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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.
In Mozambique, the legacies of colonial rule, socialism and civil war continue to constrain economic growth and agricultural production. Eighty percent of Mozambique’s labor force derives its livelihood from agriculture, but the nation remains a net food importer. The majority of all farmland is cultivated by smallholders whose fertilizer usage and crop yields are among the lowest in Africa. While Mozambique has experienced reasonable economic growth since the end of its civil war in 1992, it remains poor by almost any measure. In this literature review, we examine the state of agriculture in Mozambique, the country’s political history and post-war recovery, and the current fertilizer market. We find evidence that smallholder access to fertilizer in Mozambique is limited by lack of information, affordability, access to credit, a poor business environment, and limited infrastructure. The data demonstrate that increased investment in infrastructure is an important step to improve input and output market access for smallholders. The main government intervention currently impacting smallholder fertilizer use is the Agricultural Sector Public Expenditure Program (PROAGRI) initiative, however, more data is necessary to assess the impact of its policies and programs.
Farmers in Sub-Saharan Africa (SSA) use less fertilizer than farmers in any other region in the world. Low fertilizer use is one factor explaining the lag in agricultural productivity growth in Africa. A variety of market interventions to increase fertilizer use have been attempted over the years, with limited success. In the past several decades, Malawi has tried to alter that trend through a variety of innovative programs aimed at achieving national food security through targeted input subsidy programs. The best known of these programs is Malawi’s Starter Pack Programme. The Starter Pack Programme was amended twice into the Targeted Inputs Programme (TIP) and Expanded Targeted Inputs Programme (ETIP), and eventually replaced with the Agricultural Input Subsidy Programme (AISP). The efficiency and equity of the Starter Pack Programme and its successors have been the subject of debate. This report reviews the history, implementation, and perceived effectiveness of the various input subsidy schemes in the context of Malawi’s political economy. We find that AISP is credited with significantly increasing maize yields in Malawi. However, we also find that there are serious challenges facing the most recent input subsidy program, ranging from the rising cost of the subsidy to ongoing implementation struggles related to increased bureaucracy and corruption.