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.
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.
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.
Keynote Address by Canadian Minister of International Development, Marie-Claude Bibeau, at the Third Annual Birdsall House Conference on Women
On December 7, 2017, Marie-Claude Bibeau, Minister of International Development and La Francophonie, Government of Canada, gave a keynote address at the the third annual Birdsall House Conference on Women, "Reproductive Choices to Life Chances: The Links between Contraception and Women’s Economic Empowerment."
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
In this paper, I examine the effects of power sharing on vulnerability to adverse shocks in a multiethnic setting.
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.
While the misuse of antimicrobials in human health is a key factor accelerating the emergence of drug resistance, we should not overlook the role of agriculture. This paper makes the case for a global treaty to reduce antimicrobial use in livestock.
In 2015, India's system of fiscal devolution underwent a radical transformation. This paper uses the experience of Brazil, China, and Mexico to draw important lessons on how India can use the opportunity of fiscal devolution to create a better system of health financing through better policy coordination between federal and local governments.