When access to drugs meets catch-up: Insights from the use of CL threats to improve access to ARV drugs in Brazil

By Eduardo Urias, UNU-MERIT, urias@merit.unu.edu  @e_urias

For Citation: SITE4society Brief No. 16-2018

Related to SDG Goals:  #SDG3 (Ensure healthy lives and promote well-being for all at all ages), #NHM (National Health Mission): Universal Access Programme of Brazil

SITE focus: Technology catch-up, Innovation and Governance for Access;  

Country Focus: Brazil, Emerging Countries 

Sub-Disciplines:  Economics of technology, innovation and development, Public Health

Based on: Ramani, Shyama V., and E. Urias. “When access to drugs meets catch-up: Insights from the use of CL threats to improve access to ARV drugs in Brazil.” Research Policy 47, no. 8 (2018).

Acronyms:   CL: Compulsory License; MoH: Ministry of Health; IPR: Intellectual Property Regime; TRIPS: Trade Related Intellectual Property Rights System PPP: Public Private Partnerships

Context:  In macro-economics, catch-up refers to the hypothesis that poorer economies’ per capita incomes will tend to grow at faster rates than richer economies. A similar notion is applied to technological capabilities, wherein countries or individual firms can catch-up in relation to the technological frontier by reverse engineering existing technologies and tailoring them to suit local conditions.

Catch-up is important for policy makers, because of the underlying implicit assumption that if production is increased, then its trickle-down benefits would improve access to commodities, in terms of their availability and affordability. For most products, these trickle-down benefits are left to be determined by markets, with the state being held accountable for catch-up in terms of the technological, innovative and industrial capabilities upstream, and the quality and safety of goods reaching final consumers downstream. However, for some essential commodities and services, like medicines, access is also deemed to be the responsibility of the government, and not to be left to markets alone. This leads to a question largely understudied in the catch-up literature. Can the need to improve access to an essential commodity impact the sectoral catch-up trajectory of the corresponding industry?

When a country is faced with a high disease burden and has to improve access to the corresponding drug, its response is affected by its level of catch-up and whether or not the drug is patented. The manufacturing of small molecule drugs involves two main operations in decreasing levels of complexity and knowledge intensity: production of ‘active pharmaceutical ingredients’ (API) and drug formulation. The wider the scope of technological capabilities over the production process, the higher the catch-up in pharmaceutical manufacturing. For emerging countries with limited API production capabilities, the problem may become untenable, if drug manufacturers are unwilling to supply adequate quantities at acceptable prices and/or the corresponding technology cannot be licensed from the supplier and developed independently by other firms.

For our research queries, the Brazilian catch-up experience in the production of antiretroviral (ARV) drugs required by HIV/AIDS patients presents itself as an ideal trajectory to study. In 1996, Brazil initiated a policy of universal and free access to highly-active ARV therapy (HAART) (or simply Universal Access Policy), which put an enormous pressure on the Brazilian Ministry of Health (MoH). In order to ensure an adequate supply of ARVs in the public healthcare system with a limited budget, MoH started negotiating price reductions for high-cost patented drugs, often deploying the threat of using compulsory license.

Compulsory license (CL) is a provision in the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) that allow a government to permit third parties to produce the patented product without the consent of the patentee. This is a measure that has been purposefully introduced to minimize the potential negative impact of patents on access to medicines. Scholars have confirmed that the CL option empowers developing countries to negotiate prices with pharmaceutical companies more aggressively (Beall et al., 2015; Beall and Kuhn, 2012; Ramani and Urias, 2015).

Research Questions: For an emerging country with limited manufacturing and innovation capabilities, what are the possible inter-temporal impacts of sectoral catch-up in pharmaceuticals on access to life saving drugs and vice versa? 

Furthermore, what insights can be gained from the interrelationships between price negotiations of essential patented drugs, access and catch-up?

