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  • Author: Cindy Huang, Jimmy Graham
  • Publication Date: 05-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: There are over 68.5 million forcibly displaced people in the world, including about 40 million Internally Displaced Persons (IDPs) who have moved because of conflict, including political, communal, and criminal violence.[i] There are millions more IDPs who have been displaced by other drivers, including disasters, economic instability, and development projects such as infrastructure construction. These IDPs, 99 percent of whom are in low- and middle-income countries (LMICs), face severe economic challenges as a result of displacement.[1] To help them overcome these challenges, policymakers should focus on helping IDPs achieve greater self-reliance. The best approach to doing so will depend in large part upon the context—particularly the extent to which IDP populations are based in urban or rural areas. Our analysis shows that about half of IDPs in LMICs are in urban areas, that the composition varies significantly across countries, and that there is a substantial lack of IDP location data.
  • Topic: Displacement, Urban, Rural, Internal Displacement , Economic Integration
  • Political Geography: Global Focus
  • Author: Cindy Huang, Jimmy Graham
  • Publication Date: 05-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: As of December 2017, there were over 68.5 million forcibly displaced people in the world, including about 40 million Internally Displaced Persons (IDPs) displaced by conflict.[1] Millions more were displaced internally by other drivers, including disasters, economic instability, and development projects such as infrastructure construction.[2] IDPs face severe economic challenges as a result of their displacement, with harmful impacts on consumption, health, education, security, housing, labor conditions, and social outcomes.[3] They face these challenges for long periods of time: IDPs often spend many years or even decades displaced.[4] And for displaced women and girls—who face unique challenges ranging from legal restrictions on owning property to larger wage reductions following displacement—the economic challenges can be even greater.[5] Furthermore, IDPs tend to be disproportionately located in low- and middle-income countries (LMICs): over 99 percent of the world’s IDPs displaced by conflict are in LMICs. Within these countries, populations in more marginalized areas are often more severely affected by displacement.[6] Thus, those who are displaced tend to face greater economic difficulties to begin with and displacement only compounds these difficulties.
  • Topic: Displacement, Urban, Internal Displacement , Economic Integration
  • Political Geography: Global Focus
  • Author: Kalipso Chalkidou, Nishant Jain, Françoise Cluzeau, Amanda Glassman
  • Publication Date: 05-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Hailed as one of the largest publicly funded health insurance programs in the world, India’s “Modicare” has, since its launch a little more than six months ago, made universal healthcare coverage an election theme for the first time in the country’s history.[1] In this note, we describe the program, with an emphasis on its better-known secondary and tertiary care component, and offer policy recommendations to strengthen the scheme post-election to enhance its contribution to India’s vision for universal health coverage (UHC). In a country of almost 1.4 billion people that is home to one-third of global maternal deaths, where public spending for health accounts for roughly 1 percent of GDP and where 60 million people fall into poverty every year because of healthcare bills, fixing healthcare is a daunting task that will determine the world’s performance against the Sustainable Development Goals over the coming decade.
  • Topic: Health, Health Care Policy, Public Health, Health Insurance
  • Political Geography: India, Asia
  • Author: Scott Morris
  • Publication Date: 05-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The Kunming-Vientiane (K-V) railway, part of the Kunming-Singapore multi-country rail network (or “Pan-Asia Railway”), is an anchor investment of the Chinese government’s Belt and Road initiative (BRI). This case study will assess the rail project along four dimensions: economic implications; procurement arrangements; labor; and environmental and social safeguards. In each of these areas, evidence from the railway project suggests that Chinese policy and practice could be better aligned with the practices of other sources of multilateral and bilateral development finance. Where the project’s standards are broadly aligned, at least in principle, there is nonetheless reason to believe that China’s approach carries heightened risks given the overall scale of financing. These risks hold for China’s global program of official finance, which has made the country the largest source of official credit in the world. In this regard, BRI policymakers should consider a more rigorous set of “best practices” that align Chinese official finance with leading multilateral standards, even if these practices don’t currently characterize many other bilateral lenders. Such an approach would be consistent with the multilateral vision for BRI espoused by Chinese officials and reflected in the framework of the annual Belt and Road Forum for International Cooperation. This study considers what a stronger set of standards would look like in the context of the four areas of focus.
  • Topic: Infrastructure, Belt and Road Initiative (BRI), Transportation, Railways
  • Political Geography: China, Asia
  • Author: Michael Pisa
  • Publication Date: 05-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: As the organization responsible for setting international standards on anti-money laundering and countering the financing of terrorism (AML/CFT), the Financial Action Task Force (FATF) has encouraged countries to design measures that protect the integrity of the financial system and support financial inclusion. But it has also received criticism that poor implementation of its standards can undermine financial access. One of the FATF’s main tools for compelling effective use of its standards is the mutual evaluation process, which relies on peer reviews to assess countries’ level of compliance with the FATF Recommendations. We explore whether these reviews have been conducted in a way that helps or hinders national efforts to promote financial inclusion by reviewing the 33 developing country mutual evaluations that took place between 2015-2018. Overall, these findings suggest that assessment teams have conducted mutual evaluations in a way that supports efforts to promote financial inclusion and the flexible use of simplified measures. There is, however, inconsistency in how assessors treat risks emanating from financial exclusion, which suggests the need for a more systematic approach to evaluating these risks.
