Types of Research
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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.
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.
Water is a critical input for significantly enhancing smallholder farmer productivity in Sub-Saharan Africa (SSA) where less than 5% of farm land is irrigated, and in India where 42% of farm land is irrigated. For many years, donors have invested in human-powered treadle pump technologies as a point of entry for smallholder farmers unable to afford motorized pumps. In spite of some successes in treadle pump promotion, however, there is a widespread perception that as soon as smallholder farmers can afford to they quickly transition to motorized diesel- powered pumps. While diesel pumps substantially ease farmers’ workload, they pollute excessively (both in terms of local air quality and greenhouse gas emissions), pump excessive amounts of water, and put farmers at the mercy of cyclical spikes in fuel prices. This brief provides an overview of state-of-the-art alternative energy pumps, including technologies available and implementation lessons learned from China, India, Africa, South America and other regions. Through a literature review, written surveys and phone interviews with water pump producers and non-governmental organizations (NGOs) we evaluate the availability, affordability, and adoption rates of alternative energy technologies in developing countries. Our findings suggest that no single alternative energy water pumping system is a “silver bullet” for rural smallholder irrigation needs. Biofuels may prove a successful short- to intermediate-term solution for farmers who already have access to diesel pumps, but other problems associated with diesel engines, including high maintenance costs and excessive water use remain even when biofuels are used. Solar systems eliminate pollution almost entirely, reduce water consumption, and eliminate the need to purchase fuels. However solar systems are typically prohibitively expensive for smallholder farmers. Wind powered pumping solutions have not proven successful to date, with high costs and irregular wind patterns (either too little or too much wind) proving substantial barriers to widespread adoption.
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.
How development organizations, NGOs, and governments can best allocate scarce resources to those in need has long been debated. As opposed to universal allocation of resources, a more targeted approach attempts to minimize program costs while maximizing benefits among those with the greatest need or market opportunity. Drawing on literature from several sectors,this brief presents two categories of beneficiary targeting in the development context: administrative targeting and self-targeting. The paper includes a brief overview of targeting and segmentation in development, a summary of reasons for targeting, theoretical and practical critiques of targeting, and a discussion of targeting methods in research and practice, including examples from the literature. Implementation examples cited in this body of research include food aid program targeting by self-reported household income in Egypt; fertilizer use in low-potential zones of Uganda; and seven strategic initiatives to improve drought and disease resistance in crops in Asia and Sub-Saharan Africa. We find that beneficiary segmentation has several theoretical advantages. Improved targeting may increase the efficiency and equity of organizational and program efforts and help better match interventions to recipient preferences, increasing the likelihood of adoption and participation. Development organizations may improve the focus of both their strategic priorities and budgets through customized targeting methods. However, concerns exist regarding the accuracy, reliability, cost, and time-constraints of targeting methodologies. Creating valid and reliable target groups with implementation potential remains a significant challenge.
Limited sanitation infrastructure, poor hygienic practices, and unsafe drinking water negatively affect the health of millions of people in the developing world. Using sanitation interventions to interrupt disease pathways can significantly improve public health. Sanitation interventions primarily benefit public health by reducing the prevalence of enteric pathogenic illnesses, which cause diarrhea. Health benefits are realized and accrue to the direct recipients of sanitation interventions and also to their neighbors and others in their communities. In a report to the United Nations Development Programme (UNDP), Hutton et al. (2006) estimate that the cost-benefit ratio of sanitation interventions in all developing countries worldwide is 11.2. This literature review summarizes the risks of inadequate sanitation to public health and presents the empirical evidence on the public health benefits of complete, intermediate and multiple factor sanitation interventions. We find that complete or improved sanitary systems can offer concrete public health benefits by reducing exposure pathways to a variety of infectious diseases contained in human feces and wastewater. Substantial complementary economic gains are also predicted to accrue as a result of providing increased sanitation. In addition, community-wide sanitation interventions seem to offer the greatest promise for reducing pathogenic health risks from feces.