Data and Methodology Used: A mixed methodology is applied to answer our central questions. The literature is first examined and its main findings on catch-up and access are summarized as theoretical constructs through figures. Then, ARV price negotiations data compiled from diverse secondary sources are analysed. A case study is constructed from the above, complementing it with primary data obtained from 26 semi-structured and exploratory interviews with stakeholders familiar with the Brazilian experience in price negotiation for ARVs. The case study method is applied, because it is suitable for studying complex contemporary social phenomena, when boundaries between a phenomenon and its context are not clearly evident. Moreover, since the number of observations of CL threats in Brazil is not sufficiently high to justify a statistical analysis, the case study method is more appropriate.           

Main findings and discussion:

1. Catch-up in the manufacturing of an essential commodity need not automatically lead to better access, but public agencies can play a crucial in creating such synergies.

The catch-up literature mainly portrays it as a process within the production space of an innovation system. Like standard macroeconomic theories of growth, catch-up frameworks of income convergence and sectoral studies seem to assume that access for local consumption will improve through catch-up. 

However, the literature on access to medicines, points out that, for catch-up to improve local access to essential commodities, going beyond markets, there is a need for public actor bridging of the production and consumption sub-systems. In the Brazilian case, the MoH served that role, demonstrating that it is possible for public agencies focusing on access rather than on knowledge or firm capabilities enhancement to do the same. These confirm the observations that growth benefits may not trickle down to improve poverty alleviation unless the system, especially the state and public agencies, nurture structural changes and capability building for pro-poor growth (Kakwani et al., 2000; Nussbaum and Sen, 1993).

2. Past catch-up, even if aborted, can nurture better access in the future and present need to improve access can trigger future catch-up.

The Brazilian industrial policy implemented since the 1970s to build technological and innovation capabilities was directly responsible for the success of the Brazilian health policy to tackle the HIV/AIDS epidemics, even though there is a consensus that this policy failed to build a competitive pharmaceutical industry and reduce trade deficits in pharmaceuticals. Skills in fine and organic chemistry accumulated locally, notably at Farmanguinhos and in a handful of private companies in the 1980s, created absorptive capability and prior knowledge bases for the local production of ARV drugs. Furthermore, compulsory licensing enabled accumulation of technological capabilities for API and formulation of key drugs like efavirenz, only because of absorptive capabilities developed over prior aborted catch-up. Thus, with respect to an essential commodity like medicines, sectoral catch-up can have a strong inter-temporal relationship with access.  

3. interactions and struggles, the impact of instruments used to ensure access can be nuanced and not clearly favour either access or catch-up.

In turn, with respect to the ongoing debate about whether promoting catch-up in the pharmaceutical sector is likely to be harmful for access to medicines, or whether the two can be complementary, our results indicate that neither argument can be generalized. Evaluation has to occur on a case by case basis even within the same country.

4. For emerging countries under TRIPS: (i) lack of access can be a necessary condition to trigger catch-up, though it need not be sufficient. (ii) catch-up led access improvement will depend upon international regulation and building of organizational capabilities of local firms.

 In order to ensure access to essential commodities like medicines, countries with the requisite resources and capabilities are engaging in gradual build-up of industrial capabilities. However, if the need is urgent, prices can be negotiated and alternative corridors are available, with one of them being compulsory licensing. Drugs developed after 2005 are subjected to patent protection in emerging countries and thus their exports would demand a CL under the Paragraph 6 system of TRIPS Agreement. However, this involves enormous procedural challenges at present and must be tackled. Public private partnerships (PPP) and international partnerships are viewed as crucial for catch-up under TRIPS. Brazilian companies such as Cristalia, Orygen, Bionovis, Libbs are engaged in both. 

Policy Recommendations:

First, emerging countries with basic technology and innovation capabilities ought to invest in closing the knowledge gap in essential drugs production. The Brazilian case study indicates that given the paramount role of local technological capacity in bargaining with patent holders, public policy should support technological capacity building.

Second, for emerging countries, there can be real trade-offs between catch-up and access. As the Brazilian case study amply illustrates, price discounts by MNEs for their patented drugs improve access, but they slow down catch-up, because then it becomes even more challenging for local firms to become equally competitive. Similarly, following a CL or initiation of a PPP, while there will be catch-up, access might be improved more by importing cheap generics than by procuring costlier locally produced drugs.

