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121. Why Uncertainty in Global Health Interventions Matters—and What We Can Do About It

Author:
Kalipso Chalkidou, Anupama Dathan, and Francis Ruiz
Publication Date:
09-2019
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
Global health interventions, like many public policies, are rife with uncertainty. Will a program, such as a malaria prevention strategy that looks strong on paper, work as intended? Will a new technology, such as a specific drug or device that appears effective in clinical trial settings, work in practice and provide good value-for-money? In the case of programs made up of a complex interaction of multiple interventions, implementers often create a theory of change and then meticulously track whether it is being followed every step of the way, from each input translating into the prespecified activity, and the activities yielding the right outputs and the expected outcomes. When observational data is available that permits quantitative analysis (evaluation), it may also be possible to estimate causal impact in a given setting by applying experimental methods (such as a randomized controlled trial) or quasi-experimental techniques (such as difference-in-difference analysis). Such program evaluations generally consider outputs (e.g. the number of bed nets distributed) and relatively short-term outcomes (e.g. malaria infections following bed net distribution). Many eval- uations also collect data years after the program to identify longer-term impacts. Cost-effectiveness calculations are sometimes conducted after ascertaining the cost and impact of the program, but such analyses aren’t necessarily considered when determining whether to implement a certain program or technology—especially when politics and other concerns get in the way. Discrete clinical interventions and technologies (which are defined as including clinical interven- tions, drugs, diagnostics and even public health programs) are usually the subject of health technolo- gy assessment (HTA) to inform coverage decisions in many contexts. The underpinning evidence base for HTA typically involves a synthesis of randomized trial data, designed to reduce bias in estimating causal inference and relative effectiveness. Trial data is then combined with information from other sources and study designs to develop models of the technology’s long-term health and cost impact in a given context. A key feature of both programs and technologies is uncertainty.
Topic:
Health, International Cooperation, Science and Technology, Humanitarian Intervention, and Pharmaceuticals
Political Geography:
Global Focus

122. Marginal, Not Transformational: Development Finance Institutions and the Sustainable Development Goals

Author:
Charles Kenny
Publication Date:
09-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
Development finance institutions have positioned themselves as key agencies to help the world meet the Sustainable Development Goals. It is doubtful that they can deliver. This paper outlines the challenges facing DFIs in achieving (anywhere near) such an expansion in their impact, particularly in infrastructure and particularly in the poorest countries. It notes that private investment in SDG priority areas is low in the poorest countries, and the record of private investment in rolling out services is mixed. These issues are linked in part to significant supply side constraints based on country characteristics. DFIs do better than the market as a whole at investing in challenging infrastructure–but not by much. And while the scale of their ‘leverage’ in terms of attracting dollars that would otherwise not have been invested is hard to determine, in the poorest markets in infrastructure it is certainly low. Finally, DFIs and donors more broadly have long tried to improve deal flow with limited success, suggesting there are few deals on the margin of occurring which only require small extra incentives to materialize.
Topic:
Development, Finance, Institutions, and Sustainability
Political Geography:
Global Focus

123. Teacher Professional Development around the World: The Gap between Evidence and Practice

Author:
Anna Popova, David Evans, Mary E. Breeding, and Violeta Arancibia
Publication Date:
09-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
Many teachers in low- and middle-income countries lack the skills to teach effectively, and professional development (PD) programs are the principal tool that governments use to upgrade those skills. At the same time, few PD programs are evaluated, and those that are evaluated show highly varying results. In this paper, we propose a set of indicators—the In-Service Teacher Training Survey Instrument—to standardize reporting on teacher PD programs. Applying the instrument to 33 rigorously evaluated PD programs, we find that programs that link participation to career incentives, have a specific subject focus, incorporate lesson enactment in the training, and include initial face-to-face training tend to show higher student learning gains. In qualitative interviews, program implementers also report follow-up visits as among the most effective characteristics of their professional development programs. We then use the instrument to present novel data on a sample of 139 government-funded, at-scale professional development programs across 14 countries. The attributes of most at-scale teacher professional development programs differ sharply from those of programs that evidence suggests are effective, with fewer incentives to participate in PD, fewer opportunities to practice new skills, and less follow-up once teachers return to their classrooms.
Topic:
Development, Education, Labor Issues, Academia, and Teaching
Political Geography:
Global Focus

124. Five Principles for Use of Aid in Subsidies to the Private Sector

Publication Date:
10-2019
Content Type:
Research Paper
Institution:
Center for Global Development (CGD)
Abstract:
There is a significant and ongoing ramp-up in support for explicitly subsidized official development finance to the private sector around the world, but its role remains poorly defined. Lessons from the aid effectiveness literature as a whole and principles on effective use of aid suggest the need for approaches that do not merely finance the marginal private investment. Regarding experience of government intervention in markets, subsidies are only one of many options to incentivize the private sector, and bespoke subsidies provided by outside actors are rarely likely to be the most efficient form. This paper discusses where outside subsidy of the private sector may make sense and develops principles for the use of aid in subsidies based on that analysis. Subsidies should be allocated on the basis of necessity in meeting public policy goals; the norm for subsidy allocations should be competitive approaches or open offers; non-competitive subsidies should only support market making; subsidy levels should be capped; and subsidy levels should be transparent. Much of the content of these “new” principles is already implied or specified by the existing Multilateral Development Bank Principles to Support Sustainable Private Sector Operations, but they suggest that development finance institutions should not use their standard business model when using subsidies.
Topic:
Development, Privatization, Foreign Aid, Private Sector, and Subsidies
Political Geography:
Global Focus

