The goal of universal health coverage (UHC) requires that everyone receive needed health services, and that families who get needed services do not suffer undue financial hardship.
... See More + Tracking progress towards UHC requires measurement of both dimensions, and a way of trading them off. The authors measure service coverage (SC) by a weighted geometric average of four prevention and four treatment indicators, financial protection (FP) by the incidence of 'catastrophic' health expenditures (those exceeding ten percent of household consumption or income), and a country's UHC performance as a geometric average of the SC index and the complement of the incidence of catastrophic expenditures. They adjust SC for inequality, penalizing high-inequality countries. The authors obtain the bulk of our data from over 1,700 household surveys. A low incidence of catastrophic expenses sometimes reflects low SC (often in low-income countries) but sometimes occurs despite high SC (often in high-income countries). At a given level of SC, too, FP varies. UHC index scores are higher in higher-income countries, but there are variations within income groups. Adjusting the UHC index for inequality in SC makes little difference in some countries, but not all. Most countries have increased their UHC index, sometimes sharply, many by improving both UHC dimensions. Some have increased their UHC index despite reductions in FP by substantially increasing their SC. Some countries have seen their UHC index fall, mostly because FP has worsened with stagnant or declining SC. The SC and UHC index are significantly associated with GDP per capita and the share spent on health. Spending by social health insurance and government schemes is significantly associated with the SC index, FP and the UHC index, but spending by other schemes is not. It was concluded that the progress towards UHC can be tracked using an index that captures both SC and FP.
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Infrastructure—electricity, telecommunications, roads, water, and sanitation—are central to people’s lives. Without it, they cannot make a living, stay healthy, and maintain a good quality of life.
... See More + Access to basic infrastructure is also a key driver of economic development. This report lays out a framework for understanding infrastructure resilience - the ability of infrastructure systems to function and meet users’ needs during and after a natural hazard. It focuses on four infrastructure systems that are essential to economic activity and people’s well-being: power systems, including the generation, transmission, and distribution of electricity; water and sanitation—especially water utilities; transport systems—multiple modes such as road, rail, waterway, and airports, and multiple scales, including urban transit and rural access; and telecommunications, including telephone and Internet connections.
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Infrastructure—electricity, telecommunications, roads, water, and sanitation—are central to people’s lives. Without it, they cannot make a living, stay healthy, and maintain a good quality of life.
... See More + Access to basic infrastructure is also a key driver of economic development. This report lays out a framework for understanding infrastructure resilience - the ability of infrastructure systems to function and meet users’ needs during and after a natural hazard. It focuses on four infrastructure systems that are essential to economic activity and people’s well-being: power systems, including the generation, transmission, and distribution of electricity; water and sanitation—especially water utilities; transport systems—multiple modes such as road, rail, waterway, and airports, and multiple scales, including urban transit and rural access; and telecommunications, including telephone and Internet connections.
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Infrastructure—electricity, telecommunications, roads, water, and sanitation—are central to people’s lives. Without it, they cannot make a living, stay healthy, and maintain a good quality of life.
... See More + Access to basic infrastructure is also a key driver of economic development. This report lays out a framework for understanding infrastructure resilience - the ability of infrastructure systems to function and meet users’ needs during and after a natural hazard. It focuses on four infrastructure systems that are essential to economic activity and people’s well-being: power systems, including the generation, transmission, and distribution of electricity; water and sanitation—especially water utilities; transport systems—multiple modes such as road, rail, waterway, and airports, and multiple scales, including urban transit and rural access; and telecommunications, including telephone and Internet connections.
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Infrastructure—electricity, telecommunications, roads, water, and sanitation—are central to people’s lives. Without it, they cannot make a living, stay healthy, and maintain a good quality of life.
