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112. Global Immunization and Gavi: Five Priorities for the Next Five Years
- Author:
- Amanda Glassman, Cordelia Kenney, and Janeen Madan Keller
- Publication Date:
- 06-2019
- Content Type:
- Working Paper
- Institution:
- Center for Global Development (CGD)
- Abstract:
- Child vaccination remains among the most cost-effective uses of public and aid monies.[1] In a highly contested funding environment where priorities must be set for the allocation of scarce concessional resources, investment in expanding the availability and coverage of cost-effective vaccination must come at the top of the list. Gavi’s mission—saving children’s lives and protecting people’s health by increasing equitable use of vaccines—remains highly relevant. Gavi and its partners have made enormous progress towards increasing equity in the introduction of vaccines; children living in the lowest-income countries now have access to the same set of vaccines as those living in high-income countries. Gavi and partners have also contributed to increased coverage; immunization rates are higher in Burundi and Rwanda, for example, than in many places in the United States and Europe. Yet the effects of under-immunization anywhere can have global implications everywhere, as recent outbreaks illustrate. New or dormant threats are also a new reality—newly vaccine-preventable diseases like Ebola or virulent flu strains can spread swiftly and lethally in an interconnected world.
- Topic:
- Health, Public Health, Vaccine, and Immunization
- Political Geography:
- Global Focus
113. Digital Governance: Is Krishna a Glimpse of the Future?
- Author:
- Arshi Aadil, Alan Gelb, Anurodh Giri, and Kyle Navis
- Publication Date:
- 06-2019
- Content Type:
- Working Paper
- Institution:
- Center for Global Development (CGD)
- Abstract:
- The state of Andhra Pradesh is recognized as a leader in using technology to improve the delivery of public services, programs and subsidies. Many of its innovations were piloted in Krishna District, which has been visited by development agencies and delegations from many countries. This paper reports on research to better understand the functioning and effectiveness of its reforms to strengthen state capacity by digitalizing service delivery. Against the wider backdrop of the use of Aadhaar in India, it summarizes Andhra’s reforms, which go beyond those of most other jurisdictions in the measures taken to strengthen accountability, offer choice of service provider, and incorporate feedback loops using the vast amount of data generated by a real-time digital service system as well as beneficiary responses. It reports the results from surveys of beneficiaries who receive food rations through the Public Distribution System (PDS) and/or pensions, and on the response of landowners and tenant farmers to the digitization of land records, another important program. The results suggest strong support for the digitalization of these programs. The way in which the reforms have been implemented has indeed led to substantial improvements in delivery (as seen by beneficiaries) as well as, probably, significant fiscal savings. Is this case, then, a model for other Indian states and for other countries? Perhaps yes from a technology perspective; there are many lessons that apply to a wide range of programs and services and that others can usefully draw on. The picture is more complex from a political economy perspective, as suggested by some of the particular features of Andhra.
- Topic:
- Science and Technology, Governance, Reform, and Digitization
- Political Geography:
- Global Focus
114. Tackling the Triple Transition in Global Health Procurement
- Author:
- Rachel Silverman, Janeen Madan Keller, Amanda Glassman, and Kalipso Chalkidou
- Publication Date:
- 07-2019
- Content Type:
- Working Paper
- Institution:
- Center for Global Development (CGD)
- Abstract:
- There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive. Access to medicines, diagnostics, devices, and equipment is driven in large part by the efficiency of their procurement. Procurement is, therefore, central to the efforts of low- and middle-income countries to improve health, meet the Sustainable Development Goals, and achieve universal health coverage. Health product purchasing in low- and lower-middle-income countries already makes up a sizeable share of overall health spending; in fact, in just a subset of these countries, spending on health products totals an estimated $50 billion per year.[1] Procurement is not only essential to the missions of global health entities like the Global Fund, Gavi, UNICEF, UNFPA, and PEPFAR, but it also represents big money. In the case of the Global Fund, health product procurement accounts for $2 billion per year,[2] or almost half of its 2017 disbursements.[3] Yet despite its importance, procurement is an underappreciated health system function. Today’s procurement systems are hobbled by inefficiencies that leave some of the poorest countries paying some of the highest drug prices in the world.
