Benefit-cost analysis and other forms of economic evaluation are powerful tools, encouraging the systematic collection and assessment of the evidence needed to support sound policy decisions. In low-and middle-income countries, where resources are very scarce and needs are very great, such decisions are particularly difficult and economic evaluation can be especially useful. If not well conducted and clearly reported, however, these studies can lead to erroneous conclusions. Differences in analytic methods and assumptions can also obscure important differences in policy impacts.Recognizing these challenges, a team of experts developed reference case guidelines to increase the comparability of benefit-cost analyses, improve their quality, and expand their use. The development process involved extensive participation from stakeholders as well as experts, including both practitioners and consumers, incorporating a variety of perspectives. The resulting guidelines provide an overview of the analytic framework, including its conceptual underpinnings and its implementation. They also provide specific recommendations in seven areas: (a) comparing values across countries and over time; (2) valuing mortality risk reductions; (3) valuing nonfatal health risk reductions; (4) valuing changes in time use; (5) assessing the distribution of impacts; (6) accounting for uncertainty and nonquantifiable impacts; and (7) summarizing and presenting the results. The goal is to support the conduct of high-quality analyses that promote understanding of difficult trade-offs and support evidence-based decisions.
Among the many shifts of emphasis that have been evident in global health over the past twenty-five years or so, two stand out: a concern over the poor lagging behind the better off in progress towards global goals; and a concern to look beyond whether people get the services they need to the affordability of the out-of-pocket expenditures associated with these services. The World Bank's 2018 Health equity and financial protection indicators (HEFPI) database is a new global resource for tracking progress on both fronts. It is, in effect, the fourth in the series of such databases. The 2018 database includes eighteen indicators of service use (twelve preventative, six curative) and twenty-eight health outcome indicators. The data are calculated from household surveys, identified mostly through searches of data catalogues and websites of multicountry survey initiatives. The 2018 HEFPI dataset is freely downloadable, and a data visualisation tool is also available. To ensure the data are reproducible, and in line with the guidelines for accurate and transparent health estimates reporting, the authors document their methods thoroughly in a working paper and highlight the differences between their definitions and others; They also provide the essential computer code used to produce the estimates.
Biofortification is a promising strategy to combat micronutrient malnutrition by promoting the adoption of staple food crops bred to be dense sources of specific micronutrients. Research on biofortified orange-fleshed sweet potato (OFSP) has shown that the crop improves the vitamin A status of children who consume as little as 100 grams per day, and intensive promotion strategies improve dietary intakes of vitamin A in field experiments. However, little is known about OFSP adoption behavior, or about the role that nutrition information plays in promoting adoption and changing diet. We report evidence from similar randomized field experiments conducted in Mozambique and Uganda to promote OFSP. We further use causal mediation analysis to study impact pathways for adoption and dietary intakes. Despite different agronomic conditions and sweet potato cropping patterns across the two countries, the project had similar impacts, leading to adoption by 61% to 68% of farmers exposed to the project, and doubling vitamin A intakes in children. In both countries, two intervention models that differed in training intensity and cost had comparable impacts relative to the control group. The project increased the knowledge of key nutrition messages; however, added knowledge of nutrition messages appears to have minimally affected adoption, conditional on assumptions required for causal mediation analysis. Increased vitamin A intakes were largely explained by adoption and not by nutrition knowledge gained, though in Uganda a large share of impacts on vitamin A intakes cannot be explained by mediating variables. Similar impacts could likely have been achieved by reducing the scope of nutrition trainings.