Third, especially for emerging and developing countries, a strong public sector would be a good source of bargaining power. It is not necessary for the public sector to undertake manufacturing of drugs, this can be left to the private sector. However, the public sector must have state of the art technological and innovation capabilities so that it can transfer technology to local firms whenever necessary. Thus, emerging countries must invest in the development of well performing public sector entities to close the knowledge gap in drugs production for their important disease burdens.

All tables and figures are detailed in the article.

 

 

 

 

What are the pros and cons of having social enterprises diffuse pro-poor innovations in an innovation system? Insights from sanitation drives in India

By: Shyama V. Ramani, UNU-MERIT, Boschstraat 24, 6211 AX Maastricht, Netherlands. ramani@merit.unu.edu

For Citation: SITE4Society Brief No.15-2018

Related to the Sustainable Development Goals (SDGs) and National Programmes : #SDG6 (water and sanitation) and Swacch Bharat Abhiyan (SBM or Clean India Mission)

Country Focus: India

SITE Focus: Technology, Innovation, Governance

Sub-disciplines of science/social science/humanities: Economics of Innovation

Based on: Ramani, Shyama V., Shuan SadreGhazi, and Suraksha Gupta. “Catalysing innovation for social impact: The role of social enterprises in the Indian sanitation sector.” Technological Forecasting and Social Change 121 (2017): 216-227.

Context: In rural India, where 68.84% of the population lives, the 2011 Census reported that 69.3% of households are without toilets, even though toilets had been diffused by the government since the mid-1980’s. However, about 54% have mobile phones. Interestingly, from the view point of the Indian rural communities, both mobile phones and toilets are ‘innovations’ as they are new to them. Both are pro-poor, i.e. artefacts with the potential to improve their quality of life and livelihood possibilities; but, unlike mobile phones, lack of toilet usage is deemed a critical risk for environmental hygiene and public health. Now, in any innovation system, whenever there is a crisis that needs to be addressed for social welfare, and markets and public programs somehow fail to do it, then social entrepreneurship is expected to emerge and address the needs-gap.

What is social entrepreneurship? Well, it is a social or environmental value generation or dissemination activity practised by a variety of economic actors ranging from individuals (do-gooders or social entrepreneurs), micro-enterprises to large firms. In the context of innovation, the crucial distinction between business entrepreneurship and social entrepreneurship is that for the former, diffusion of innovation is the end objective, whereas for the latter, impact through innovation adoption and effective usage is key. Firms which practice social entrepreneurship are called social enterprises, if they satisfy three conditions: (i) make a market or non-market offering addressing a social need; (ii) are financially viable, either through its direct offerings (through market or non-market routes) or via third party financiers like foundations and public agencies that support its activities; and (iii) apply business management principles in their internal governance, marketing and delivery of goods/services.

Both social entrepreneurs and social enterprises have overlapping objectives and require similar capabilities, but there is a major distinction. Social enterprises behave like corporate ventures in the social   sector, tackling a problem only if they can leverage adequate resources to achieve their financial targets, whereas social entrepreneurs practise entrepreneurial effectuation and are more likely to make do with what they have to work towards their social mission. Given the above, the study of the evolution of sanitation coverage in India forms an ideal setting to explore the potential role of social entrepreneurship as a carrier of pro-poor innovations.

Research Questions:

1. What are the advantages and limits of social entrepreneurship as a carrier of pro-poor innovations?
2. How can the diffusion of pro-poor innovations be incentivized via social entrepreneurship?
3. How can the adoption of pro-poor innovations be incentivized via social entrepreneurship?

Motivation for Research Questions: 

Social enterprises are getting embedded more densely within innovation systems worldwide, because financiers are interested in social impact, but lack knowledge on the BoP communities. Hence, they are seeking social enterprises to implement their welfare enhancing BoP projects. Here, social enterprises serve as catalysers to transform the resources from the providers into innovations for the intended beneficiaries such that there is a social welfare enhancing transformation. That said, given the systemic uncertainties and challenges associated with the BoP context within a constantly evolving innovation system, how does such outsourcing perform?  This query is worthwhile, because while policy makers and scholars recognize that within a national innovation system, social entrepreneurship has a crucial role to play as an innovation carrier, they are much less clear on how the system ought to catalyse this process for optimal social impact. 

