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  • Author: Rachel Silverman, Janeen Madan Keller, Amanda Glassman, Kalipso Chalkidou
  • Publication Date: 07-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive. Access to medicines, diagnostics, devices, and equipment is driven in large part by the efficiency of their procurement. Procurement is, therefore, central to the efforts of low- and middle-income countries to improve health, meet the Sustainable Development Goals, and achieve universal health coverage. Health product purchasing in low- and lower-middle-income countries already makes up a sizeable share of overall health spending; in fact, in just a subset of these countries, spending on health products totals an estimated $50 billion per year.[1] Procurement is not only essential to the missions of global health entities like the Global Fund, Gavi, UNICEF, UNFPA, and PEPFAR, but it also represents big money. In the case of the Global Fund, health product procurement accounts for $2 billion per year,[2] or almost half of its 2017 disbursements.[3] Yet despite its importance, procurement is an underappreciated health system function. Today’s procurement systems are hobbled by inefficiencies that leave some of the poorest countries paying some of the highest drug prices in the world.
  • Topic: Health, Public Health, Transition, Procurement
  • Political Geography: Global Focus
  • Author: Alan Gelb, Anit Mukherjee
  • Publication Date: 07-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Reforming inefficient and inequitable energy subsidies continues to be an important priority for policymakers as does instituting “green taxes” to reduce carbon emissions. Simply increasing energy prices will have adverse impact on poorer consumers, who may spend substantial budget shares on energy and energy-intensive products even though the rich typically appropriate more of the price subsidy. Equitable pricing reforms therefore need to be accompanied by programs to transfer compensation: depending on the situation, this can be targeted or universal. Successful reforms require measures to raise awareness-of the subsidies and the problems they cause, effective dissemination of the reform to the population, and rapid feedback loops to facilitate mid-course corrections. Digital technology, including for unique identification and payments, as well as general communications, can help build government capacity to undertake such reforms and respond to changes in fuel markets. The paper outlines the use of digital technology, drawing on four country cases. The technology is only a mechanism; it does not, in itself, create the political drive and constituency to push reform forward. However, it can be employed in a number of ways to increase the prospects for successful and sustainable reform.
  • Topic: Climate Change, Energy Policy, Environment, Science and Technology, Reform, Digitalization
  • Political Geography: Africa, Middle East, India, Latin America
  • Author: Michael Clemens, Helen Dempster, Kate Gough
  • Publication Date: 07-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The world is experiencing significant demographic shifts. By 2100, Europe’s working-age population will have declined, and sub-Saharan Africa’s working-age population will have greatly increased. Many of these new labor market entrants will seek opportunities in Europe, plugging skill gaps and contributing to economies in their countries of destination. Germany is one country piloting and implementing projects that can help alleviate such demographic pressures and maximize the potential mutual benefits of legal labor migration. We discuss these projects, and highlight differences in their potential impact on development in the country of origin. We recommend that European governments build on, adapt, and pilot-test one of Germany’s approaches, also known as the Global Skill Partnership model: training potential migrants in their countries of origin before migration, along with non-migrants. Ideally, governments should pursue such pilot-tests with those countries that exhibit rising future migration pressure to Europe, particularly in sub-Saharan Africa. Neither the conclusion nor the results of this analysis reflect the opinion of the Federal Ministry of Economic Cooperation and Development (BMZ) or Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ).
  • Topic: Migration, Labor Issues, Immigration, Border Control
  • Political Geography: Africa, Europe, Germany, Sub-Saharan Africa
  • Author: David Evans, Fei Yuan
  • Publication Date: 07-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Despite dramatic global gains in access to education, 130 million girls of school age remain out of school. Among those who do enter, too many do not gain the essential skills to succeed after they complete their schooling. Previous efforts to synthesize evidence on how to improve educational outcomes for girls have tended to focus on interventions that are principally targeted to girls, such as girls’ latrines or girls’ scholarships. But if general, non-targeted interventions—those that benefit both girls and boys—significantly improve girls’ education, then focusing only on girl-targeted interventions may miss some of the best investments for improving educational opportunities for girls in absolute terms. This review brings together evidence from 270 educational interventions from 177 studies in 54 low- and middle-income countries and identifies their impacts on girls, regardless of whether the interventions specifically target girls. The review finds that to improve access and learning, general interventions deliver gains for girls that are comparable to girl-targeted interventions. At the same time, many more general interventions have been tested, providing a broader menu of options for policy makers. General interventions have similar impacts for girls as for boys. Many of the most effective interventions to improve access for girls are household-based (such as cash transfer programs), and many of the most effective interventions to improve learning for girls involve improving the pedagogy of teachers. Girl-targeted interventions may make the most sense when addressing constraints that are unique to girls.
