Promoting innovation: Lessons from the Global Fund

By Guido Schmidt-Traub, Executive Director, Sustainable Development Solutions Network

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Since its inception in 2001, the Global Fund to Fight AIDS, Tuberculosis and Malaria has become a highly respected pooled financing institution that scores top marks in independent reviews.1, 2

It has disbursed some USD 40 billion in grants for complex disease control and treatment programmes in fragile and non-fragile countries alike.

Success was far from assured in 2001, as developing countries, particularly in sub-Saharan Africa, faced a perfect storm of surging HIV/AIDS, multi-drug-resistant tuberculosis and surging malaria deaths. Control and treatment interventions were available in high-income countries, but no one knew how to tackle the diseases in resource-poor settings. In particular, HIV/AIDS treatment was deemed impossible in Africa and was outside recommended approaches for tackling the disease.3

The Global Fund was designed precisely to tackle the lack of quality programmes and implementation mechanisms in developing countries. All too often, however, it is seen as just another funding mechanism. Many reviews lump it together with other multilateral mechanisms and trust funds.4

This is a mistake. The Global Fund has unique design principles that set it apart from bi- and multilateral financing mechanisms with the notable exception of Gavi.5

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Infrastructure, jobs, good governance: Bringing Africans’ priorities to the G20 table

By Michael Bratton, University Distinguished Professor of Political Science and African Studies at Michigan State University and senior adviser to Afrobarometer, and E. Gyimah-Boadi, Executive Director of Afrobarometer and the Ghana Center for Democratic Development

 

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Beyond the limelight and the headlines, the recent Group of 20 (G20) summit accomplished an important piece of business by launching the Compact with Africa. The next step is crucial: negotiating the priorities that the compact will address.

One key concept is that the compact is with – rather than for – Africa, implying that it will rely on true partnerships to pursue mutually agreed-upon goals.

With its contribution to a “20 Solutions” document presented to the G20 by a consortium of think tanks, the pan-African research network Afrobarometer is working to ensure that the compact will take into account what ordinary Africans say they want and need.

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Girls robbed of their childhood in the Sahel

By Laurent Bossard, Director, Sahel and West Africa Club Secretariat (SWAC/OECD)

In Mali, Niger and Chad, 40% of children under five suffer from stunting. These children do not receive enough nutrients. Their bodies — their brains, bones and muscles — do not get enough calcium, iron or zinc or enough vitamins (A, B2, B12 etc.), so they do not have enough energy to grow and develop. Many of these children will suffer from chronic diseases and will have cognitive problems — so they won’t be able to go to school for long, if at all. As adults, they will have little chance to flourish and, secondarily, will have low economic productivity. Many will also die very young, often before turning five.

In these countries, at least 100 children out of every thousand die before reaching the age of five. That’s 10 times more than in Sri Lanka, 20 times more than in Canada and 50 times more than in Luxembourg. Why are these children dying and why are they doomed to a hopeless future?  Continue reading

Human development and the 2030 Agenda: Effecting positive change in people’s lives

By Selim Jahan, Director, Human Development Report Office, UNDP

humandevThis September marked the first anniversary of the adoption of the 2030 Agenda for Sustainable Development and the 17 Sustainable Development Goals (SDGs). As we shift into the implementation phase, increasingly I am asked: “How is the concept of human development linked to the 2030 Agenda? How is it relevant to the achievement of the new goals?”

The UN Millennium Declaration and the Millennium Development Goals already mirrored the basic principles of human development – expanding human capabilities by addressing basic human deprivations (ending extreme poverty and hunger, promoting good health and education, etc.).
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Speeding ahead with a rear-view vision: the looming crisis of air pollution in Africa

By Dr Rana Roy, Consulting Economist, author of The Cost of Air Pollution in Africa, OECD Development Centre Working Papers, 2016

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WHO Global map of modelled annual median concentration of PM2.5

Africa is speeding toward a new crisis: an explosive increase in air pollution, with all its human and economic costs.

Africa is by no means alone in suffering the modern curse of air pollution. No less than 92% of the world’s population is now exposed to pollution levels exceeding World Health Organisation limits.[1] Nor is Africa “over-represented” in the global death toll from air pollution as it stands today. The total of premature deaths attributable to each of the two main types of air pollution, ambient particulate matter pollution (APMP) and household air pollution (HAP), stood at around 3 million.[2] Of these, Africa accounted for around 250,000 premature deaths from APMP, less than its share of the global population would suggest, and over 450,000 premature deaths from HAP, roughly in line with its share. In comparison, it is China, with its 900,000 deaths from APMP and 800,000 deaths from HAP that dominated the global death toll in 2013. Continue reading

How middle class are middle-income households in Latin America?

