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Cover of Policy Paper 122
March 9, 2018

Perspective in Economic Evaluations of Healthcare Interventions in Low- and Middle-Income Countries: One Size Does Not Fit All

As developing nations are increasingly adopting economic evaluation as a means of informing their own investment decisions, new questions emerge. The right answer to the question “which perspective?” is the one tailored to these local specifics. We conclude that there is no one-size-fits-all and that the one who pays must set or have a major say in setting the perspective.

Stock photo of pills in a row
February 5, 2018

Healthcare Systems as Intelligent Payers: What Can the Global Health Community Learn from the English National Health Service?

Today, politicians are under growing pressure to squeeze more out of every dollar and guarantee greater access to better, more affordable healthcare for their citizens. In such a resource-constrained environment, wasting trillions of dollars on health every year is not viable. This note provides an overview of some of the approaches and policy options that the National Health Service in England has been using to maximise value for money.

Cover of Policy Paper 117
January 26, 2018

Structuring and Funding Development Impact Bonds for Health: Nine Lessons from Cameroon and Beyond

Despite the considerable interest in Development Impact Bonds, only a few have reached the implementation phase. We use information from stakeholder interviews to describe the design of one DIB in-depth and use lessons from a range of impact bonds to develop recommendations for potential partners to future DIBs. Lessons from the set of impact bonds reveal a need to reset expectations, particularly around the time and effort needed to develop and market a DIB. 

Roxanne Oroxom , Amanda Glassman and Lachlan McDonald
A chart of Health Commodity Market Size in 50 Low and Middle Income Countries, 2015
December 13, 2017

An Initial Estimation of the Size of Health Commodity Markets in Low- and Middle-Income Countries

This post previews preliminary answers to one initial question: what can we say about the size and nature of health commodity markets in low- and middle-income countries? We share early insights; list the data sources we used, while also signalling others we hope to draw on going forward; and highlight our assumptions and caveats.

Cover of Working Paper 472
December 13, 2017

Meeting the Sustainable Development Goal Zero Targets: What Could We Do? - Working Paper 472

The Sustainable Development Goals are an ambitious set of targets for global development progress by 2030 that were agreed by the United Nations in 2015. A review of the literature on meeting "zero targets" suggests very high costs compared to available resources, but also that in many cases there remains a considerable gap between financing known technical solutions and achieving the outcomes called for in the SDGs. In some cases, we (even) lack the technical solutions required to achieve the zero targets, suggesting the need for research and development of new approaches.

Cover of Working Paper 470
December 7, 2017

Family Planning and Fertility Behavior: Evidence from Twentieth Century Malaysia - Working Paper 470

There is longstanding debate about the contribution of family planning programs to fertility decline. Studying the staggered introduction of family planning across Malaysia during the 1960s and 1970s, we find modest responses in fertility behavior. Overall, Malaysia’s total fertility rate declined by about one quarter birth under family planning, explaining only about 10 percent of the national fertility decline between 1960 and 1988. Our findings are consistent with growing evidence that global fertility decline is predominantly due to underlying changes in the demand for children.

Kimberly Singer Babiarz , Jiwon Lee , Grant Miller , Tey Nai Peng and Christine Valente
Cover of Working Paper 471
December 7, 2017

Family Planning and Women’s Economic Empowerment: Incentive Effects and Direct Effects among Malaysian Women - Working Paper 471

Although family planning programs can improve women’s welfare directly through changes in realized fertility, they may also have important incentive effects by increasing parents’ investments in girls not yet fertile. We study these potential incentive effects, finding that family planning may have raised raise girls’ educational attainment substantially. We also find that these early investments are linked to gains in women’s paid labor at prime working ages and to greater support for women’s elderly parents (a marker for women’s bargaining power within the household). Notably, these incentive effects may be larger than the direct effects of family planning alone.

Kimberly Singer Babiarz , Jiwon Lee , Grant Miller , Tey Nai Peng and Christine Valente
Stock photo of a stethoscope, a computer keyboard, and charts
November 8, 2017

Six Reasons Why the Global Fund Should Adopt Health Technology Assessment

With aid budgets shrinking and even low-income countries increasingly faced with cofinancing requirements, this is the right time for global health funders such as the Global Fund and their donors to formally introduce Health Technology Assessment (HTA), both at the central operations level and at the national or regional level in recipient countries. In this CGD Note, we explain why introducing HTA is a good idea. Specifically, we outline six benefits that the application of HTA could bring to the Global Fund, the countries it supports, and the broader global health community.