 Data and Methodology Used:

Two case studies of the evolution of sanitation coverage in India were constructed, the first at the sectoral level, and the second, at a village level. The sectoral study was compiled from the existing economics literature on sanitation drives in India as well as government documents. The village case study was based on the data accumulated by the author over a period of ten years (from 2005 to 2015) as a development practitioner in a multi-stakeholder platform to improve sanitation coverage in an Indian village through social entrepreneurship. The data used comes from extensive memos, reports to donors, notes by villagers and emails exchanged as a participant-observer in sanitation drives implemented by social enterprises both in that village and in other villages of India.

Main findings and discussion: 

1. For any challenge, composition of social entrepreneurship practitioners in an innovation system depends on the underlying business opportunities: Social entrepreneurship emerges whenever there are grave social or environmental problems, but the business opportunities for revenue generation from making impact determines which type of actor will be mainly engaged in this activity. When business opportunities are scarce, social entrepreneurs will dominate, and in the opposite case, social enterprises, with or without social entrepreneurs will be the main actors. This was confirmed by the sectoral case study. In India’s pre-liberalization period, i.e. before 1991, passion-driven social entrepreneurs, Mahatma Gandhi and Bhindeswar Pathak being notable examples, strived for maximal social impact with whatever resources they could mobilize. The situation changed completely thereafter.

 

2. For any challenge, greater business opportunities will increase the volume of social entrepreneurship: Echoing the widely confirmed proposition for mainstream innovation driven sectors that tend to emerge and grow, when there are institutions ready to bear the costs of risky investment, the density of social enterprises and the volume of their activities in an innovation system will also depend on the financial resources made available for risky pro-poor innovation creation and diffusion. After liberalization in 1991, and the declaration of universal sanitation coverage as a national mission, business opportunities for social enterprises were created by the state, international agencies, faith-based organizations from foreign countries, industry associations and large firms. Notably, unlike in mainstream knowledge intensive sectors, in the context of deep poverty, multinational faith based organizations that have established their legitimacy are an important financier.

3. Collaboration with social enterprises poses strategic risks: Sanitation drives are a principal agent game, where the principal is the sponsor and the social enterprise is the agent. A principal-agent model is a setting where the payoff to the principal depends on an action taken by the agent, which may not be observable. Further, the principal may not be able to fully confirm some of the agent’s characteristics such as the latter’s true intentions about fulfilling the contractual obligations or engagement. Thus, when financiers interested in making a social impact, say toilet usage, hire social enterprises on the basis of trust, despite incomplete information about the latter’s capabilities or intention, they take strategic risks that are no different from those taken with organisations in mainstream markets. Strategic uncertainty stemming from incomplete information about social enterprises can pose risks at the level of partner selection and thereafter in contract implementation. Adverse selection or inadequate selection processes may lead to the hiring of an ill qualified partner. Thereafter, imperfect monitoring systems and/or incentive systems can allow for moral hazard in the form of inadequate effort by the social enterprise. Both these problems can lead to sub-optimal outcomes as illustrated in our case studies.

 

4. Access ≠Adoption ≠Sustained usage = Demand side challenges: Our village case study demonstrated that ‘need’ is not always a ‘want’ of the BoP and further it need not be supported as ‘demand’ i.e. willingness to pay. After adoption, there can be abandoning, and thus ‘adoption’ need not be maintained or sustained. This is because in BoP markets, there is often a gap in perceptions of innovation value between the provider and intended beneficiaries. Unless this gap is breached, the intended beneficiaries are not motivated to adopt the innovation efficiently. The innovation providers may not be aware of other challenges faced by intended beneficiaries such as lack of financial resources, ownership of required complementary assets (say water for toilet use), knowledge and skills for usage and maintenance of the innovation provided. Again, if these problems are not tackled, the social impact will be sub-optimal, as the dynamics of toilets abandoning revealed in our case study.

