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91. 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 (CGD)
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

92. 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 (CGD)
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

93. 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 (CGD)
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

94. 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 (CGD)
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

95. WHO Technical Report on Cancer Pricing Misses the Mark—It Should Focus on the “Demand Side”

Author:
Kalipso Chalkidou, Adrian Towse, and Richard Sullivan
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
Criticising cancer medicine pricing as too high is what football fans know as an "open goal"—a target that is hard to miss. Yet somehow the World Health Organization (WHO) Technical Report on Cancer Pricing manages to do just that with a paper to the WHO Executive Board calling for price and cost transparency. The assumption goes that transparency will reduce the prices and costs of cancer medicines, a mantra that has united the Trump administration, the US Congress, and the Italian health minister with many NGOs who have called for “greater cost and price transparency”—a sentiment echoed by KEI, which states that “international action is required to improve transparency in reporting the costs of R&D and production, including public sources of funding.”
Topic:
World Health Organization, Health Care Policy, Medicine, Cancer, and Price
Political Geography:
Global Focus

96. Pooled Procurement of Drugs in Low and Middle Income Countries

Author:
Pierre Dubois, Yassine Lefouili, and Stephane Straub
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
We use data from seven low and middle income countries with diverse drug procurement systems to assess the effect of centralized procurement on drug prices and provide a theoretical mechanism that explains this effect. Our empirical analysis is based on exhaustive data on drug sales quantities and expenditures over several years for forty important molecules. We find that centralized procurement of drugs by the public sector allows much lower prices but that the induced price reduction is smaller when the supply side is more concentrated.
Topic:
Drugs, Medicine, Centralization, and Price
Political Geography:
Global Focus

97. Who Benefits from Pharmaceutical Price Controls? Evidence from India

Author:
Emma Boswell Dean
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
With the goal of driving down drug costs, governments across the globe have instituted various forms of pharmaceutical price control policies. Understanding the impacts of such policies is particularly important in low- and middle-income countries, where lack of insurance coverage means that prices can serve as a barrier to access for patients. In this paper, we examine the theoretical and empirical effects of one implementation of pharmaceutical price controls, in which the Indian government placed price ceilings on a set of essential medicines. We find that the legislation resulted in broadly declining prices amongst both directly impacted products and competing products. However, the legislation also led to decreased sales of price-controlled and closely related products, preventing trade that would have otherwise occurred. The sales of small, local generics manufacturers were most impacted by the legislation, seeing a 14.5 percent decrease in market share and a 5.3 percent decrease in sales. These products tend to be inexpensive, but we use novel data to show that they are also of lower average quality. We provide evidence that the legislation impacted consumer types differentially. The benefits of the legislation were largest for quality-sensitive consumers, while the downsides largely affected poor and rural consumers, two groups already suffering from low access to medicines.
Topic:
Medicine, Pharmaceuticals, Price, and Price Control
Political Geography:
Global Focus

98. Making Basel III Work for Emerging Markets and Developing Economies

Author:
Thorsten Beck and Liliana Rojas-Suarez
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
A sound financial regulatory framework is critical for minimizing the risk imposed by financial system fra­gility. In the world’s emerging markets and developing economies (EMDEs), such regulation is also essential to support economic development and poverty reduc­tion. Meanwhile, it is increasingly recognized that global financial stability is a global public good: recent decades have seen the development of new inter­national financial regulatory standards, to serve as benchmarks for gauging regulation across countries, facilitate cooperation among financial supervisors from different countries, and create a level playing field for financial institutions wherever they operate. For the worldwide banking industry, the international regulatory standards promulgated by the Basel Com­mittee on Banking Supervision (BCBS) stand out for their wide-ranging scope and detail. Even though the latest Basel recommendations, adopted in late 2017 and known as Basel III, are, like their predecessors, calibrated primarily for advanced countries, many EMDEs are in the process of adopting and adapting them, and many others are considering it. They do so because they see it as in their long-term interest, but at the same time the new standards pose for them new risks and challenges. This report assesses the implica­tions of Basel III for EMDEs and provides recommen­dations for both international and local policymakers to make Basel III work for these economies.
Topic:
Development, Economics, Emerging Markets, and Markets
Political Geography:
Global Focus

99. Aggregating Demand for Pharmaceuticals is Appealing, but Pooling Is Not a Panacea

Author:
Cassandra Nemzoff, Kalipso Chalkidou, and Mead Over
Publication Date:
05-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
As low- and middle-income countries reduce their reliance on donor aid, they are increasingly obliged to assume some degree of financial responsibility for donor projects. This challenge will be particularly complex in the procurement of health commodities. In recent decades, recipient countries have benefitted from donor-aggregated demand and pooling mechanisms, negotiated prices, purchasing, and delivery of commodities. However, as countries shift away from donor support, their challenge will be finding a way to aggregate demand in order to achieve the benefits that the pooled purchasing arrangements of vertical health programs now provide. As a first step in tackling this challenge, much can be learned from a diverse group of pooled procurement initiatives that have developed over the past 40 years in high-, middle-, and low-income countries. This note reviews the rationale and functions of these initiatives, notes their potential benefits and barriers, and draws lessons regarding how best to incorporate pooled pharmaceutical purchasing models into the design and implementation of health financing reforms in countries in transition. We first provide a brief background on the procurement challenges faced by countries in transition. In section 2, we provide an overview of different types of pooling initiatives, highlighting the key features of each. Leveraging our research and key interviews, we outline the real and potential benefits of pooling in section 3, and the most pressing barriers that organizations or countries will face as they seek ways to aggregate demand in section 4. In section 5 we discuss some of the issues that countries and development partners should address when considering pooled procurement initiatives and make two recommendations: (1) countries and development partners should conduct further research on the merits of pooled procurement, and (2) they should develop a straw model of a pooled procurement governance structure that could be tested using a series of pilots.
Topic:
Budget, Public Health, Medicine, and Pharmaceuticals
Political Geography:
Global Focus

100. Struggling with Scale: Ebola’s Lessons for the Next Pandemic

Author:
Jeremy Konyndyk
Publication Date:
05-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
The next pandemic is a matter of when, not if. Preparing for this inevitability requires that policymakers understand not just the science of limiting disease transmission or engineering a drug, but also the practical challenges of expanding a response strategy to a regional or global level. Achieving success at such scales is largely an issue of operational, strategic, and policy choices—areas of pandemic preparedness that remain underexplored.
Topic:
International Cooperation, Ebola, Public Health, and Pandemic
Political Geography:
Global Focus