Without availability and access to a variety of foods, populations in the developing world are suffering from deficiencies in iron, zinc, iodine, vitamin A, and other micronutrients in addition to deficiencies in energy and protein. Supplementation and fortification programs have demonstrated effectiveness, but there is an increasing interest in potentially more sustainable solutions via agricultural interventions. The review examines the literature regarding agricultural interventions and pathways to diet diversification and whether desired nutritional outcomes are achieved. We find a strong sentiment that agricultural interventions can improve dietary diversity, and that dietary diversity can improve nutrition and related health outcomes. The programs with demonstrated ability to improve nutrition outcomes are most often cross-cutting interventions, borrowing from the agriculture, nutrition, and public health traditions. While these multi-platform programs can be costly to evaluate and difficult to implement, the evidence supports their potential to create sustainable quality-of-life improvements in target regions. The pathways by which agricultural interventions achieve impact are not fully clear, however. The greatest knowledge gaps are directly related to the lack of integration between program design and evaluation. Many evaluations are based on small sample sizes, lack control groups or baseline data, are subject to selection bias, or face other challenges to rigorous statistical analysis.
The purpose of this literature review is to examine research and decision-making tools that model the impacts of agricultural interventions. We begin with a short explanation of what model features are being described. We then review decision-support tools and user-end modeling tools (menu-driven tools with an interface designed for easy use), as well as academic and professional research models for assessing the potential impacts of agricultural interventions. This review also includes decision tools and models for analyzing agricultural and environmental policies outside of technology impacts in Sub-Saharan Africa and South Asia. The other tools mentioned here, for example a tool that considers nutritional intervention impacts, are included to help provide a broader understanding of the structure and availability of user-end, decision-making tools. In the final section of this brief, we review the most complex models used more in academic research than for in-field decision-making.
How development organizations, NGOs, and governments can best allocate scarce resources to those in need has long been debated. As opposed to universal allocation of resources, a more targeted approach attempts to minimize program costs while maximizing benefits among those with the greatest need or market opportunity. Many international development organizations strategically target clients based on geographic location (e.g., community, region, country) or socio-economic indicators, such as the World Bank’s “$1 a day” poverty line. Drawing on literature from several sectors, this brief presents additional methods of beneficiary targeting that international development organizations might consider. We find that beneficiary targeting/segmentation has the potential to make organizational and program efforts more equitable and efficient. With limited resources, smaller organizations have tended to use single robust indicators or simple heuristics, whereas agribusinesses and private sector firms have used more data-intensive marketing tools to position their products. Technological innovation and better access to data have made targeting more prevalent and potentially more affordable in agricultural development. However, creating valid and reliable target segments remains the most significant challenge.
Ecosystem services are the benefits people obtain from ecosystems, such as provisioning of fresh water, food, feed, fiber, biodiversity, energy, and nutrient cycling. Agricultural production can substantially affect the functioning of ecosystems, both positively and negatively. The purpose of this report is to provide an overview of the impacts of agricultural technologies and practices on ecosystem services such as soil fertility, water, biodiversity, air, and climate. The report describes the environmental impacts of different aspects of intensive cropping practices and of inputs associated with intensification. We further explore these impacts by examining intensive rice systems and industrial crop processing. Although this report focuses on the impacts of agricultural practices on the environment, many of the practices also have implications for plant, animal, and human health. Farmers and others who come in contact with air, water, and soils polluted by chemical fertilizers and pesticides may face negative health consequences, for instance. By impacting components of the ecosystem, these practices affect the health of plants and animals living within the ecosystem. We find that the unintended environmental consequences of intensive agricultural practices and inputs are varied and potentially severe. In some cases, sustaining or increasing agricultural productivity depends upon reducing impacts to the environment, such as maintaining productive soils by avoiding salinization from irrigation water. However, in other cases, eliminating negative environmental impacts may involve unacceptable trade-offs with food provision or other development goals. Determining the appropriate balance of costs and benefits from intensive agricultural practices is a location-specific exercise requiring knowledge of natural, economic, and social conditions.