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1. The Future of UK Global Health Policy: Challenges and Opportunities

Author:
Pete Baker
Publication Date:
11-2023
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
Since 2019, the UK’s strong reputation in global health has been undermined by a series of deep cuts and a distracting departmental reorganisation. 2024 may, however, represent a turning point, with new Foreign and Development Ministers, both with a strong track record on development, the implementation of a new development white paper, and a possible election which may bring a new government with new priorities. In this paper, we summarise the challenges and opportunities in global health on which the UK will need to act if it wishes to restore its reputation. We review UK global health aid expenditure data up to 2022, current UK global health policies, and major external global trends. We find that in 2018, the UK reported spending £2.17 billion (0.1 percent of Gross National Income (GNI)). By 2022, this fell to £1.73 billion (0.07 percent of GNI). If the UK had continued at 0.1 percent of GNI level, it would now have an additional £844 million to spend on global health annually. Bilateral programmes, Foreign Commonwealth & Development Office-managed aid programmes, and reproductive health programmes were particularly hard hit by the cuts. We identify three global trends that the UK must accommodate: an acute-on-chronic health financing crises in low- and middle-income countries; changing demographics, burden of disease, and increasing global threats; and the inadequacy of global health architecture. Finally, we recommend a five-point plan for the UK government to take forward: 1) Champion debt relief and “health taxes” to increase resources for health; 2) Support countries to strengthen health system efficiency; 3) Prioritise limited UK financing on key, measurable objectives in a few low-income countries. 4) Conduct a multilateral aid review that focuses on developing country priorities; and 5) Direct UK health system strengthening funding through the World Bank and long-term bilateral programmes.
Topic:
Development, Foreign Aid, and Global Health
Political Geography:
United Kingdom and Europe

2. Are Development Finance Institutions Good Value for Money?

Author:
Paddy Carter
Publication Date:
10-2021
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
Finance institutions take money from foreign aid budgets to invest in private enterprises. How much should they be given? We can make some progress on that question by looking at the return on investment in the form of higher real incomes for workers and customers, and comparing that to a cash transfer benchmark. There is considerable uncertainty, but what evidence we have suggests returns on investment are in a range that compares well to that benchmark. There is also a diversification argument that because we don’t know which of the things that aid can finance will ultimately prove most important for poverty eradication, aid allocation should hedge its bets. A low single digit percentage of aid allocated to increase the quantity and quality of private investment in low- and middle-income countries seems reasonable.
Topic:
Development, Foreign Aid, Finance, Investment, and Institutions
Political Geography:
Global Focus

3. Some Unpleasant ODA Arithmetic

Author:
Ranil Dissanayake and Atousa Tahmasebi
Publication Date:
10-2021
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
Official development assistance is supposed to be designed to prioritise the economic development and welfare of developing countries. The OECD’s Development Assistance Committee is a club of wealthy donor countries which collaborate to set rules and norms to this effect. However, digging into the official data submitted by donors to the OECD reveals some unpleasant truths. We use data on every funding line reported by donors to the OECD between 2006 and 2019 to investigate the pattern and distribution of commitments and disbursements of ODA to developing countries, and discover that ODA is targeted poorly within the group of eligible developing countries; that this group of eligible countries is gradually expanding to include more relatively wealthy places; that aggregate ODA flows are organized and structured sub-optimally; and that ODA responds more to arbitrary income classifications than it should. We suggest informational and incentive reforms in response. These findings also suggest limits to what realistic reform of ODA can achieve, and, consequently, the importance of non-aid development policy for outcomes in developing countries.
Topic:
Development, International Cooperation, Foreign Aid, and Welfare
Political Geography:
Global Focus

4. Creating an Accountability Framework that Serves the Global Fragility Act’s Mission

Author:
Susanna Campbell, Dan Hoing, and Sarah Rose
Publication Date:
01-2020
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
In the final days of 2019, Congress passed the Global Fragility Act, an ambitious bill that aims to im- prove how the US government approaches stabilizing conflict-affected states and preventing the es- calation of violence in other fragile contexts. Introduced by a coalition of lawmakers from both sides of the aisle in the House and Senate—led by House Foreign Affairs Committee Chair Eliot Engel (D- NY) and Senator Chris Coons (D-DE)—a version of the legislation was passed by the House this spring and boasted 26 cosponsors in the Senate. The Global Fragility Act’s final passage, as part of a large FY2020 spending bill, is a testament to bipartisan commitment and cooperation. The Global Fragility Act asks the State Department to create—jointly with USAID, the Department of Defense, and other agencies—a coordinated, coherent strategy to help prevent violence in fragile states and stabilize conflict-affected areas. As overseers of the taxpayer funds that will be used to implement the act, Congress also included several provisions to hold these agencies to account for achieving results. Accountability for results is important, especially when overseers are far removed from implementation. But how accountability is structured matters quite a bit. When accountability frameworks revolve largely around tight controls and reporting against targets, their good intentions can backfire and contribute to ineffective programming, especially in fragile states. To ensure that the Global Fragility Act’s accountability requirements support rather than undermine the act’s laudable goals, the monitoring, evaluation, and learning processes that accompany the act’s implementation must accomplish two linked but fundamentally distinct things. They must be able to satisfy Washington-based overseers’ reporting needs while also providing projects the space needed for locally informed adaptive management and learning (or continuous adjustment aimed at achiev- ing transformative aims in a dynamic context), which is associated with better outcomes in fragile states. The Global Fragility Act offers an opportunity to rethink the tools through which aid agencies pursue accountability. This note explains how tight controls and target-oriented reporting can nega- tively affect outcomes in fragile states and offers some initial recommendations for creating a stron- ger, outcome-oriented accountability framework.
Topic:
Foreign Aid, Leadership, Fragile States, Legislation, and Accountability
Political Geography:
North America and United States of America

