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81. Performance-Based Incentives for Health: Six Years of Results from Supply-Side Programs in Haiti - Working Paper 121

Author:
Rena Eichler, Paul Auxila, Uder Antoine, and Bernateau Desmangles
Publication Date:
04-2007
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
USAID launched a project in 1995 to deliver basic health services in Haiti. The project began by reimbursing contracted NGOs for documented expenditures or inputs. In 1999, payment was changed to being based partly on attaining performance targets or outputs. The project also provided technical assistance to the NGOs, along with opportunities to participate in an NGO network and other cross-fertilization activities. Remarkable improvements in key health indicators have been achieved in the six years since payment for performance was phased in. Although it is difficult to isolate the effects of performance-based payment on these improved indicators from the efforts aimed at strengthening NGOs and other factors, panel regression results suggest that the new payment incentives were responsible for considerable improvements in both immunization coverage and attended deliveries. Results for prenatal and postnatal care were less significant, perhaps suggesting a strong patient behavioral element that is not under the influence of provider actions.
Topic:
Development, Education, Health, and Poverty
Political Geography:
Haiti

82. Performance-Based Incentives for Health: A Way to Improve Tuberculosis Detection and Treatment Completion?

Author:
Rena Eichler, Diana Weil, and Alexandra Beith
Publication Date:
04-2007
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Tuberculosis is a public health emergency in Africa, Eastern Europe, and Central Asia. Of the estimated 1.7 million deaths from TB, 98 percent are in the developing world, the majority being among the poor. In order to reach the MDG and the Stop TB partnership targets for 2015, TB detection rates need to double, treatment success rates must increase to more than 7075 percent, and strategies to address HIV-associated TB and multi-drug resistant TB must be aggressively expanded. DOTS, the internationally-recommended TB control strategy is the foundation of TB control efforts worldwide. A standard recording and monitoring system built on routine service-based data allows nearly all countries in the world to track progress in case detection and treatment completion through routine monitoring. This provides a good base for measuring the impact of different strategies for improving TB control outcomes.
Topic:
Health, International Organization, and Poverty
Political Geography:
Africa, Europe, and Asia

83. The Provision of Banking Services in Latin America: Obstacles and Recommendations

Author:
Liliana Rojas-Suarez
Publication Date:
06-2007
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
The depth of and access to financial services provided by banks throughout Latin America are extremely low in spite of its recognized importance for economic activity, employment and poverty alleviation. Low financial depth and access hurts the poor the most and is due to a variety of obstacles that are presented in this paper in four categories, along with recommendations to overcome them. The first category groups socio-economic obstacles that undercut the demand for financial services of large segments of the population. The second category identifies problems in the operations of the banking sector that impedes the adequate provision of financial services to households and firms. The third category captures institutional deficiencies, with emphasis on the quality of the legal framework and the governability of the countries in the region. The fourth category identifies regulations that tend to distort the provision of banking services. Recommendations to confront these obstacles include innovative proposals that take into consideration the political constraints facing individual countries. Some of the policy recommendations include: public-private partnerships to improve financial literacy, the creation of juries specialized in commercial activities to support the rights of borrowers and creditors, and the approval of regulation to allow widespread usage of technological innovations to permit low-income families and small firms to gain access to financial services.
Topic:
Development, Economics, International Trade and Finance, and Poverty
Political Geography:
Latin America

84. Reflections on the Macro Foundations of the Middle Class in the Developing World

Author:
Nancy Birdsall
Publication Date:
10-2007
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
In this working paper I define inclusive growth as growth conducive to increasing the size and economic command of the middle class. I suggest a definition of the middle class based on absolute and relative measures of country-based income distributions, and present evidence of change in the size of the “middle class” for selected developing countries. I then review how macroeconomic policies shape the environment and incentives for inclusive growth, focusing on three areas: fiscal discipline, the more rule-based the better; a fair tax and redistribution system; and a business friendly exchange rate.
Topic:
Education and Poverty
Political Geography:
South America, Latin America, and Central America

85. Liberia's External Debt: Moving Towards Comprehensive Debt Relief

Author:
Steven Radelet
Publication Date:
04-2007
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
In this essay, CGD senior fellow Steve Radelet describes Liberia's debt situation and the key issues in moving forward on debt relief with the IMF, World Bank, African Development Bank and bilateral creditors. He explains why it is important for Liberia's recovery that the international community act quickly and outlines the key steps necessary for Liberia to achieve a debt deal before the end of 2007.
Topic:
Debt, Political Economy, and Poverty
Political Geography:
Africa and Liberia