- Topic:
- Health, Public Health, Transition, and Procurement
- Political Geography:
- Global Focus
115. What We Learn about Girls’ Education from Interventions that Do Not Focus on Girls
- Author:
- David Evans and Fei Yuan
- Publication Date:
- 07-2019
- Content Type:
- Working Paper
- Institution:
- Center for Global Development (CGD)
- Abstract:
- Despite dramatic global gains in access to education, 130 million girls of school age remain out of school. Among those who do enter, too many do not gain the essential skills to succeed after they complete their schooling. Previous efforts to synthesize evidence on how to improve educational outcomes for girls have tended to focus on interventions that are principally targeted to girls, such as girls’ latrines or girls’ scholarships. But if general, non-targeted interventions—those that benefit both girls and boys—significantly improve girls’ education, then focusing only on girl-targeted interventions may miss some of the best investments for improving educational opportunities for girls in absolute terms. This review brings together evidence from 270 educational interventions from 177 studies in 54 low- and middle-income countries and identifies their impacts on girls, regardless of whether the interventions specifically target girls. The review finds that to improve access and learning, general interventions deliver gains for girls that are comparable to girl-targeted interventions. At the same time, many more general interventions have been tested, providing a broader menu of options for policy makers. General interventions have similar impacts for girls as for boys. Many of the most effective interventions to improve access for girls are household-based (such as cash transfer programs), and many of the most effective interventions to improve learning for girls involve improving the pedagogy of teachers. Girl-targeted interventions may make the most sense when addressing constraints that are unique to girls.
- Topic:
- Education, Children, Women, and Feminism
- Political Geography:
- Global Focus
116. Trends in Private Capital Flows to Low-Income Countries: Good and Not-So-Good News
- Author:
- Nancy Lee and Asad Sami
- Publication Date:
- 07-2019
- Content Type:
- Policy Brief
- Institution:
- Center for Global Development (CGD)
- Abstract:
- Interest in mobilizing private finance for SDG investments is surging in a world of stagnating aid, limited fiscal space, and rising LIC debt. But is more reliance on private finance realistic for LICs? This paper explores the performance since the global financial crisis of one source of private finance for LICs: cross-border private capital inflows. Much of the evidence is encouraging, and some of it flies in the face of conventional wisdom. For LICs, private capital inflows are an important and growing source of finance. For the median LIC, private capital inflows are now as large as ODA as a share of GDP. And the FDI component—most of LIC inflows—has been stable and resilient throughout the post-crisis period. Importantly, inflows are not all captured by resource-rich LICs. In 2017, more than half of capital inflows to LICs went to non-resource-rich LICs. Increasingly, policies, not just resource endowments, shape LIC destinations for foreign capital. The relation between median capital inflows/GDP and median regulatory quality is significantly positive for non-resource-rich LICs. And sources of FDI are diversifying. In 2016, China’s stock of FDI in Africa was almost as large as that of the traditional investors: the US, UK, and France. But there is also not-so-good news. Median private capital inflow/GDP ratios are not positively correlated with median private domestic investment/GDP in LICs. Nor is there a significant relationship with median public investment/GDP. The apparent lack of complementarity between foreign and domestic investment may point to problems related to investment enclaves and/or the role of the state in LIC economies. As in other countries, non-FDI inflows to LICs are volatile and sensitive to global commodity prices and interest rates. We find no relation between median country per capita income levels and private inflows/GDP, highlighting the need for caution in IDA graduation policies.
- Topic:
- Development, Capital Flows, Interest Rates, Private Sector, and Capital
- Political Geography:
- Global Focus
117. “Contractors or Collectives?” Earmarked Funding of Multilaterals, Donor Needs and Institutional Integrity: The World Bank as a Case Study
- Author:
- Owen Barder, Euan Ritchie, and Andrew Rogerson
- Publication Date:
- 07-2019
- Content Type:
- Case Study
- Institution:
- Center for Global Development (CGD)
- Abstract:
- We revisit the policy dilemmas thrown up by so-called Multi-bi funding (earmarked bilateral aid routed via multilateral channels), based on a case study of World Bank trust funds, given their industry-leading overall size and relative transparency. We update patterns of sources and uses of Multi-bi using the 2019 Trust Funds Directory and use this to derive a new Index of Responsible Multi-bi Donorship. We consider complementary donor motivations for Multi-bi, highlighting their perceived need to shift the focus of a multilateral institution faster than they believe possible through its core systems. We examine potential negative effects of Multi-bi on the distortion of funding choices available to client countries, and above all on the risk of “hollowing out” of the multilateral itself, as the locus of power and accountability shifts from the wider collective toward a narrower set of contracting relationships. We find that current trust fund reform efforts can at best partly address these dynamics, while the growing trend toward creation of sub-windows within the main core funding instrument could potentially make things worse. Instead, we offer a pragmatic two-track solution that could significantly reduce tensions between funder needs and institutional integrity. This involves (a) developing an improved battery of output indicators mapped to donor core contributions, to enhance visibility and results reporting and (b) routing new Multi-bi proposals increasingly through core governance processes, focusing initially on greater transparency and on demonstrating their additionality to donors’ core funding.
