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151. Financial Regulations for Improving Financial Inclusion

Author:
Stijn Claessens and Liliana Rojas-Suarez
Publication Date:
03-2016
Content Type:
Special Report
Institution:
Center for Global Development (CGD)
Abstract:
As recently as 2011, only 42 percent of adult Kenyans had a financial account of any kind; by 2014, according to the Global Findex, database that number had risen to 75 percent. [1] In sub­Saharan Africa, the share of adults with financial accounts rose by nearly half over the same period. Many other developing countries have also recorded gains in access to basic financial services. Much of this progress is being facilitated by the digital revolution of recent decades, which has led to the emergence of new financial services and new delivery channels. Whereas payment services often are the entry point into using formal financial services, they are not the only low­cost and widely accessible financial services being delivered in recent years. Driven by advances in new digital payment services, small­scale credit and new modes for delivering insurance services are being offered in several developing countries. Digital (payment) records are being used to make decisions about provision of credit to small businesses or individuals who do not have traditional collateral or credit history to secure loans. Additionally, affordable mobile systems have led to the provision of new and innovative financial services that would not be economically sustainable under the traditional brick­and­mortar model such as mobile­based crop microinsurance in sub­Saharan Africa and pay­as­you­go energy delivery models for off­grid customers in India, Peru, and Tanzania. [2] Increased access to basic financial services, especially payments services, by larger segments of the population reflects the growing use of digital technologies in developing countries. Simultaneously, the adoption of proper regulation based on country­specific opportunities, needs and conditions has been critical.
Topic:
International Political Economy, International Trade and Finance, and Financial Markets
Political Geography:
Global Focus

152. Aligning Incentives, Accelerating Impact

Author:
Rachel Silverman, Mead Over, and Sebastian Bauhoff
Publication Date:
12-2015
Content Type:
Special Report
Institution:
Center for Global Development (CGD)
Abstract:
Founded in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) is one of the world’s largest multilateral health funders, disbursing $3–$4 billion a year across 100-plus countries. Many of these countries rely on Global Fund monies to finance their respective disease responses—and for their citizens, the efficient and effective use of Global Fund monies can be the difference between life and death. Many researchers and policymakers have hypothesized that models tying grant payments to achieved and verified results—referred to in this report as next generation financing models—offer an opportunity for the Global Fund to push forward its strategic interests and accelerate the impact of its investments. Free from year-to-year disbursement pressure (like government agencies) and rigid allocation policies (like the World Bank’s International Development Association), the Global Fund is also uniquely equipped to push forward innovative financing models. But despite interest, the how of new grant designs remains a challenge. Realizing their potential requires technical know-how and careful, strategic decisionmaking that responds to specific country and epidemiological contexts—all with little evidence or experience to guide the way. This report thus addresses the how of next generation financing models—that is, the concrete steps needed to change the basis of payment from expenses to something else: outputs, outcomes, or impact. For example, when and why is changing the basis of payment a good idea? What are the right indicators and results to purchase from grantees? How much and how should grantees be remunerated for their achievements? How can the Global Fund verify that the basis of payment is sound—that the reported results are accurate and reliable and represent real progress against disease control goals? And what is needed to protect communities against coercion or other human rights abuses, ensuring that these new incentives do not drive unintended consequences?
Topic:
International Trade and Finance and Global Political Economy
Political Geography:
Global Focus

153. Power to the States: Making Fiscal Transfers Work for Better Health

Author:
Center for Global Development
Publication Date:
12-2015
Content Type:
Special Report
Institution:
Center for Global Development (CGD)
Abstract:
Most money and responsibility for health in large federal countries like India rests with subnational governments — states, provinces, districts, and municipalities. The policies and spending at the subnational level affect the pace, scale, and equity of health improvements in countries that account for much of the world’s disease burden: India, Indonesia, Nigeria, and Pakistan. Fiscal transfers between levels of government can — but do not always — play an important role in turning money into outcomes at the subnational level. Well designed, transfers can help put states on a level financial playing field by equalizing spending across states and adjusting allocations for the health risks of each state’s population. Transfers can increase accountability and create incentives for greater spending or effectiveness in service delivery. But transfers are rarely designed with attention to their desired outcomes. To get to better outcomes, international experience suggests that transfers need to be reexamined and reformed along three dimensions. First, central government’s allocation of national revenues to subnational governments should respond to needs and population size. Second, transfers should generate incentives to improve subnational governments’ spending quality and performance on outcomes. Third, independent systems to monitor, evaluate, and provide feedback data on subnational performance can generate greater accountability to the central government, parliaments, and legislatures as well as to citizens. These insights are seemingly simple and suggestive, but each country starts from its own unique history that requires careful technical analysis and political savvy to define reforms with genuine potential to improve health.
Topic:
International Political Economy, International Trade and Finance, and Financial Markets
Political Geography:
Global Focus

154. Better Hospitals, Better Health Systems, Better Health – A Proposal for a Global Hospital Collaborative for Emerging Economies

Author:
Center for Global Development
Publication Date:
11-2015
Content Type:
Special Report
Institution:
Center for Global Development (CGD)
Abstract:
Hospitals are central to building and maintaining healthy populations around the world. They serve as the first point of care for many, offer access to specialized care, act as loci for medical education and research, and influence standards for national health systems at large. Yet despite their centrality within health systems, hospitals have been sidelined to the periphery of the global health agenda as scarce financial resources, technical expertise, and political will instead focus on the expansion of accessible primary care. As a result, many hospitals in low- and middle-income countries have failed to evolve and modernize, both in operations and infrastructure, while the knowledge base on hospital effectiveness and efficiency remains small and inadequate. In turn, the standard of care and efficiency achieved by these hospitals has stagnated. The gap in treatment capacity and quality between wealthier and poorer countries—and between hospitals serving wealthier and poorer populations—is widening, just as emerging economies are poised to expand the range and depth of healthcare through universal health coverage.
Topic:
World Health Organization and Health Care Policy
Political Geography:
Global Focus

155. Social Cohesion, Institutions

Author:
William Easterly, Michael Woolcock, and Jozef Ritzen
Publication Date:
08-2006
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
We present evidence that measures of “social cohesion,” such as income inequality and ethnic fractionalization, endogenously determine institutional quality, which in turn casually determines growth.
Topic:
Civil Society, Development, Government, and Poverty
Political Geography:
Global Focus