86. The World Bank: Toward a Global Club

Author:
Nancy Birdsall
Publication Date:
05-2007
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
In this Essay, CGD president Nancy Birds all describes the World Bank as a global club with a structure close to that of a credit union in which the members are nations. Its mission, as originally conceived—to promote broadly shared and sustainable global prosperity—serves the common interests of all its country members. In light of this, Birds all addresses the issues that arise with respect to its current governance structure and how these issues affect the Bank's legitimacy, effectiveness and relevance in the global system.
Topic:
Globalization, Political Economy, and Poverty

87. A Risky Business: Saving Money and Improving Global Health Through Better Demand Forecasts

Publication Date:
05-2007
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Today's global health programs will attain their objectives only if products appropriate to the health problems in low-and middle income countries are developed, manufactured and made available when and where they are needed. Achieving this requires mobilizing public and charitable money for more and better products to diagnose, prevent and treat HIV/AIDS, tuberculosis, malaria, reproductive health problems and childhood killers. But more money is only one part of the story. Weak links in the global health value chain—from research and development (R) through service delivery—are constraining on-the ground access to essential products. The consequences of those weak links are many: supply shortages, inefficient use of scarce funding, reluctance to invest in R for developing country needs and, most important, the loss of life among those who need essential products.
Topic:
Globalization, Health, Political Economy, and Poverty

88. What Have IMF Programs With Low-Income Countries Assumed About Aid Flows?

Author:
David Goldsbrough and Ben Elberger
Publication Date:
04-2007
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper examines the nature of aid projections in IMF programs with low-income countries. On average, IMF projections of net aid increased sharply in the first year of programs but tapered off in subsequent years. Projections were also significantly more optimistic in countries with low initial levels of aid but differed little across regions. Most notably, projections of net aid to countries in Sub-Saharan Africa following the Gleneagles Summit are significantly more pessimistic than the path implied by commitments to double aid to Africa by 2010. This pattern is strong throughout the group with only two Sub-Saharan African countries showing increases in net aid consistent with the Gleneagles commitments.
Topic:
Development, Political Economy, Poverty, and International Monetary Fund
Political Geography:
Africa

89. Cost-Effective Prevention of Diarrheal Diseases: A Critical Review

Author:
Michael Kremer and Alix Peterson Zwane
Publication Date:
04-2007
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper critically reviews the existing research on the cost-effective prevention and treatment of diarrheal diseases, and identifies research priorities in this area aimed at finding ways to reduce the diarrheal disease burden. In contrast to the empirical knowledge base that exists for traditional child health programs to reduce diarrheal morbidity and mortality, evidence on the relative effectiveness and cost-effectiveness of various environmental health interventions is limited and subject to significant methodological concerns. There is a limited understanding of the determinants of long-term water and sanitation technology adoption and behavior change at the individual level. Even less is known about how collective action problems in water and sanitation infrastructure maintenance can be overcome. An agenda for future research includes evaluating alternative transmission interruption mechanisms, improving understanding of the determinants of individual-level technology adoption in the water and sanitation sector, and assessing the quality of infrastructure maintenance under different management schemes.
Topic:
Health, Human Welfare, Humanitarian Aid, and Poverty

90. Income Distribution: Effects on Growth and Development

Author:
Nancy Birdsall
Publication Date:
04-2007
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
I review the literature on the effects of inequality on growth and development in the developing world. Two stylized facts emerge from empirical studies: inequality is more likely to harm growth in countries at low levels of income (below about $3200 per capita in 2000 dollars); and it is at high levels of inequality (at or above a Gini coefficient of .45) that a negative association emerges. Between 15 and 40 percent of the developing world's population lives in countries with these characteristics, depending on the inclusion of China, whose level of inequality has recently been measured at almost .45. Theory and evidence suggest that high inequality affects growth: (1) through interaction with incomplete and underdeveloped markets for capital and information; (2) by discouraging the evolution of the economic and political institutions associated with accountable government (which in turn enable a market environment conducive to investment and growth); and (3) by undermining the civic and social life that sustains effective collective decision-making.
Topic:
Development, Humanitarian Aid, Political Economy, and Poverty
Political Geography:
China