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1231. Improving Global Health Supply Chains through Traceability

Author:
Michael Pisa and Denise McCurdy
Publication Date:
02-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
In many low- and lower-middle-income countries (LMICs) where disease burdens are highest, health supply chains function poorly, resulting in frequent stockouts and a high prevalence of substandard and even falsified medications. In response to these concerns, the global health initiatives have stepped up their efforts to improve supply chain management. At the same time, a growing number of rich country pharmaceutical companies are investing in digital technologies that help them “track and trace” the movement of medicines through the supply chain at the package-level. Drawing from interviews with over thirty experts, we find that traceability offers a realistic solution to some of the problems found in LMIC health supply chains but that implementing the approach is a huge logistical endeavor that requires a strong political commitment. We close by discussing how donors can support committed governments, by taking an evidence-based approach to determine what traceability methods work best.
Topic:
International Cooperation, Health Crisis, Pharmaceuticals, and Tracing
Political Geography:
Global Focus

1232. Learning Equity Requires More than Equality: Learning Goals and Achievement Gaps between the Rich and the Poor in Five Developing Countries

Author:
Maryam Akmal and Lant Pritchett
Publication Date:
02-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
The Sustainable Development Goals (SDGs) for education include the goal that “all youth...achieve literacy and numeracy” (Target 4.6). Achieving some absolute standard of learning for all children is a key element of global equity in education. Using the Annual Status of Education Report (ASER) data from India and Pakistan, and Uwezo data from Kenya, Tanzania, and Uganda that test all children of given ages, whether in school or not, on simple measures of learning in math, reading (local language), and English, we quantify the role of achieving equality between the richest 20% and the poorest 40% in terms of grade attainment and learning achievement toward accomplishing the global equity goal of universal numeracy and literacy for all children. First, excluding Kenya, equalizing grade attainment between children from rich and poor households would only close between 8% (India) and 25% (Pakistan) of the gap to universal numeracy, and between 8% (Uganda) and 28% (Pakistan) of the gap to universal literacy. Second, children from the poorest 40% of households tend to have lower performance in literacy and numeracy at each grade. If such children had the learning profiles of children from rich households, we would close between 16% (Pakistan and Uganda) and 34% (India) of the gap to universal numeracy, and between 13% (Uganda) and 44% (India) of the gap to universal literacy. This shows that the “hidden exclusion” (WDR, 2018) of lower learning at the same grade levels—a gap that emerges in the earliest grades—is a substantial and often larger part of the equity gap compared to the more widely documented gaps in enrollment and grade attainment. Third, even with complete equality in grade attainment and learning achievement, children from poor households would be far from the equity goal of universal numeracy and literacy, as even children from the richest 20% of households are far from universal mastery of basic reading and math by ages 12-13. Achieving universal literacy and numeracy to accomplish even a minimal standard of global absolute equity will require more than just closing the rich-poor learning gap, it will take progress in learning for all.
Topic:
Development, Education, Sustainable Development Goals, and Language
Political Geography:
Pakistan, Kenya, Africa, Middle East, India, Asia, and Tanzania

1233. US-China Trade Tensions: Impact on Mexico | Estados Unidos-China Tensiones Comerciales: Impacto en Mexico

Author:
COMEXI
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Mexican Council on Foreign Relations (COMEXI)
Abstract:
For the mid- or long-term, no country in the world—and much less Mexico—benefits from a strained environment in which there is no adherence to international trade rules. However, for the short-term, a strained trade environment produces adjustments to the supply chains, which could benefit competitors of those economies that are currently in conflict. Mexico, the second supplier of the United States only behind China, could reassert its position as a credible competitor of the Asian economy in the US. Likewise, in the context of trade friction, or even just the threat of a conflict, Mexico could strengthen its trade positioning in China by replacing part of the US offering. /// En el mediano o largo plazo, a ningún país del mundo, y menos a México, le conviene que exista un clima de tensiones donde no se respeten las reglas del comercio internacional. Ahora bien, en el corto plazo, el clima de tensiones comerciales genera ajustes en las cadenas de suministro, lo cual puede beneficiar a los competidores de las economías en conflicto. México, el segundo proveedor de Estados Unidos sólo después de China, puede reafirmar su posición como competidor creíble de la economía asiática en Estados Unidos, así como fortalecer su posición comercial en China, al sustituir parte de la oferta estadounidense, en un contexto de fricciones comerciales o su amenaza.
Topic:
Foreign Policy, Economy, Economic growth, Trade Wars, Exports, and Trade
Political Geography:
China, Mexico, and United States of America