 

5. Systemic Implementation challenges: Even in the absence of adverse selection (i.e. the partners are good) and moral hazard (i.e. no partner cheats), there could be systemic challenges like unexpected inflation, lack of capabilities, sudden problems in supply etc. as captured in the figure.

Policy Recommendations:

Financiers should take a long term view: To enhance the positive social impact from pro-poor innovations the focus must not only be on the management of technology, but also on the management of social impact. Rather than opportunism for its own sake, it is the cost, time and target-driven pressures embedded in the project routines of financiers and revenue maximizing social enterprises that drive the system towards immediate rather than long term social impact maximization. These problems can be addressed if financiers are made aware of them.

Sustainability audits should be introduced for social enterprises: While striving to create an enabling environment for social entrepreneurship, long term impact evaluation audits must be conducted to identify and reward ‘sustained social impact’ makers. For this purpose, devising guidelines corresponding to the sector or pro-poor innovation concerned, along with workshops for the social enterprises on the quality and sustainability of their initiatives can promote early systemic dialogue for best possible impact. Social enterprises have to be induced to go beyond provision of knowledge, technology or products for immediate impact to catalyze efficient adoption for sustained social impact.

Move it! It’s good for you! On the Influence of aerobic exercise training (AET) on disease symptoms, cardiovascular fitness, sleep, and depression in children and adolescents with Inflammatory Bowel Disease (IBD)

By: Laura Mählmann, Phd, Psychiatric Clinics of the University of Basel, Centre for Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland and Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT), Maastricht University

Laura.maehlmann@upkbs.ch

Serge Brand, PD Phd, Psychiatric Clinics of the University of Basel, Centre for Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland and Kermanshah University of Medical Sciences (KUMS), Psychiatry Department, Substance Abuse Prevention and Sleep Disorders Research Center, Kermanshah, Iran

Serge.Brand@upk.ch

For Citation: SITE4Society Brief No.14-2018

Related to Sustainable Development Goals (SDGs): #SDG3 (Good Health and Well Being) 

Country Focus: Switzerland, Developed and developing countries

SITE Focus:  Science, Technology, Engagement

Sub-disciplines of sciences/social sciences/humanities concerned: Psychology, Gastroenterology and Movement Science.

Based on the following articles:

1. Mählmann L, Gerber M, Furlano RI, Legeret C, Kalak N, Holsboer-Trachsler E, Brand S: Psychological wellbeing and physical activity in children and adolescents with inflammatory bowel disease compared to healthy controls. BMC Gastroenterol 2017;17:160.
2. Mählmann L, Gerber M, Furlano RI, Legeret C, Kalak N, Holsboer-Trachsler E, Brand S: Impaired objective and subjective sleep in children and adolescents with inflammatory bowel disease compared to healthy controls. Sleep Med 2017;39:25–31.
3. Mählmann L, Gerber M, Furlano RI, Legeret C, Kalak N, Sadeghi Bahmani D, Holsboer-Trachsler E, Brand S: Aerobic exercise training in children and adolescents with inflammatory bowel disease: Influence on psychological functioning, sleep and physical performance. Eur Psychiatry 2017;41:125.
4. Mählmann L, Gerber M, Legeret C, Köhler H, Kalak N, Holsboer-Trachsler E, Brand S, Furlano R: Favorable impact of chronic aerobic exercise training on disease symptoms in children and adolescents with inflammatory bowel disease. About to be submitted 2018.

Context: Around one-quarter of individuals with Inflammatory Bowel Disease (IBD) are diagnosed in the first 20 years of life with increasing incidences. Children and adolescents with IBD report impairments in daily activities, social interaction, coping and sleep. A possible reason for this rising trend in IBD could be increased consumption of western diet which is rich in red meat, dairy products, processed and artificially sweetened foods, and salt, with minimal intake of fruits, vegetables, fish, legumes, and whole grains as well as insufficient physical activity – a lifestyle problem in many countries. Given the encouraging results of previous studies investigating the beneficial effect of physical activity in other chronic disease or among adults with IBD, the aim of the present study was to investigate possible beneficial effects of regular physical activity on psychological functioning, symptoms of depression, sleep and physical activity behaviour in paediatric patients with IBD.