By Ángel Melguizo (OECD Development Centre) and Nora Lustig (Tulane University)

On labour informality and its causes

 One of the most important achievements of the recent period of economic expansion in Latin America has been the substantial reduction of poverty and the surge of an emerging middle class. According to World Bank estimates (Ferreira et al, 2013), in 2009 the Latin American population with a daily income of between 4 and 50 dollars a day (in parity of purchasing power) represents 68% in the region today, compared with 29% who still are moderate poverty. These ‘middle sectors’ are composed of 38% belonging to a vulnerable population, which has between 4 and 10 dollars a day, and 30% middle class, between 10 and 50 dollars. Continue reading

India’s Development Tug-of-War: Which side will win?

By Shailaja Chandra, Former Permanent Secretary of the Government of India and former Chief Secretary, Delhi; Former Executive Director, National Population Stabilisation Fund, India

For a chaotic country full of argumentative Indians many of whom are poor and uneducated, India’s continuous economic growth (not prosperity) remains a surprise. But something else is even more striking. The country has the world’s largest youngest population: 27 million babies are added each year. With such youth to bank on, India’s productivity seems to possess the best ingredients for success for decades to come.

But all great stories have another side that also must be told. Most births in India take place in some of the country’s poorest states where high fertility, low age of marriage, and a disproportionately large number of mother’s and children’s deaths present an ever-distressing picture. A group of five states have had the dubious distinction of accounting for around 45% of the country’s population, suffering and stymied from poor investments in health and education. No wonder these states were officially referred to as the BIMARU states, an acronym for their names of Bihar, Madhya Pradesh, Rajasthan, Odisha and Uttar Pradesh, which denotes much more since the word bimaru in Hindi means sickly.

For decades, these states have defied conventional experience about the process of development and held back the achievements of the rest of the country. The differences are stark: some other states in India reached replacement level of fertility as early as 1989 and 1992. Bihar, Madhya Pradesh, Rajasthan, Odisha and Uttar Pradesh, however, may need another five years to get there. The infant and maternal mortality in the progressive states is lower by half, and in some cases even 70% less, than in these laggard states.

Some 15 years ago, the Indian government decided to pay focused attention to these states, particularly in the highly neglected area of reproductive health. Around the same time, the five states were reorganised and became eight in number with the hope that being smaller would help them respond better to the process of development. They were rechristened the Empowered Action Group (EAG), and the pejorative title BIMARU was wiped out of the official vocabulary.  In 2005, the National Rural Health Mission, India’s largest-ever health programme, started pumping resources into these “high-focus states.”  Strategies included revamping rural health infrastructure, promoting health centre-based deliveries, facilitating access to emergency obstetric care, and assigning a trained health activist to make family-level contact, undertake pregnancy tracking and provide access to contraceptives.

Many hoped that with such a high dose of attention, the EAG would eventually catch up. Most, however, did not share this optimism, and not without reason. Even today, strong patriarchal attitudes continue to discriminate against women. Girls are denied access to schooling once they reach puberty. They are married off well before the legal age of 18 and subjected to a host of discriminatory barriers. The political leadership in most of these states has seldom accorded high priority to health or education; many have invested in perpetrating caste-based divisions in society. This backdrop naturally fails to inspire change.

Yet the good news is that by focusing attention on these laggard states and monitoring health indicators annually, a decline in fertility has begun and it is faster than anywhere else in the country. The increase in institutional deliveries has been impressive, and family health surveys and other research show that an increase in the age of marriage and greater use of contraception have contributed to lowering fertility. After decades of stagnation, the population growth rate in these states has registered a significant fall for the first time, dropping from 25% to 20.9%. From the point of view of women, the opportunity to have hospital-based deliveries stands out, complemented by such popular incentives as transportation to a health facility, compensation for leaving home, supplementary nutrition and contraception advice.

While these are positive trends, the push has to continue. These states will contribute 50% of India’s population within the next five years, equalling if not exceeding the combined population of the rest of India. The prospect of half of India holding back the other half is a dismal one. Only if the special efforts mounted receive commensurate political support that simultaneously encourage girls’ education and skill learning, later marriages and spacing between children will the laggard 50% eventually catch up. Happily, the process has begun.

India has been a member of the OECD Development Centre since 2001.


 

This article should not be reported as representing the official views of the OECD, the OECD Development Centre or of their member countries. The opinions expressed and arguments employed are those of the author.