Telecommunication reform in Ghana

In 1996 Ghana privatized its incumbent telecommunications firm by selling 30 percent of Ghana Telecom to Telekom Malaysia, licensing a second network operator, and allowing multiple mobile firms to enter the market. The reforms yielded mixed results. Landline telephone penetration increased dramatically while the number of mobile subscribers surpassed even this higher level of fixed line subscribers. On the other hand, the network did not reach the levels the government hoped, the second network operator never really got off the ground, and the regulator remained weak and relatively ineffective. The sustainability of competition is unclear. The government ended Telekom Malaysia's management of Ghana Telecom and has invited Norway's Telenor as a strategic partner. What this means in practice remains unclear, and the process for selecting Telenor lacked any transparency. Meanwhile, some of the mobile firms are in precarious financial positions. Competition is still relatively strong, but its sustainability will depend on the government's future commitment to ensuring it.Economic Theory&Research,Public Sector Economics&Finance,Rural Communications,ICT Policy and Strategies,Environmental Economics&Policies

Health and poverty in Guatemala

Unlike many other countries in Latin America, Guatemala is only at the beginning of the demographic, and epidemiological transition. The population is young, is growing rapidly, and is still primarily rural. Guatemala is among the worst performers in terms of health outcomes in Latin America, with one of the highest infant mortality rates, and one of the lowest life expectancies at birth. Major causes of death in Guatemala still include treatable, and communicable diseases, such as diarrhea, pneumonia, cholera, malnutrition, and tuberculosis. A significant share of Guatemalans lack access to health care services. A combination of both supply- and demand-side constraints limit the ability of households to seek health care services in Guatemala, with supply-side constraints playing a more dominant role in rural areas than urban. Some progress has been made in reforming the health sector. Important steps have been taken on the institutional side, with health being one of the pilot ministries to decentralize financial management under the Integrated System for Health Care (SIAS program). Public spending has shifted toward preventive care, which is essential for treating the health problems faced by the poor. Despite these efforts, spending and health outcomes has not improved significantly. In addition, public spending on health is not well targeted. Overall, public health spending benefits the highest quintiles disproportionately, By type of facility, public spending on hospitals is by far the more regressive.Health Systems Development&Reform,Health Monitoring&Evaluation,Early Child and Children's Health,Public Health Promotion,Disease Control&Prevention,Health Systems Development&Reform,Health Economics&Finance,Health Indicators,Adolescent Health,Health Monitoring&Evaluation

Malnutrition and poverty in Guatemala

The objective of this paper is to document the extent, and distribution of child, and adult malnutrition in Guatemala; to analyze the relationship between selected child, maternal, household and community characteristics, and children's nutritional status; and, to outline the implications of the most important findings for nutritional policy. The prevalence of chronic malnutrition among Guatemalan children in 2000, was the highest in Latin America, and among the highest in the world. The data show very strong socioeconomic, and geographic inequality. The econometric analysis reveals a strong impact of income, and of inter-generational effects. Education of adults in the household, and the availability of infrastructure, are other important determinants of children's growth attainment. Finally, even controlling for income, and other household and community characteristics, ethnicity remains an important determinant of child nutritional status. The study also reveals an increasing prevalence of excess weights, and obesity among children and adults. Over-nutrition tends to be higher among individuals living in urban areas, and among non-poor, and non-indigenous households.Health Monitoring&Evaluation,Early Child and Children's Health,Primary Education,Public Health Promotion,Early Childhood Development,Early Childhood Development,Youth and Governance,Nutrition,Health Monitoring&Evaluation,Early Child and Children's Health