1234. A Short-Sighted Vision for Global Britain

Author:
Owen Barder, Hannah Timmis, and Arthur Baker
Publication Date:
03-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
here has been a resurgence in calls to reconsider the cross-party consensus in the UK on foreign aid and development. The main political parties are all committed to spending 0.7 percent of gross national income on aid, to using the internationally agreed definition of aid, and to maintaining a separate government department to administer the majority of this aid, led by a Cabinet Minister. In their recent report, Global Britain: A Twenty-first Century Vision, Bob Seely MP and James Rogers lay challenge to these long-established pillars of UK development policy. In this note, we consider some of the questions they raise and suggest alternative answers.
Topic:
Development, Government, Foreign Aid, and Bureaucracy
Political Geography:
Britain and Europe

1235. The Principles on Commercial Transparency in Public Contracts

Author:
The Working Group on Commercial Transparency in Public Contracts
Publication Date:
03-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Transparency by design: Transparency should be the norm for all government contracts, particularly regarding information on what is being exchanged and for what price. Contracting systems should be designed to support proactive publication of contracts as open data. Public contracting should be designed for transparency and efficiency. Full contract publication should be the norm. Information needed to judge value for money should be disclosed. Exceptions in the public interest: Redactions on the basis of commercial sensitivity should only be justified where the public interest in withholding information is greater than the public interest in having that information published. The assessment should take into account both any commercial harm to the contractor and the broader benefits of transparency to markets and public trust. Where exceptions to publication are considered: Information should only be redacted for reasons of commercial sensitivity when the public interest in withholding information is greater than the public interest in disclosure. The public interest test should take into account the wider economic benefits of the sharing of commercial information, as well as the case for accountability and the public’s right to know. All redactions should be clearly marked with the reason for redaction. A clear and robust process: Governments should issue detailed guidance on commercial sensitivity principles and exemptions, put in place systems to support publication, ensure that redaction is time-limited, and use other oversight mechanisms to compensate for information withheld from publication. Governments should issue clear guidance to public entities, agencies, and firms on contract publication and when information may be exempted from publication for commercial sensitivity reasons. Where redaction is potentially allowed, there should be a clear process for determining what is redacted, why, for how long, and with what appeals process. There should be a system for ensuring that contracts and contract information are in fact disclosed in practice. Where exemption to disclosure of information is granted for commercial sensitivity reasons, this should be grounds for increased scrutiny through other oversight mechanisms.
Topic:
Government, Transparency, Public Service, and Contracts
Political Geography:
Global Focus

1236. The Limits (And Human Costs) of Population Policy: Fertility Decline and Sex Selection in China under Mao

Author:
Kimberly Singer Babiarz, Paul Ma, Grant Miller, and Shige Song
Publication Date:
03-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Most of China’s fertility decline predates the famous One Child Policy—and instead occurred under its predecessor, the Later, Longer, Fewer (LLF) policy. Studying LLF’s contribution to fertility and sex selection behavior, we find that it i) reduced China’s total fertility rate by 0.9 births per woman (explaining 28% of China’s modern fertility decline), ii) doubled the use of male-biased fertility stopping rules, and iii) promoted postnatal neglect (implying 210,000 previously unrecognized missing girls). Considering Chinese population policy to be extreme in global experience, our paper demonstrates the limits of population policy—and its potential human costs.
Topic:
Population, Sexuality, and Fertility
Political Geography:
China and Asia