... See More + Access to basic infrastructure is also a key driver of economic development. This report lays out a framework for understanding infrastructure resilience - the ability of infrastructure systems to function and meet users’ needs during and after a natural hazard. It focuses on four infrastructure systems that are essential to economic activity and people’s well-being: power systems, including the generation, transmission, and distribution of electricity; water and sanitation—especially water utilities; transport systems—multiple modes such as road, rail, waterway, and airports, and multiple scales, including urban transit and rural access; and telecommunications, including telephone and Internet connections.
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This country brief provides an overview of tobacco control legislation, use, and taxation in the country. This country brief provides an overview of tobacco control legislation, use, and taxation in the country.
... See More + Nicaragua became a Party to the WHO Framework Convention on Tobacco Control in 2008 and was the first country in the world which ratified the FCTC Protocol to Eliminate Illicit Trade in Tobacco Products. Data on smoking prevalence and tobacco consumption in Nicaragua are scarce, and it is difficult to estimate recent tobacco consumption trends among adults. However, the decline in the prevalence of current smoking among GYTS participating adolescents from 20.4 percent in 2003 to 13.8 percent in 2014 among boys and from 12.8 percent in 2003 to 10.3 percent in 2014 among girls may be considered an indicator of tobacco control policy success. In 2009, Nicaragua switched from ad valorem to specific excise system for cigarettes. The specific excise tax rates and cigarette prices increased in 2012-2016. Available data demonstrate some decline in cigarette sales in Nicaragua in 2013-2017, as cigarettes became less affordable after the price increase and the taxation policy was beneficial for public health. Specific excise rates in 2017 and 2018 were increased by only 5 percent annually, and it was insufficient both for the reduction of tobacco affordability and for the increase of the government revenue. In February 2019, Nicaragua adopted rather substantial cigarette excise hikes: by 210 percent in 2019 and further by 25 percent in 2020 and 38 percent in 2021. These tax hikes are able to reduce tobacco consumption in the country and bring additional resources to the government coffers. However, the tobacco industry will probably try to distort positive results of the taxation reform. The government should be ready to counteract these tactics using the experience of other countries and conducting careful and timely monitoring of indicators of cigarette prices, supply, and sales. Tobacco use surveillance and monitoring should be developed in Nicaragua, including a regular collection of information on smoking prevalence, tobacco consumption and various economic indicators.
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Traditionally, improvements to accessibility for rural women through World Bank transport programs have been measured by the change in the number of villagers who live within 2 km of an all-weather or paved road.
... See More + Unfortunately, this indicator is not helpful for rural road maintenance or service planning, because the objective of our programs is not to maximize the number of persons living next to paved roads. Rather, it is to reduce travel times for the most villagers to the places they need to go, markets, schools, health clinics, etc. For example, if all roads traversing villages were paved, while the rest of the network is unpaved, we could achieve 100 percent success with the traditional indicator, without having actually improved the lives of the persons for which the project is intended.
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Report AUS0000817 JUN 18, 2019
Antos,Sarah Elizabeth; Qu,Li; Fox,Charles James Edward; Krambeck,HollyDisclosed
According to the WHO Global Status Report on Road Safety 2015, road crashes claim more than 1.2 million lives each year, most of which are in low- and middle-income countries, costing governments approximately three percent of their annual GDP.
... See More + While some road crashes can be predictable and preventable, efforts to systematically reduce crashes in resource-constrained environments have been stymied by lack of accurate, geo-referenced crash and health outcome data to support targeted interventions. To meet the UN Decade of Action goal of reducing global road fatalities by 50 percent by 2020, the UN emphasizes the need to improve the quality of data collection in the local, national and global levels. These activities enable governments to more effectively prioritize funding, monitor impact of investments, and strengthen cross-agency collaboration and capacity.
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This review examines the literature on the welfare impacts of infrastructure disruptions. There is widespread evidence that households suffer from the consequences of a lack of infrastructure reliability, and that being connected to the grid is not sufficient to close the infrastructure gap.