Intellectual property rights, licensing, and innovation

There is considerable debate in economics literature on whether a decision by developing countries to strengthen their protection of intellectual property rights (IPRs) will increase or reduce their access to modern technologies invented by industrial countries. This access can be achieved through technology transfer of various kinds, including foreign direct investment and licensing. Licensing is the focus of this paper.To the extent that inventing firms choose to act more monopolistically and offer fewer technologies on the market, stronger IPRs could reduce international technology flows. However, to the extent that IPRs raise the returns to innovation and licensing, these flows would expand. In theory, the outcome depends on how IPRs affect several variables-the costs of, and returns to, international licensing; the wage advantage of workers in poor countries; the innovation process in industrial countries; and the amount of labor available for innovation and production. The authors develop a theoretical model in which firms in the North (industrial countries) innovate products of higher quality levels and decide whether to produce in the North or transfer production rights to the South (developing countries) through licensing. Different quality levels of each product are sold in equilibrium because of differences in consumers'willingness-to-pay for quality improvements. Contracting problems exist because the inventors in the North must indicate to licensees in the South whether their product is of higher or lower quality and also prevent the licensees from copying the technology. So, constraints in the model ensure that the equilibrium flow of licensing higher-quality goods meets these objectives. When the South strengthens its patent rights, copying by licensees is made costlier but the returns to licensing are increased. This change affects the dynamic decisions regarding innovation and technology transfer, which could rise or fall depending on market parameters, including the labor available for research and production. Results from the model show that the net effects depend on the balance between profits made by the Northern licensor and lower labor costs in the South. If the size of the labor force used in Northern innovation compared with that used in producing goods in both the North and South is sufficiently small (a condition that accords with reality), stronger IPRs in the South would lead to more licensing and innovation. This change would also increase the Southern wage relative to the Northern wage. So, in this model a decision by developing countries to increase their patent rights would expand global innovation and increase technology transfer. This result is consistent with recent empirical evidence. It should be noted that while the results suggest that international agreements to strengthen IPRs should expand global innovation and technology transfer through licensing, the model cannot be used for welfare analysis. Thus, while the developing countries enjoy more inward licensing, the cost per license could be higher, and prices could also rise, with an unclear overall effect on economic well-being.Agricultural Research,Environmental Economics&Policies,Knowledge Economy,Labor Policies,Economic Theory&Research,Environmental Economics&Policies,Economic Theory&Research,Education for the Knowledge Economy,Knowledge Economy,Agricultural Research

The epidemiological impact of an HIV vaccine on the HIV/AIDS epidemic in Southern India

The potential epidemiological impact of preventive HIV vaccines on the HIV epidemic in Southern India is examined using a mathematical deterministic dynamic compartmental model. Various assumptions about the degree of protection offered by such a vaccine, the extent of immunological response of those vaccinated, and the duration of protection afforded are explored. Alternative targeting strategies for HIV vaccination are simulated and compared with the impact of conventional prevention interventions in high-risk groups and the general population. The impact of disinhibition (increased risk behavior due to the presence of a vaccine) is also considered. Vaccines that convey a high degree of protection in a share of or all of those immunized and that convey life-long immunity are the most effective in curbing the HIV epidemic. Vaccines that convey less than complete protection may also have substantial public health impact, but disinhibition can easily undo their effects and they should be used combined with conventional prevention efforts. Conventional interventions that target commercial sex workers and their clients to increase condom use can also be highly effective and can be implemented immediately, before the arrival of vaccines.Poverty and Health,Disease Control&Prevention,Health Monitoring&Evaluation,Public Health Promotion,HIV AIDS,HIV AIDS,Health Monitoring&Evaluation,Adolescent Health,HIV AIDS and Business,Health Service Management and Delivery

Trade liberalization and labor market adjustment in Brazil

The authors study the impact of the 1988-94 trade liberalization in Brazil on wage distribution. They explore three main channels through which trade liberalization could have affected wage distribution: (1) increasing returns to skilled workers because of Hecksher-Ohlin adjustments to trade policy; (2) trade-induced skill-biased technological change; and (3) changes in industry wage premiums. The results suggest that trade reform inBrazil did contribute to the growing skill premium through skill-biased technological change, which was partially instigated by increased foreign competition. The authors also find that sector-specific returns to skill increased more in sectors with bigger tariff reductions. But they find little support for Hecksher-Ohlin type adjustments to trade reform. Overall, the effects of trade reform on wage inequality seem relatively small.Water and Industry,Municipal Financial Management,Health Monitoring&Evaluation,Environmental Economics&Policies,Public Health Promotion,Municipal Financial Management,Health Monitoring&Evaluation,TF054105-DONOR FUNDED OPERATION ADMINISTRATION FEE INCOME AND EXPENSE ACCOUNT,Environmental Economics&Policies,Water and Industry