5. 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 (CGD)
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

6. The Dos and Don’ts of USG Humanitarian Reorganization

Author:
Jeremy Konyndyk
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
The FY 2020 budget request released by the White House last month contained a sweeping proposal to rationalize and streamline US government humanitarian assistance programs overseas. The proposal would merge the three humanitarian budget accounts (International Disaster Assistance, Migration and Refugee Assistance, and Food For Peace Title II); strip programming responsibilities from the State Department’s refugee bureau and consolidate them entirely in a new humanitarian bureau at USAID; and establish a vaguely described “dual hat” senior leader role to oversee humanitarian activities at both USAID and the State Department. The proposed changes would be the most significant overhaul of USG humanitarian structures in decades. The proposal in its current form is unlikely to get much traction in Congress, where it is seen on both sides of the aisle as dramatically weakening US leadership on refugees. In light of other moves by the administration—like slashing refugee resettlement numbers and treating asylum seekers roughly—that is a legitimate and vital concern. There is ample reason to approach the proposal with caution, particularly the idea of stripping away the refugee bureau’s resources.
Topic:
Foreign Aid, Budget, Refugees, and Humanitarian Crisis
Political Geography:
United States and North America

7. When Does “What Works” Work? And What Does that Mean for UK Aid R&D Spend?

Author:
Charles Kenny, Euan Ritchie, and G. Lee Robinson
Publication Date:
10-2019
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
The UK’s Secretary of State for International Development[1] oversees an aid-financed R&D[2] budget that is larger than that of the next 15 biggest donors combined. [3] At the moment, a considerable proportion of that UK R&D spend goes towards solving global technological challenges related to neglected tropical diseases including malaria, and a considerable proportion again towards local evaluation of aid-financed development interventions. Much of the rest is somewhat opaquely distributed to British universities for research supposedly related to development. As well as reform of this last category, the range of more legitimate activities benefiting from ODA “research and development” calls for innovation in approaches to deliver outcomes. This paper will argue there is a (fuzzy) spectrum of development procedures, for some of which global innovation, evaluation, or “best practice” can be informative, for some of which local evaluation or experimentation can be useful, and for some of which perhaps only practical experience and local wisdom can help. That there is a spectrum of intervention types and research opportunities, and that local evidence is often required, has implications for the kind of research that UK aid can usefully support as part of its R&D program and where that research should happen. In turn, that suggests a reform agenda for the way UK ODA for R&D is currently spent.
Topic:
Development, International Cooperation, Foreign Aid, and Research
Political Geography:
United Kingdom and Europe

8. 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

9. 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

10. Focusing on Fragility: The Future of US Assistance to Fragile States

Author:
Sarah Rose
Publication Date:
10-2019
Content Type:
Special Report
Institution:
Center for Global Development (CGD)
Abstract:
Global development is increasingly intertwined with state fragility. Poverty is becoming concentrated in fragile states, and conflict, violent extremism, and environmental stresses can both stem from and be ex- acerbated by fragility. As a result, many donors—including the United States—are rethinking how their engagement can better help countries address the underlying causes of fragility, build peace and stability, and cope with complex risks. The United States is the top provider of official development assistance to fragile states, but much of this aid has not focused on reducing fragility. Even where confronting fragility has been a central objec- tive of US development assistance, the track record of success has been mixed, at best. New efforts are emerging to change this story. Reflecting on lessons of the past, the United States government has been developing new policy frameworks, initiatives, and proposed reforms that seek to address shortcomings in how the US government engages in fragile states. To contribute to this conversation, the Center for Global Development convened a working group of more than 20 experts, including former officials from the State Department, the United States Agency for International Development (USAID), the Department of Defense (DOD), and the US intelligence community, along with noted academics and policy experts to identify specific ideas for how the US government can more effectively use its develop- ment assistance—in conjunction with diplomatic and security assistance tools—in fragile states.
Topic:
Foreign Aid, Fragile States, State Building, and Strategic Stability
Political Geography:
North America and United States of America