... See More + Disruptions and irregular service have adverse effects on household welfare, due to missed work and education opportunities, and negative impact on health. Calibrating costs of unreliable infrastructure on existing willingness to pay assessments, we estimate the welfare losses associated with blackouts and water outages. Overall, between 0.1 and 0.2 percent of GDP would be lost each year because of unreliable infrastructure -- electricity, water and transport.
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Policy Research Working Paper WPS8902 JUN 18, 2019
Much micro-econometric evidence suggests that precipitation has wide ranging impacts on vital economic indicators such as agricultural yields, human capital, and even conflict.
... See More + And yet paradoxically most macro-econometric evidence (especially in the climate economy literature) finds that precipitation has no robust and significant impact on various measures of aggregate economic output. This paper argues that spatial aggregation of weather at the country level explains this result. The paper uses annual subnational gross domestic product data to show a concave relationship between precipitation and local gross domestic product growth between 1990 and 2014. It then demonstrates that when the data are aggregated at larger spatial scales, the impact decreases and eventually vanishes. The impact of precipitation on aggregate economic activity is predominantly felt in developing countries; it is insignificant in developed countries. Agriculture is found to be the dominant pathway. The results have significant consequences for measuring the economic impacts of climate change.
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Policy Research Working Paper WPS8888 JUN 17, 2019
This paper shows that the increased policy-selectivity of aid allocations observed in recent years provides recipient countries an incentive to improve policies.
... See More + The paper estimates that a change in the World Banks Country Policy and Institutional Assessment policy index from 1.5 to 2 for a recipient is associated with an increase of about 13 percent in aid. The analysis also finds a modest but statistically significant positive relationship between the share of policy-selective aid in the global aid budget and policy, suggesting that policy-selective aid improves policies. This effect is properly identified, as the share of policy-selective aid in the global aid budget is exogenous to recipient country policy choices. Furthermore, the paper provides a game theoretic model that establishes the link between the policy-selectivity of the global budget and better recipient country policies in equilibrium.
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Policy Research Working Paper WPS8889 JUN 17, 2019
Emerging market corporations have significantly increased their borrowing in international markets since 2008. This paper shows that this increase was driven by large-denomination bond issuances, most of them with face value of US$500 million.
... See More + Large issuances are eligible for inclusion in international market indexes, which attract institutional investors. Emerging market firms were able to cut their cost of funds by roughly 100 basis points by issuing large-denomination bonds. Firms face a tradeoff: issue large, index-eligible bonds to borrow at a lower cost (about 100 basis points) but pay the expense of hoarding cash. Because of the "size yield discount," many companies issued index-eligible bonds, increasing their cash holdings. The willingness to issue large bonds and hoard cash was greater for firms in countries with high carry trade opportunities. These post-2008 behaviors reflected a search for yield by institutional investors into higher-risk securities and are not apparent in developed economies.
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Policy Research Working Paper WPS8890 JUN 17, 2019
The country brief provides and overview of Tobacco Use, Tobacco Control Legislation, and Taxation in Ecuador. Ecuador has a strong tobacco control policy.
... See More + A comprehensive tobacco control law was adopted and implemented. In 2017, Ecuador was awarded the World No Tobacco Day Prize of the World Health Organization (WHO) for its tobacco control efforts and implementation of the WHO Framework Convention on Tobacco Control (FCTC). Such policy was very beneficial to public health: according to the National Institute of Statistics and Censuses (INEC), the prevalence of daily smoking among people aged 15 years and older was 9.5 percent in 1998, and in 2014 it reached 2.8 percent. Estimated annual cigarette consumption in Ecuador declined from about three billion cigarettes in 2007-2010 to about one billion cigarettes in 2017. The pricing policy of the tobacco industry also contributed to the reduction in cigarette affordability and cigarette sales in Ecuador. However, due to such pricing policy, the tobacco industry apparently increased its profits despite the sharp decline in cigarette sales in the country. These recommendations could bring both public health and fiscal benefits to Ecuador : specific excise rate for cigarettes should be annually increased by at least 20 percent to ensure the reduction in tobacco affordability and the increase in the excise revenues, tobacco use surveillance and monitoring should be further developed in Ecuador, including a regular collection of information on smoking prevalence, tobacco consumption, licit and illicit cigarette sales, prices, and other economic indicators, and effective policies to counteract tobacco smuggling and other kinds of illicit tobacco sales should be implemented in line with the provisions of the FCTC Protocol to Eliminate Illicit Trade in Tobacco Products.