Cover of Working Paper 467
October 23, 2017

Urban Water Disinfection and Mortality Decline in Developing Countries - Working Paper 467

We analyzed a large-scale municipal water disinfection program in Mexico in 1991 that rapidly increased access to chlorinated water. Our results suggest that childhood diarrheal disease mortality in Mexico would have declined by 86 percent if all municipalities had good quality infrastructure—a decline consistent with historical experience.

Sonia R. Bhalotra , Alberto Diaz-Cayeros , Grant Miller , Alfonso Miranda and Atheendar S. Venkataramani
Cover of Working Paper 464
October 11, 2017

Different Strokes for Different Folks: Experimental Evidence on the Effectiveness of Input and Output Incentive Contracts for Health Care Providers with Different Levels of Skills - Working Paper 464

A central issue in designing performance incentive contracts is whether to reward the production of outputs versus use of inputs: the former rewards efficiency and innovation in production, while the latter imposes less risk on agents.

Manoj Mohanan , Grant Miller , Katherine Donato , Yulya Truskinovsky and Marcos Vera-Hernández
What's In, What's Out? Designing Benefits for Universal Health Coverage
October 10, 2017

What's In, What's Out: Designing Benefits for Universal Health Coverage

What’s In, What’s Out: Designing Benefits for Universal Health Coverage argues that the creation of an explicit health benefits plan—a defined list of services that are and are not available—is an essential element in creating a sustainable system of universal health coverage. With contributions from leading health economists and policy experts, the book considers the many dimensions of governance, institutions, methods, political economy, and ethics that are needed to decide what’s in and what’s out in a way that is fair, evidence-based, and sustainable over time.

Amanda Glassman , Ursula Giedion and Peter C. Smith
Cover of What's In What's Out factsheet
October 10, 2017

What’s In, What’s Out: Designing Benefits for Universal Health Coverage: Key Messages for Donors and Advocates

Many low- and middle-income countries aspire to universal health coverage (UHC), but for rhetoric to become reality, the health services offered must be consistent with the funds available, which may require tough tradeoffs. An explicit health benefits package—a defined list of services that are and are not subsidized—is essential in creating a sustainable UHC system.

Credit: Pippa Ranger/Department for International Development
August 21, 2017

Good Quality Evaluations for Good Policy: Findings and Recommendations from Aid Agency Evaluations in Global Health

Evaluations are key to learning and accountability yet their usefulness depends on the quality of their evidence and analysis. This brief summarizes the key findings of a CGD Working Paper that assessed the quality of aid agency evaluations in global health. By looking at a representative sample of evaluations—both impact and performance evaluations—from major health funders, the study authors developed 10 recommendations to improve the quality of such evaluations and, consequently, increase their usefulness.

William Savedoff , Janeen Madan Keller and Julia Goldberg Raifman
Cover of Working Paper 461
August 18, 2017

Evaluating Evaluations: Assessing the Quality of Aid Agency Evaluations in Global Health - Working Paper 461

We assessed the methodological quality of global health program evaluations from five major funders between 2009 and 2014. We found that most evaluations did not meet social science methodological standards in terms of relevance, validity, and reliability. Nevertheless, good quality evaluations made it possible to identify ten recommendations for improving evaluations, including a robust finding that early planning is associated with better quality.

Julia Goldberg Raifman , Felix Lam , Janeen Madan Keller , Alexander Radunsky and William Savedoff
June 8, 2017

Investing UK Aid in a Global Skills Partnership: Better Health at Home and Abroad

 A Global Skills Partnership combines training funded by donors with pre-agreed arrangements for qualified graduates to work temporarily overseas, usually in the donor country. This paper shows through one hypothetical example how a GSP for a specific sector (nursing) financed by a specific donor (the UK) delivering training in a specific country (Malawi) addresses critical nursing shortages in both countries.

April 25, 2017

Annual Report 2016

This annual report marks two milestones in 2016: CGD’s 15th anniversary and, at the end of the year, its first leadership transition, with founding president Nancy Birdsall being succeeded by Masood Ahmed.

The Center for Global Development

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