1237. Why “Leapfrogging” in Frontier Markets Isn’t Working

Author:
Bright Simons
Publication Date:
03-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Just before the yuletide of 2018, I arrived in my native Ghana after one of my long spells away. I flipped out my phone, opened Uber, and tried to flag a ride from inside the shiny new terminal of Accra’s international airport. After a couple of false starts I gave up, walked out, and headed for the taxi stand. In the many days that followed, this ritual repeated itself with remarkable regularity. Sometimes I got the Uber, but on as many occasions, I couldn’t. The reasons for the frequent failure ranged from curious to bizarre. The “partner-drivers” would accept the request. Then they would begin to go around in circles. Sometimes they would start heading in the opposite direction. On a few occasions they would call and announce that they were “far away,” even though their registered location was visible to me on the app and their estimated time of arrival had factored into my decision to wait. It would take me a whole week to figure out that the problem wasn’t always that many Ghanaian Uber drivers couldn’t use GPS all that well, or that they were displeased with fares. There were other issues that I’d left out of my calculation, such as my payment preference, which was set to “bank card” instead of “cash.” The drivers want cash because it allows them to unofficially “borrow” from Uber and remit Uber’s money when it suits their cashflow. Though Uber offers two tiers of service, the difference in quality appeared negligible. Even on the upper tier, it was a constant struggle to find an Uber whose air conditioner hadn’t “just stopped working earlier today.” As something of a globetrotter used to seamless Uber services in European and American cities, I found the costs of onboarding onto Uber as my main means of mobility in Accra onerous. Why is a powerful corporation like Uber, reportedly valued by shrewd investment bankers at $120 billion, with $24 billion in capital raised, unable to maintain even a relative semblance of quality in its product in Ghana? And in other African cities I have visited? It may seem bleedingly obvious why heavily digitalised Facebook, Twitter, Microsoft, and Google manage to deliver fairly uniform standards of product quality regardless of where their customers are based, whilst Uber, because of its greater “embeddedness in local ecosystems” and lower digitalisation of its value chain, fails. But in that seemingly redundant observation enfolds many explanations for why the innovation-based leapfrogging narrative in frontier markets, especially in Africa, unravels at close quarters.
Topic:
Development, Science and Technology, Governance, Digital Economy, and Emerging Technology
Political Geography:
Africa

1238. Midline Effects of a Randomized Controlled Trial to Increase the Utilization of Financial Services by Women Business Owners in Rural Indonesia

Author:
James C. Knowles
Publication Date:
03-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This is the report of a midline evaluation of a randomized controlled trial to increase the utilization of saving and other financial services by women business owners in Indonesia. The trial was motivated by a recent law in Indonesia supporting the development of branchless banking services for a large unbanked rural population and by the results of several studies suggesting that it is possible to stimulate savings and improve a range of downstream outcomes with suitable interventions targeted to under-banked rural populations. The trial was conducted in 400 purposively selected rural and semi-urban villages in five districts of East Java province in which branchless banking services (including basic savings accounts accessible through mobile phones) were available. The randomized interventions supported by this trial include both supply-side treatments (higher agent incentives) and demand-side treatments (training and mentoring of female business owners). The data analyzed include both baseline and midline survey data on female and male business owners and branchless banking agents. Implementation of the trial was delayed due to difficulties in recruiting suitable agents in all 400 trial villages. Numerous supply-side problems, both technical and logistical, were also reported in the monitoring data. However, the midline results indicate that the interventions were successfully delivered, resulting in significant positive effects on key intermediate outcomes, including knowledge and use of mobile banking services and initial take up of a mobile basic savings account. Downstream effects indicate that the supply- and demand-side interventions, particularly in combination, increased women business owners’ savings, empowerment, self-confidence, and economic welfare.
Topic:
Women, Finance, Rural, and Financial Services
Political Geography:
Indonesia and Indo-Pacific