Research Questions: What is the influence of aerobic exercise training or AET on inflammatory indices (C-reactive Protein (CRP) erythrocyte sedimentation rate (ESR), Thrombocytosis), cardiovascular fitness, depression and sleep among child and adolescent IBD patients?

Motivation for Research Questions: Today, there is a major lifestyle problem among many middle and upper-income households worldwide, where simple common sense habits such as regular exercise are absent. The problem is even more in Emerging and Developing countries due to lack of sports facilities, parks and competition at school for university entrance. However, if a clear relationship between aerobic exercise and ailments such as poor cardiorespiratory fitness, IBD, sleep problems, and depression can be established, then it would motivate parents, school and public authorities to ensure that children and youth engage in regular physical activity, as a means to prevent lifestyle diseases or to alleviate the individual burden of diseases such as IBD. At a macro-level, incentivizing physical activity would not only save governments expenditures on curative health programs, but also build human capital for economic growth and well-being.

Data and Methodology Used: 

The study took place in 2015 at the Children’s Hospital in Basel, Switzerland (UKBB). 21 children and adolescents with IBD were compared to 23 gender- and age-matched healthy controls (HC). The IBD group was split into a “remission-group” (IBD-RE; n=14) and an “active disease group” (IBD-AD; n=7). The remission group is in a non-active state of the disease and is successfully drug-adjusted, while the latter group was still in an active state of the disease experiencing the full burden of the disease.

All participants completed an 8-week AET exergame intervention reaching 60-80% of maximum heart rate for 5 days per week, 30 min each time. At the start of the study and after 8 weeks, psychological functioning, depressive symptoms, subjective sleep and subjective PA were assessed with a questionnaire. Objective sleep was measured with an EEG at the children’s homes. Finally, all participants had to wear a fitbit step counting device on their wrist during the intervention time.

Main findings:

1. Comparison of children and adolescents with IBD and healthy control participants (Article 1): At the start of the investigation before any games were played, participants with IBD in an active state of the disease (IBD-AD) showed higher markers of inflammation including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) values, haemoglobin, and leukocyte values. IBD-AD had poorer psychological functioning, meaning lower scores on the depression scale, and they were less physically active, measured with a accelerometer counting the steps walked per day, compared to participants with IBD in remission (IBD-RE) and healthy controls (HC). No mean differences were found between IBD-RE and HC.

2. Association between inflammation and sleep (Article 2): Compared to HC and IBD-RE, IBD-AD patients showed impaired objective sleep patterns (e.g. more awakenings, longer sleep latency, and reduced deep sleep). Downward sloping linear relationships described the inverse correlation between higher chronic inflammation and more deep sleep. Nonlinear relationships described the relation between chronic inflammation and subjective sleep quality (inverse U-shaped) and between acute inflammation and sleep latency (U-shaped).

3. Impact of exercise on physical activity, psychological wellbeing and sleep of groups (Article 3):

The 8-week physical activity intervention led to improved exercise capacity of all participants. Self-reported fitness and daily physical activity increased in IBD-AD, but not in IBD-RE and HC.

No improvements were reported by IBD-RE and HC subjects for psychological functioning, depressive symptoms. The lack of impact of aerobic exercise training on psychological functioning and depressive symptoms is in marked contrast to many studies demonstrating a positive influence of structured exercise training on mental health. The following possible reasons may explain our findings: First, the majority of our sample of patients could be characterized as mentally healthy and consequently improvements were unlikely and high pretest values provided only limited scope for improvement. Second, as concluded from previous research, exercise needs to be sustained in the longer term to affect mental health. Therefore, it seems likely that only a prolonged period of exercising may lead to long-term benefits for mental health. Put another way, the intervention period of eight weeks might have been too short or at too low intensity. Third, self-perception of psychological functioning may have changed, but in ways too subtle to be captured by the questionnaires, which might have been inappropriate or too coarse-grained.

Regarding sleep, subjective sleep did not improve among the groups e.g. sleep efficiency, however, specific favorable sleep changes have been observed among objective sleep markers (according to EEG recordings), such as deep sleep increased, light sleep decreased in all groups and in the IBD-AD group the number of arousals after sleep onset also decreased.