- Topic:
- Development, Economics, Finance, Banks, Donors, and Funding
- Political Geography:
- Global Focus
118. Five Takeaways on the Future of Humanitarian Reform
- Author:
- Jeremy Konyndyk
- Publication Date:
- 08-2019
- Content Type:
- Policy Brief
- Institution:
- Center for Global Development (CGD)
- Abstract:
- The world’s humanitarian aid architecture is growing outdated. Relief programs are most effective when they are integrated, locally owned, and demand driven. But humanitarian action in the 21st century remains constrained by a 20th-century aid model: siloed, supply driven, and centered on the individual mandates and sectors of major international aid agencies. This makes aid both less effective and less responsive than it could be. In a world where displacement is at the highest levels in generations, climate disasters are increasing, and humanitarian funding is beginning to level off, this disconnect is no longer tenable. But fixing it is not a simple matter—multiple rounds of humanitarian reform over the past 15 years have made progress but fallen short of fundamental change. Earlier this summer in Geneva, CGD convened two high-level private roundtables, one with leaders from humanitarian donor institutions and another with senior executives from major humanitarian aid agencies (both multilaterals and NGOs), to discuss how to make humanitarian aid more cohesive and user-centered. The meetings were part of a multiyear research initiative exploring how modernizing the humanitarian business model and humanitarian governance are integral to improving field-level humanitarian impact. CGD teed up the conversation with three emerging ideas from our research (you can see the presentation slides here). These ideas—the subjects of several forthcoming papers CGD is developing —explore ways of better aligning aid delivery around enhanced impact toward affected people’s priorities
- Topic:
- Development, Humanitarian Aid, International Cooperation, Reform, and Humanitarian Intervention
- Political Geography:
- Global Focus
119. Promoting Investment in Research for Development Outcomes: A Research Ventures Fund at the World Bank
- Author:
- Scott Morris
- Publication Date:
- 08-2019
- Content Type:
- Policy Brief
- Institution:
- Center for Global Development (CGD)
- Abstract:
- This note proposes a new Research Ventures Fund (RVF) at the World Bank to better prioritize R&D investments in support of development progress. The RVF would employ financing mechanisms that are consistent with research needs: significant scale and scope, patience, and tolerance for failure. Existing development-oriented research consortia like CGIAR would provide a promising start for RVF funding allocations. Donors to the IDA-19 replenishment should take the first step in securing funding for the new fund in 2019.
- Topic:
- Development, International Cooperation, Science and Technology, World Bank, Finance, Research, and Banking
- Political Geography:
- Global Focus
120. People-Driven Response: Power and Participation in Humanitarian Action
- Author:
- Jeremy Konyndyk and Rose Worden
- Publication Date:
- 09-2019
- Content Type:
- Research Paper
- Institution:
- Center for Global Development (CGD)
- Abstract:
- The notion that humanitarian response should center on the people it serves, rather than the aid agencies serving them, has been repeatedly codified in humanitarian commitments as far back as the early 1990s. Yet the mainstream humanitarian system has struggled to translate these commitments into practice: corresponding reform efforts have failed to systemically broaden accountability to and participation of aid recipients in response efforts. Major constraints have included misaligned incentive structures between donors and aid agencies, power imbalances between aid providers and aid recipients, and operational and political complexities arising at field level. To produce real systemic change, the aid system must move beyond technical and rhetorical approaches to accountability and begin reshaping the power and incentive structures that influence aid decision-making. This paper proposes a set of mutually reinforcing recommendations centered around three imperatives: enshrining the influence of aid recipients at all levels of aid decision-making; developing independent channels for soliciting the priorities and perspectives of crisis-affected people; and institutionalizing a set of enabling changes to humanitarian operational and personnel practices.
- Topic:
- Development, Humanitarian Aid, Institutionalism, and Humanitarian Crisis
- Political Geography:
- Global Focus