  • Topic: Education, Children, Women, Feminism
  • Political Geography: Global Focus
  • Author: Jeremy Konyndyk
  • Publication Date: 12-2018
  • Content Type: Commentary and Analysis
  • Institution: Center for Global Development
  • Abstract: The Government Reform and Reorganization Plan released earlier this year by the White House calls for substantial reform of US humanitarian institutions. The plan mandates that the State Department and USAID produce a “specific reorganization proposal” to “optimize” humanitarian assistance and “eliminate duplication of efforts and fragmentation of decision-making.” This policy note lays out guidance for how an ambitious but feasible optimization could be achieved. It is informed by two high-level private roundtables convened by the Center for Global Development to solicit expert input, as well as a desk review of documents, expert interviews, and the author’s own experiences serving in the humanitarian arms of both USAID and the State Department. While numerous experts contributed thoughts and feedback, the author takes sole responsibility for the views represented herein.
  • Topic: International Affairs
  • Political Geography: Global Focus
  • Author: Todd Moss
  • Publication Date: 12-2018
  • Content Type: Research Paper
  • Institution: Center for Global Development
  • Abstract: After nearly thirty years of working on and in Zimbabwe, I was hopeful, after the long nightmare of misrule by Robert Mugabe, that the July 2018 election was an opportunity to put the country on a positive track. I had the good fortune of visiting Zimbabwe with a delegation of former US diplomats prior to the election to assess conditions. I came away from that trip deeply pessimistic about the prospects for a free, fair, and credible election, unconvinced that economic reforms were real, and skeptical of the intentions of Emmerson Mnangagwa and the ruling ZANU-PF. It all appeared little more than a poorly-disguised charade.
  • Topic: International Affairs
  • Political Geography: Global Focus
  • Author: Susannah Hares
  • Publication Date: 12-2018
  • Content Type: Commentary and Analysis
  • Institution: Center for Global Development
  • Abstract: It’s tricky to evaluate government education policies. They’re not implemented in NGO-like laboratory conditions, and political motivation and public sector capacity constraints play as much of a role in their success or failure as policy design. Using the examples of three rigorous studies of three different education policies, this note aims to shed some light from the perspective of someone on the policy side on how, why, and when to evaluate government-led reforms. A government education policy is not an abstract theory that can easily be replicated in a different place. In each new context, it is effectively a brand-new programme and needs to be evaluated as that. None of the three examples presented was “new” as a policy: school inspections, school vouchers, and charter schools have all been tried and evaluated elsewhere. But the evaluations of these policies—when implemented in new contexts—illuminated a new set of challenges and lessons and generated a different set of results.
  • Topic: Education, International Affairs
  • Political Geography: Global Focus
  • Author: Michael Clemens, Kate Gough
  • Publication Date: 11-2018
  • Content Type: Research Paper
  • Institution: Center for Global Development
  • Abstract: The world needs better ways to manage international migration for this century. Those better ways finally have a roadmap: the Global Compact for Migration. Now begins the journey. National governments must lead in order to implement that Compact, and they need tools. One promising tool is Global Skill Partnerships. This brief explains what Global Skill Partnerships are and how to build them, based on related experiences around the world.
  • Topic: International Affairs
  • Political Geography: Global Focus
  • Author: Scott Morris
  • Publication Date: 12-2018
  • Content Type: Research Paper
  • Institution: Center for Global Development
  • Abstract: First, we should recognize that much of the value of the IFIs for the United States derives from their multilateral character. It greatly oversimplifies things to suggest they are strictly a US tool, available to do our bidding no matter what the issue. The reality is that when we want to get something done in these multilateral institutions, we need to work with other countries. In turn, these institutions are most effective when they have the buy-in of the largest number of their member countries. And when the United States is seeking something from them that doesn’t have broad-based support, it can be a tough road.
  • Topic: Global Political Economy
  • Political Geography: Global Focus
  • Author: Nancy Birdsall
  • Publication Date: 12-2018
  • Content Type: Special Report
  • Institution: Center for Global Development
  • Abstract: Does governance matter for the long-run financing of the multilateral development banks? The structure of governance of the legacy MDBs (the World Bank and the four major regional development banks founded in the twentieth century) ideally should minimize any tradeoff between the confidence of creditor shareholding countries, on which an MDB’s own financing depends, and the sense of ownership, legitimacy, and trust of borrowing countries, on which the MDB’s effectiveness in supporting development in those borrowing countries depends. Among the five legacy MDBs, the African Development Bank stands out as the one where the governance arrangements, including the distribution of shares and votes between borrowers and nonborrowers, most favors borrowers. Indicators of the AfDB’s relative financial strength (a measure of creditworthiness based on sovereign members’ vote shares, and a measure of the capacity of each bank’s members to engage in collective action or cooperation in raising financing) indicate that its current governance is likely to make it less competitive than its sister MDBs in sustaining creditor (or “donor”) confidence in its operations over the long run, and thus in raising substantial capital and concessional resources. The governance problem is most obvious in the case of the African Development Bank’s African Development Fund, which today has only about 15 percent of the resources the World Bank has for Africa. The creditors of the AfDB have sufficient control to ensure the Bank’s financial soundness (and AAA rating), but a collective action constraint in pushing for reforms in the Bank’s operations. The paper concludes with ideas for long-run reform of governance at the African Development Bank, modeled more closely on the governance of the Inter-American Development Bank.
  • Topic: International Affairs
  • Political Geography: Global Focus