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Serbia has rather high prevalence of smoking. According to the National Health Surveys, the prevalence of daily smoking among men in 2013 was 33 percent which was lower than in 2000 (41 percent), while among women it was almost as high as in 2000 (26 percent).
... See More + Cigarette smoking among adolescents aged 13-15 years old decreased in 2013-2017; however, the use of electronic cigarettes and waterpipe is growing among young people. To overcome the tobacco epidemic, Serbia became a Party to the WHO Framework Convention on Tobacco Control on May 9, 2006, and implemented some tobacco control policies. Tobacco taxation policy in Serbia in 2009–2013 was very successful from a public health perspective as it reduced tobacco consumption, in line with the FCTC obligations. Estimated tobacco consumption in the country declined by 33 percent in four years. The outflow of cigarettes taxed in Serbia to other countries also declined, while the volume of cigarettes, which were smoked but not taxed in Serbia, did not change much after the tax increases. This taxation policy also increased the tobacco excise revenue from 39 billion RSD in 2008 to 84 billion RSD in 2013 (by 44 percent in real terms). However, the tobacco industry managed to modify the impact of the tobacco taxes. In 2012-early 2014, it vastly increased its (net-of-tax) part of cigarette price, and this reinforced the taxation impact on tobacco sales as the final retail price increased more than expected. As the growth of the industry profit margins was disproportionately soaring, the industry increased its profits despite the decline of tobacco sales. The main factor behind the cigarette sales reduction in 2012-2014 was the industry pricing tactics, while the excise rate increases were rather moderate. The combined effect of government taxes and industry prices substantially reduced cigarette affordability, and the resulting sales decline exceeded the excise burden growth; so, the government excise revenue decreased. In late 2014, the tobacco industry decreased prices for some brands, and it also contributed to the excise revenue decline in 2014, as ad valorem part of cigarette excise was rather high in Serbia.
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This paper provides a framework to assess the impact of infrastructure investment expected under the Belt and Road Initiative (BRI) on the debt vulnerabilities of countries that are located on BRI transport and connectivity corridors in the absence of comprehensive and consistent information on investments and financing terms.
... See More + Key assumptions relate to the amount of public and publicly guaranteed (PPG) debt financing and its terms, the size and sectoral type of identified BRI investment, and the expected impact of growth in the medium and long term of that investment. BRI debt financing is expected significantly increase PPG debt in a number of countries. The paper provides estimates for both the medium and the long term. In the medium term, defined as the period 2019-2023, debt financing of BRI investment is expected to be fully disbursed while the full growth impact of BRI related infrastructure is not entirely realized. In this initial phase, around one-third of assessed BRI-recipient countries are estimated to face elevated debt vulnerabilities post- BRI, several of which have already high debt vulnerabilities. The impact of BRI on public debt would improve over the longer term under the assumption of a sustained negative interest rate-growth differential and in the absence of the materialization of BRI related fiscal risks. Still, debt to GDP ratio is expected to remain higher in one-third of countries (11 out of 30 with available data).
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Policy Research Working Paper WPS8891 JUN 17, 2019
This country brief provides an overview of tobacco legislation, use, and taxation in Argentina. Argentina is the only country in Latin America which did not become a Party to the WHO Framework Convention on Tobacco Control (FCTC).