125. What Is “Country Ownership”? A Formal Exploration of the Aid Relationship

Author:
William Savedoff
Publication Date:
10-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
The aid literature and high-level accords like the Paris Declaration argue that “country ownership” is critical to the effectiveness of aid. In response, donors and recipients renamed themselves “development partners,” obscuring the tendency for country ownership benefits (i.e. more successful and sustainable programs) to come at the expense of satisfying the funding countries’ priorities. This paper illustrates the tradeoff between country ownership and funders’ priorities with a formal model in which aid is governed by a contract to produce a jointly desired outcome. The model generalizes the Principal-Agent approaches for studying aid which treat countries as having multiple objectives. The new model illustrates how a recipient country’s rational resource allocation choices vary with different aid contracts, whether based on lump sum payments, input-based payments, conditional payments, matching grants or outcome payments. It reveals two critical aspects of the country ownership debate. First, even when funders and recipients agree on project goals, funders can only achieve their priorities through distorting domestic allocative choices. Second, funders are likely to fully embrace country ownership only in cases where they believe alternative uses of domestic funds have integrity (as defined by the funder). The model also shows that when funders put higher priority on achieving their goals than accommodating recipient allocation preferences, they should prefer conditional payments, matching grants, or outcome payments. Among these, the donor’s preferences would depend on the relative observability of expenditures to outcomes. If instead funders embrace country ownership and seek to maximize the country’s welfare, lump sum grants are better. In terms of Paris Declaration goals of sustainability, the aid contracts which are least aligned with recipient country priorities will not be sustained after aid ends unless domestic preferences are altered by a process of hysteresis.
Topic:
Development, Diplomacy, International Cooperation, and Foreign Aid
Political Geography:
Global Focus

126. A Smoother Trade Transition for Graduating LDCs

Author:
Kimberly Ann Elliott
Publication Date:
11-2019
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
For nearly 50 years, the world’s “least developed countries” have received extra financial support and preferential trade treatment to help them grow and develop. In the first three decades after the Unit- ed Nations (UN) created the LDC category in 1971, only one country—diamond-rich Botswana—out- grew that status. Since then, four more countries have graduated, and the pace is set to accelerate over the coming decade. Moreover, the countries approaching graduation in the next decade will pose different adjustment challenges than those that preceded them. When a country successfully graduates, it loses access to the special finance and trade programs that come with LDC status. In the case of trade, that can mean the graduating country’s exporters sudden- ly face the higher tariffs that their more advanced competitors face, so-called most-favored nation (MFN) tariffs. Even if these countries remain eligible for the Generalized System of Preferences (GSP) that is available to developing countries, those programs are typically much less generous than the duty-free, quota-free market access that most advanced economies provide for LDCs.1 Moreover, out- side the European Union (EU), few countries provide transition measures for graduating LDCs (see Annex A). Nor does there appear to be much planning to prepare for the coming wave of graduations. The United Kingdom has already committed to provide barrier-free market access for LDCs, similar to the EU’s Everything But Arms (EBA) program.2 But British policymakers have a unique opportunity to improve on that model as part of post-Brexit trade and development planning, including to ad- dress the coming wave of graduations. And if the UK remains in the customs union, it can work with EU policymakers to improve the graduation process as part of the review of the GSP regulation that expires in 2023.
Topic:
Development, International Cooperation, European Union, Trade, and Transition
Political Geography:
Europe and Global Focus

127. Taxing “Bads”: An Overview of Research Initiatives

Author:
Ruth Lopert
Publication Date:
11-2019
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
Around the world, development economists and researchers are exploring proposals to tax excise goods, and several have produced models demonstrating that such taxes can generate substantial revenues. This note attempts to list the organizations and research initiatives currently addressing taxation of tobacco, alcohol, and sugar-sweetened beverages—the “bads”—to help navigate the landscape of existing research and identify gaps and opportunities for further work.
Topic:
Development, Economics, Tax Systems, and Revenue Management
Political Geography:
Global Focus

