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Much literature discusses the importance of investing in human capital—or “the sum of a population’s health, skills, knowledge, experience, and habits” (World Bank, 2018, p. 42)—to a country’s economic growth. For example, the World Bank reports a “chronic underinvestment” in health and education in Nigeria, noting that investing in human capital has the potential to significantly contribute to economic growth, poverty reduction, and societal well-being (World Bank, 2018). This research brief reports on the evidence linking investment in human capital—specifically, health and education—with changes in economic growth. It reviews the literature for five topic areas: Education, Infectious Diseases, Nutrition, Primary Health Care, and Child and Maternal Health. This review gives priority focus to the countries of Bangladesh, Burkina Faso, Democratic Republic of Congo, Ethiopia, India, Kenya, Madagascar, Nigeria, Rwanda, and Tanzania. For each topic area, we report the evidence in support of a pathway from investing in human capital to economic growth.
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.
In this report we analyze three waves nationally-representative household survey data from Kenya, Uganda, Tanzania, Nigeria, Pakistan, Bangladesh, India, and Indonesia to explore sociodemographic and economic factors associated with mobile money adoption, awareness, and use across countries and over time. Our findings indicate that to realize the potential of digital financial services to reach currently unbanked populations and increase financial inclusion, particular attention needs to be paid to barriers faced by women in accessing mobile money. While policies and interventions to promote education, employment, phone ownership, and having a bank account may broadly help to increase mobile money adoption and use, potentially bringing in currently unbanked populations, specific policies targeting women may be needed to close current gender gaps.
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.
This brief presents an overview of EPAR’s previous research related to gender. We first present our key takeaways related to labor and time use, technology adoption, agricultural production, control over income and assets, health and nutrition, and data collection. We then provide a brief overview of each previous research project related to gender along with gender-related findings, starting with the most recent project. Many of the gender-related findings draw from other sources; please see the full documents for references. Reports available on EPAR’s website are hyperlinked in the full brief.