  • Topic: Development, Terrorism, Finance, Financial Integrity
  • Political Geography: Global Focus
  • Publication Date: 05-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Internationally set goals and guidelines directly influ­ence the setting of health care priorities at the national level, affecting how limited resources are generated and allocated across health care needs. The influence of global priority setting, such as through the formu­lation of overarching goals or normative guidelines for specific disease areas, is particularly significant in low- and middle-income countries that rely heavily on overseas development assistance. Because no sys­tematic approach exists for dealing with resource con­straints, however, which vary across countries, goals and guidance are often inappropriate for some country contexts; their implementation can, therefore, reduce the efficiency and equity of health care spending. The Working Group on Incorporating Economics and Modelling in Global Health Goals and Guidelines, co-convened by the Center for Global Development, Thanzi la Onse, and the HIV Modelling Consortium, has brought together disease specialists, policymakers, economists, and modelers from national governments, international organizations, and academic institutions across the globe to address these issues, to take stock of current approaches, and make recommendations for better practice. The Working Group deliberated on the roles and purposes of goals and guidelines and consid­ered how economic evidence might be formally incor­porated into policy recommendations and health care decision making. The target audiences for this report are international health institutions, large stakehold­ers in disease programs across the world, and national governments.
  • Topic: Development, Health, Health Care Policy, Public Health
  • Political Geography: Global Focus
  • Author: Dan Hoing, Lant Pritchett
  • Publication Date: 05-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Accountability is rightly at the center of the conversation regarding how to improve governance systems, particularly health and education systems. But efforts to address accountability deficits often focus primarily on improving what can be counted and verified—what we term “accounting-based accountability.” We argue that introducing greater accounting-based accountability will only very rarely be the appropriate solution for addressing accountability problems. We illustrate this by exploring the role of Accountability ICT in (not) improving education system performance. Strengthening “real” accountability is not the same as improving data systems for observation and verification, and often attempts at the latter undermine the former. The development discourse’s frequent semantic misunderstanding of the term “accountability” has pernicious real-world consequences with real effects on system reform efforts and ultimately global welfare.
  • Topic: Education, Governance, Accountability, Welfare
  • Political Geography: Global Focus
  • Author: Felice Apter, Amanda Glassman, Janeen Madam Keller
  • Publication Date: 05-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Next week, Women Deliver—the world’s largest conference on gender equality and the health, rights, and wellbeing of women and girls—will kick off. At just around 200 days before the calendar turns to 2020, this conference is an opportunity for the family planning (FP) community—including the FP2020 Core Partners (the Bill & Melinda Gates Foundation, DFID, UNFPA, and USAID) and Reference Group—to review lessons from the past eight years and look forward beyond 2020, the landmark that has long dominated FP discussions. The key question: In a rapidly changing context, how can the FP community sustain gains and realize the benefits of high-quality FP access in low- and middle-income countries, including lower maternal mortality, better newborn and child health, and increased women’s empowerment?[1] This note highlights three issues for the global FP movement post-2020, building on CGD’s engagement in this space, including our working group on alignment in family planning.[2] We review the underlying critical assumptions in FP2020’s initial design along with their strengths and weaknesses, and place future approaches squarely within the context of today’s evolving landscape—one that looks very different than the year 2012, when FP2020 was launched.
  • Topic: Gender Issues, Feminism, Family Planning, Sex Education
  • Political Geography: Global Focus
  • Author: Liesl Schnabel, Cindy Huang
  • Publication Date: 06-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: In August 2017, widespread violence carried out with “genocidal intent” in Myanmar forced 745,000 Rohingya to flee to Bangladesh and settle in camps in Cox’s Bazar.[1] Fifty-two percent of the refugee population there are women and girls.[2] Those of reproductive age are in dire need of emergency and longer-term sexual and reproductive health and rights (SRHR)[3] services. Many have additional needs related to sexual trauma experienced in Myanmar and/or in Bangladesh.[4],[5] For many, these needs are not being fully met due to implementation and access barriers.
  • Topic: Gender Issues, Health, Women, Reproductive Rights, Sexual Health
  • Political Geography: Asia, Myanmar
  • Author: Janeen Madam Keller, William Savedoff
  • Publication Date: 06-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The availability and affordability of health products—medicines, diagnostics, devices, and equipment—are critical to achieving universal health coverage and improving health outcomes. Yet low- and middle-income countries face multiple challenges in procuring health products related to institutional inefficiencies, market failure, and fragmented demand. At the same time, the world is evolving rapidly in ways that will affect health procurement, from changes in countries’ eligibility for foreign assistance to advances in information technologies. Looking forward, efforts to improve global health procurement must proactively address the sweeping changes on the horizon. Drawing on a range of political, economic, and social trends, this paper envisions how the global landscape might change between now and 2030, with a focus on the implications for global health, particularly the procurement of health products. The paper develops three possible but distinct futures—worlds characterized as atomistic, privately led, or multilateral.It concludes by describing the policy options and locus of action to improve global health procurement in light of these scenarios, emphasizing three areas of work: financing and modes of collaboration, procurement procedures and tools, and procurement capacity.
  • Topic: Health, Health Care Policy, Public Health, Health Crisis
  • Political Geography: Global Focus