The strategic use and potential demand for an HIV vaccine in Southern Africa

HIV prevalence in Southern Africa is the highest in the world and the impact of HIV/AIDS in the region are devastating at all levels of society, including the wider economy. Government response has lagged behind the pace of the epidemic, but programs are now beginning to focus on a broad range of interventions to combat its further spread and to mitigate its impact. The authors investigate the issues around the targeting of an eventual HIV vaccine. There is at present no vaccine against HIV. Although several candidates are in the trial stage, it is not likely that a vaccine effective against the sub-type of the virus prevalent in Southern Africa will be available for 10-15 years. When it is, it may be expensive, only partially effective, and confer immunity for a limited period only. Vaccination programs will need to make the best use of the vaccine that is available and effective targeting will be essential. The authors identify potential target groups for a vaccine, and estimate how many individuals would be in need of vaccination. They develop a method for estimating how many cases of HIV infection are likely to be avoided for each vaccinated individual. The cases avoided are of two kinds: primary-the individual case that might have occurred in people who are vaccinated, and secondary-the number of people that the vaccinated individual would otherwise have caused to become infected. Both ofthese depend on assumptions about the efficacy and duration of vaccine protection and the extent and nature of sexual risk behavior in the population groups. The authors distinguish between the HIV cases averted per vaccination and the cases averted per 100 recruits into a vaccination program. The cases averted per 100 recruits is used to develop a priority ranking of the identified population groups for vaccination. The authors discuss the issue of ease of access to those groups and how the differential costs would affect the vaccination strategy. They conclude that an expensive vaccine should be administered to commercial sex workers first, while an inexpensive vaccine would be better administered first to general population groups, in particular, schoolchildren. The authors conclude with a discussion of current levels of public and private expenditure on HIV prevention and treatment, and the implications for an assessment of the willingness to pay for an eventual HIV vaccine.Disease Control&Prevention,Health Monitoring&Evaluation,HIV AIDS,Public Health Promotion,Early Child and Children's Health,Adolescent Health,Health Economics&Finance,HIV AIDS and Business,Health Monitoring&Evaluation,HIV AIDS

Rural extension services

The authors analyze the considerations that lead policymakers to undertake extension investments as a key public responsibility, as well as the complex set of factors and intra-agency incentives that explain why different extension systems'performance vary. The authors provide a conceptual framework outlining farmers'demand for information, the welfare economic characterizations of extension services, and the organizational and political attributes that govern the performance of extension systems. They use the conceptual framework to examine several extension modalities and to analyze their likely and actual effectiveness. Specifically, the modalities reviewed include"training and visit"extension, decentralized systems,"fee-for-service"and privatized extension, and farmer-field-schools. The authors also discuss methodological issues pertaining to the assessment of extension outcomes and review the empirical literature on extension impact. They emphasize the efficiency gains that can come from locally decentralized delivery systems with incentive structures based largely on private provision that in most poorer countries is still publicly-funded. In wealthier countries, and for particular higher income farmer groups, extension systems will likely evolve into fee-for-service organizations.Decentralization,Agricultural Knowledge&Information Systems,Environmental Economics&Policies,ICT Policy and Strategies,Health Economics&Finance,Agricultural Knowledge&Information Systems,ICT Policy and Strategies,Environmental Economics&Policies,Health Economics&Finance,Knowledge Economy

Determinants of Nutritional Outcomes of Children in India: A Quantile Regression Approach

In this paper, we use quantile regressions on data from the 2005-06 wave of the Indian National Family Health Survey to study the determinants of child body-mass-index, height-for-age, and hemoglobin at different points of the conditional distribution. Our results show that only considering the conditional mean of the entire distribution can yield misleading results. In light of compelling evidence on sex-selective abortion and infanticide, we use a Heckman correction for our quantile regression to control for the “underreporting” of female births documented by Rose (1999). We find that household maternal health and education have larger effects at the lower end of the distribution than on the upper end, for all three child nutritional indicators. Results show that iron supplements are less effective at increasing hemoglobin levels in the worst-off children. We argue that policy interventions must account for socioeconomic diversity or have little hope of meeting their target.Food Consumption/Nutrition/Food Safety, International Development,

Short but not sweet - new evidence on short duration morbidities from India

India spends 6 percent of its GDP on health-three times the amount spent by Indonesia and twice that of China-and spending on non-chronic morbidities is three times that of chronic illnesses. It is normally assumed that the high spending on non-chronic illnesses reflects the prevalence of morbidities with high case-fatality or case-disability ratios. But there is little data that can be used to separate out spending by type of illness. The authors address this issue with a unique dataset where 1,621 individuals in Delhi were observed for 16 weeks through detailed weekly interviews on morbidity and health-seeking behavior. The authors'findings are surprising and contrary to the normal view of health spending. They define a new class of illnesses as"short duration morbidities"if they are classified as non-chronic in the international classification of disease and are medically expected to last less than two weeks. The authors show that short duration morbidities are important in terms of prevalence, practitioner visits, and household health expenditure: Individuals report a short duration morbidity in one out of every five weeks. Moreover, one out of every three weeks reported with a short duration morbidity results in a doctor visit, and each week sick with such a morbidity increases health expenditure by 25 percent. Further, the absolute spending on short duration morbidities is similar across poor and rich income households. The authors discuss the implications of these findings in understanding household health behavior in an urban context, with special emphasis on the role of information in health-seeking behavior.Health Systems Development&Reform,Public Health Promotion,Disease Control&Prevention,Health Monitoring&Evaluation,Health Economics&Finance,Health Monitoring&Evaluation,Health Economics&Finance,Health Systems Development&Reform,Environmental Economics&Policies,Housing&Human Habitats