128. Lending Terms for IFAD Projects

Author:
Scott Morris and Jessie Lu
Publication Date:
11-2019
Content Type:
Research Paper
Institution:
Center for Global Development (CGD)
Abstract:
Donor support for agriculture development is not keeping pace with developing country demand or the need for finance implied by Sustainable Development Goal 2. In order to increase the overall volume of resources available for these needs, IFAD is pursuing a reform agenda that considers providing loans on harder terms to its client countries. This study assesses whether this hardening of lending terms will affect country demand for projects. Using the World Bank experience as a proxy, this paper examines whether graduation from the International Development Association to the International Bank for Reconstruction and Development affects the sector portfolios of countries and the types of investment demands within agriculture through both statistical and qualitative country case study analysis. We find that as countries graduate, there is a relative shift away from “soft” sector investments and a different mix of investments within the agricultural sector. We argue that IFAD’s consideration of harder lending terms should also include consideration of how to respond to a different mix of country demand within the agricultural sector. Specifically, the fund should consider some scaling up of projects, increased emphasis on capital investments, and a greater emphasis on policy engagement with client countries.
Topic:
Agriculture, Development, Investment, Sustainability, and Banking
Political Geography:
Global Focus

129. Development Impact Bonds Targeting Health Outcomes

Author:
Lorcan Clarke, Kalipso Chalkidou, and Cassandra Nemzoff
Publication Date:
12-2018
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
As of December 2018, seven development impact bonds (DIBs) have been launched across seven countries with nearly US$55million in cumulative outcome funding. DIBs fund public services through contracts where private investors provide upfront flexible funding to service providers and outcome funders repay these investors based on the outcomes achieved by people receiving services. Three DIBs specifically target health outcomes: the Humanitarian Impact Bond, the Utkrisht Impact Bond, and the Cameroon Cataract Bond. The three “health DIBs” involve US$26.5 million in upfront investment, US$38.1 million in outcome funding and aim to impact the health of at least 31,600 people. Using publicly available information, we describe all seven DIBs, and evaluate the three “health DIBs” in more detail, comparing their stakeholders, implementation, and outcome structures. Building on a scoping review of relevant literature, we outline health DIBs in the pipeline and note that the potential of DIBs as a funding structure is hindered by the lack of publicly available information on their estimated impact and value for money. We offer three recommendations to improve evaluation and inform development of DIBs in the future: (1) publish plans and evaluations, (2) create and use consistent reporting guidelines, and (3) allocate funding to evaluate impact and value for money.
Topic:
Development, Health, and Humanitarian Intervention
Political Geography:
Global Focus

130. The International Development Finance Club and the Sustainable Development Goals

Author:
Scott Morris
Publication Date:
12-2018
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
The Sustainable Development Goals (SDGs) face a key dilemma . Although major multilateral institutions like the World Bank and the other core multilateral devel- opment banks (MDBs) have played a leadership role in shaping the SDG financing framework, there is a sig- nificant misalignment between the structure of these institutions and SDG financing needs . Specifically, the SDGs put countries, not multilateral institutions or foreign donors, at the forefront in achieving desired outcomes . Further, the SDG financing agenda identi- fies an important role for the private sector and other nonsovereign actors . Although the MDBs will remain key players in SDG financing, other leading actors—and particularly, other ways of organizing across institu- tions—will be needed to meet the SDGs . The International Development Finance Club (IDFC) is uniquely positioned to play a leadership role on the SDGs . A diverse group of development finance insti- tutions (DFIs), IDFC members collectively embrace a strong country-led focus and private-sector orienta- tion . Members represent a variety of models . Some act as national banks, focused primarily on domestic financing . Others act as bilateral aid agencies and DFIs . Still others act as regional and multilateral develop- ment institutions . Together they bring considerable financial and strategic resources to meet SDG financing needs, and they appear to be well matched to respond to key SDG requirements, including the call for nation- ally led development strategies and the need for sub- stantial private-sector and nonsovereign investment, particularly in infrastructure . This report surveys 22 IDFC member institutions to identify the club’s role in meeting SDG financing needs . Through institutional snapshots, aggregated financial data, qualitative inputs, and case studies, the report reveals a high degree of SDG relevance in these development institutions . We find that the total assets of IDFC institutions are significantly greater than the total assets of core MDBs, indicating that as an orga- nization, IDFC has untapped power as an organiz- ing platform for the SDG agenda . We also find a high degree of alignment between IDFC-reported activities and the full range of SDGs, though only a minority of IDFC members inform their operations with an explicit SDG strategy . Most relevant to the question of leveraging private financing for the SDGs, especially infrastructure, our survey indicates that as a group, IDFC members primarily finance nonsovereign enti- ties, especially private firms, in the course of pursuing development objectives . The IDFC could play a stronger leadership role on behalf of its membership by better aligning its mandate with the SDG agenda . We see a future in which IDFC members adopt common standards for SDG frame- works and for tracking the inputs and outputs relevant to the SDGs . Members should consider the degree to which they wish to make the club a meaningful plat- form for coordination, deliberation, and visibility for the broader SDG agenda . This agenda implies a wid- ening set of demands on members and may require a more robust secretariat to support a wider range of reporting activities, information gathering, agenda setting, and convening . Through a greater commitment to SDG-oriented activ- ities, IDFC members could demonstrate the value of organizing around national, bilateral, and multilateral development institutions to address the leading devel- opment challenges in the years ahead .
Topic:
Development, Finance, Sustainable Development Goals, and Sustainability
Political Geography:
Global Focus