongly associated with poverty alleviation. We conducted a literature review on pathways out of poverty for low-income households in developing countries and identified and categorized general strategies and outcomes demonstrated to be empirically associated with poverty alleviation. We organized the general strategies into four asset groups that could be targeted to alleviate poverty: human, natural, built / financial, and social / political. Much of the literature presents positive results on poverty alleviation, but it is difficult to compare across studies because many of the studies were conducted in different countries and at different scales, and use a variety of outcome measures.
This report reviews and summarizes the existing evidence on the impact of access to financial services/products on measures of production, income and wealth, consumption and food security, and resilience for smallholder farmers and other rural customers and their households in Sub-Saharan Africa. This study covers four main types of financial products/services: 1) credit; 2) savings; 3) insurance; 4) transactional products. We also review the very limited evidence on the effectiveness of bundling these products/services together and of combining them with other offerings such as trainings or support for access to markets, and of providing them via digital channels. We note when financial products/services have been specifically designed to serve the needs of rural customers or smallholder farmers, since the needs of these groups are often very different from those of other stakeholders.
This report provides a summary of findings from six Financial Inclusion Insights (FII) data analysis reports conducted by various agencies for the Bill & Melinda Gates Foundation (BMGF). These reports investigate barriers to financial inclusion and use of digital financial services (DFS) in Bangladesh, India, Kenya, Nigeria, Pakistan, Tanzania, and Uganda. We compile comparable gender-specific statistics, summarize the authors’ findings to determine commonalities and differences across countries, and highlight gender-specific conclusions and recommendations provided in the studies.
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).
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.