1239. The Machines Are Not So Easy to Ride: Another Take on Automation

Author:
Bright Simons
Publication Date:
03-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
In 1981, a former sheep farmer took a one-week crash course in computing, had an epiphany, and teamed up with a car tyres millionaire to form DJ AI. DJ AI announced a new artificial intelligence platform for sale at $600 that could build computer programs for customers. They named their game-changer “The Last One.” All users had to do was follow a set of screen menus, plug, and play, and bingo, they could do away with all those pesky system administrators and programmers. $6 million was spent marketing this powerful piece of magic on both sides of the Atlantic, sometimes to comic effect. Such dreams of software building software, literally cutting out the middleman, have recurred regularly since the 1960s in peaks and troughs, but we are still waiting. From the late 90s onwards, however, new data-driven approaches to automation, particularly so-called deep learning, and the involvement of many of the world’s smartest and most loaded companies, have begun to convince many level-headed analysts that this time it is going to be different. The technologies, we are told, can learn, and so it is about time we paid critical attention to the pace at which they are already and could even further turn upside down the world of work as we know it. Some of the most elegant attempts to evaluate and categorise the impact of these new capabilities on employment and income inequality can be found in papers by David Autor and his co-authors on labour market polarisation and the effect of computerisation on the market demand for skills. More than a decade after these papers were written, their core ideas and the schemas they proposed continue to inspire the framing of the issues in influential circles, making them the most cited in their writers’ corpus. The Economist is right to describe Autor’s seminal work as enormously influential. The elegance and rigorous use of data in these two persuasive treatises are not, however, enough to prevent one major convenient generalisation from weakening their key arguments. The generalisation in question emanates from the conflation of several different patterns of computerisation with “automation,” the replacement of human actors in the chain of work, which is then used as a proxy for technology diffusion and infusion into various modes of work, following in a tradition that also encompasses Goldin and Katz’s equally elegant formulation of the automation question as one of a contention between returns to skills versus returns to algorithms. Having taken “automation” as the predominant form in which modern technology manifests itself in the workplace, Autor and his collaborators then proceed to construct a spectrum of possibilities for technology’s infusion: complement, substitute, or bypass (CSB). In the CSB paradigm, modern technology in the workplace tends to complement super-skilled, high-earning, workers, in complex, adaptive, operations, thereby boosting their productivity and bargaining power; substitute for the contribution of most medium-skilled workers in many routine tasks, thus depressing their wage potential; and bypass low-skilled workers, such as drivers, waiters, and janitors, thus rendering their fate somewhat indeterminate even if their numbers grow. It is not difficult to see why Autor et al.’s extensive use of crosswalking across census-based industrial classification schemes and the Dictionary of Occupational Titles should encourage this neat stratification. Once something is coded, it acquires a hardness that confers rigour and opacity.
Topic:
Science and Technology, Automation, and Emerging Technology
Political Geography:
Global Focus

1240. Can Transparency Lower Prices and Improve Access to Pharmaceuticals? It Depends

Author:
Kalipso Chalkidou and Adrian Towse
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
spending on pharmaceuticals and other healthcare commodities is high and makes up a large proportion of healthcare spending in rich and poorer markets alike. A popular response to the problem of escalating drugs budgets has been transparency of drug pricing within and across borders. In a rare alignment of policy priorities, the Trump administration, the US Senate, and the World Health Organisation are calling for more transparency of the prices paid for prescription drugs as a means of tackling the ever-growing pharmaceuticals bill. Recently Italy’s health minister joined in, calling for a World Health Assembly resolution which would mandate WHO to “provide governments with a forum for sharing information on drug prices, revenues, research and development costs, public sector investments and research and development subsidies, marketing costs and other related information.” But is price transparency really the answer to healthcare systems’ fiscal sustainability challenges as they strive to expand access to new technologies or even merely sustain provision within strained public budgets? Well, it depends!
Topic:
Transparency, Medicine, Pharmaceuticals, and Price
Political Geography:
Global Focus