... See More + Still, many of the FCTC provisions are included in the legislation. The prevalence of smoking was quite high in 1970-1990s ranging between 40-58 percent among men and 20- 25 percent among women. After tobacco control measures were implemented, the prevalence of smoking decreased. Tobacco consumption and smoking prevalence in Argentina decreased due to the implementation of comprehensive tobacco control policies and some economic factors, which reduced cigarette affordability in the country. In Argentina, cigarette affordability and tobacco consumption reduction were observed in: (1) 1999-2002; (2) 2014-2015; (3) 2016. In the first case (1999-2002), it was mainly caused by the reduction in population income during the economic recession. In 2014-2015, tax rates were not changed, and the main factor of the affordability reduction was the pricing policy of the tobacco industry. The largest decline in affordability was achieved by the government taxation policy implemented in May 2016: the effective excise tax rate was actually increased by about 100. Cigarette sales in 2016 declined by 5 billion sticks or by 12 percent. Tobacco taxation system should be simplified to one excise tax with a unified ad valorem rate for all tobacco products and specific minimum excise rates for each tobacco product. The specific tax rates should be set high enough to prevent the sales of very cheap tobacco products, and these specific rates should be annually increased above the inflation rate to ensure both the reduction of tobacco consumption and the increase of governmental revenue. Subsidies for tobacco growers through the Special Tobacco Fund are counterproductive from both public health and economic perspectives. Tobacco use surveillance and monitoring should be further developed in Argentina, including regular surveys with a collection of comprehensive information on tobacco products consumed in the country.
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Resilience against infrastructure failure is essential for ensuring the health and safety of communities during and following natural hazard situations.
... See More + Understanding how natural hazards impact society in terms of economic cost, recovery time, and damages to critical infrastructure is essential for developing robust approaches to increasing resilience. Identifying specific vulnerabilities allows for better communication, planning, and situation-specific interventions. This is particularly relevant in areas recovering from a natural hazard that have the opportunity to build back their infrastructure, and for those currently planning infrastructure expansions. This study considers recent hurricanes, earthquakes, droughts, heat waves, extreme wind and rainfall events, ice and thunder storms as well as wildfires. For many of these, data are available for the same type of hazard in different geographies which provides information not only on specific vulnerabilities, but whether the impacts are location dependent. Where available, specific design considerations, cost information for repairs, and the recommendations for 'building back better' are presented. Above-ground transmission systems were the most commonly affected power system component, with fuel and maintenance supply chains representing a major vulnerability for isolated regions and islands. Generation systems were most commonly affected when a hazard exceeded design limits, particularly in relation to water temperature or wind speeds. Institutional capabilities are important throughout the sector. In all case studies analyzed, the design standards of the infrastructure asset, and the ongoing maintenance of assets and the organized response (or lack of) has major implications for the performance of the electricity grid.
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Policy Research Working Paper WPS8900 JUN 17, 2019
Considerable work has been done to understand and improve the resilience of individual infrastructure components. However, systems of components, or even systems of systems, are far less well understood.
... See More + Cascade effects, where the loss of one infrastructure affects others, is a major source of vulnerability which can lead to catastrophic disruptions of essential services. Interdependencies can also lead to large-scale failures when even a single component is disrupted and results in 'cascading' failures within and between networks. This is particularly true for power systems, as many other lifeline infrastructure systems rely on electricity. In this study we review the literature and give a primer on the vulnerabilities of networked energy infrastructure. Several recurrent themes emerge from across different systems: (1) Electricity is essential for many lifeline infrastructure systems to function; (2) Electrical distribution systems are particularly vulnerable to disruption from natural and manmade hazards; (3) Highly networked systems can be unstable even when their individual components are functioning as intended; (4) Redundancy and network density can increase reliability but also increase the likelihood of cascade effects when failures do occur; (5) Disruption of ports and roads can limit fuel supplies for generators and replacement components. Based on these insights, this study offers suggestions for further research and policy actions.
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Policy Research Working Paper WPS8901 JUN 17, 2019