4. Short and Medium term Impact of exercise on inflammation (Article 4):

Finally, after a single bout of exercise inflammation markers (albumin, haemoglobin, erythorcytes, haematocrit, leukocytes) strongly increased in all three groups. Finally, after a long-term AET intervention, inflammation markers ESR, CRP and thrombocytes significantly decreased.

	IBD AD	IBD RE	Healthy Control
Psychological functioning	Small effect	Small effect	Small effect
Depressive symptoms	Small effect	Small effect	Small effect
Subjective sleep	Small effect	Small effect	Small effect
Objective sleep	Large Effect	Moderate Effect	Small effect
Inflammation markers	Large Effect	Large Effect	Large Effect

To conclude, our research clearly indicates that the role of lifestyle factors in IBD is crucial, and may affect treatment outcomes. Regular physical activity can reduce inflammation and improve. Therefore, moderate physical activity should be promoted as an adjuvant therapy in pediatric IBD for its various beneficial effects. This would contribute to the improvement of existing treatments and potential new treatment options through retrospective evaluation.

Policy Recommendations: 

1. Introduce psychological counselling of children and adolescents in an active state of IBD in addition to standard treatment schedules.

2. Include assessment of subjective sleep quality in the care of pediatric IBD patients as an additional indicator for study of sleep disturbances due to inflammation.

3. Even in households where children and adolescents cannot access sports programs or be provided accompaniment for the same, promote computer/phone based exercise games and moving activity (such as the exergames played in intervention). In all education institutes, starting from kindergarten to universities, physical activity should be encouraged. Especially for children and adolescents, it can be introduced several times a week as part of the educational curriculum to become embedded as a lifestyle norm. This would have clear socio-economic benefits, as our research confirms that moderate physical activity lowers inflammatory markers in children and adolescents with IBD in the long run, though they may spike them in the short run.

4. Moderate regular physical activity can be promoted as an adjuvant anti-inflammatory therapy in paediatric IBD.

Acknowledgements:

This study has been conducted together with the IBD study team and we would like to express our gratitude towards the entire team for this great collaborative work which led to the successful execution of this study: Corinne Légeret, PhD, Children’s University Hospital of Basel, Basel, Switzerland; Nadeem Kalak, PhD, Psychiatric Clinics of the University of Basel, Centre for Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland; Markus Gerber, Prof., Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland; Edith Holsboer-Trachsler, Prof., Psychiatric Clinics of the University of Basel, Centre for Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland and Raoul Furlano, PD, PhD, Children’s University Hospital of Basel, Basel, Switzerland.

Further, we thank the Freiwillige Akademische Gesellschaft Basel (FAG, Basel, Switzerland) and the Forschungsfond of the Psychiatric Clinics of the University of Basel for financially supporting the project.

Breeding seeds of contention: the global diffusion of intellectual property rights in agriculture

By: Mercedes Campi,National Scientific and Technical Research Council (CONICET) and University of Buenos Aires, Faculty of Economics
Instituto Interdisciplinario de Economía Política de Buenos Aires, IIEP-Baires
mercedes.campi@fce.uba.ar – mmcampi@gmail.com
www.mercedescampi.wordpress.com

Alessandro Nuvolari, Scuola Superiore Sant’Anna, Institute of Economics
alessandro.nuvolari@santannapisa.it
https://www.santannapisa.it/it/alessandro-nuvolari

For Citation: SITE4Society Brief No.13-2018

Related to Sustainable Development Goals (SDGs) and National Programmes of country concerned as: #SDG2 (Zero hunger)

 Country Focus: Developed and developing countries

 SITE Focus: Innovation, Environment, Governance

 Sub-disciplines of science/social science/humanities: Economics of Innovation, Law

 Based on: Campi, M. and A. Nuvolari (2015), “Intellectual property protection in plant varieties. A worldwide index (1961-2011)”, Research Policy, Vol. 44 (4), 951-964. Data is available at: https://mercedescampi.wordpress.com/data/

Context

The Trade Related Aspects of Intellectual Property Rights (TRIPS) in 1994 made patentability of micro-organisms, and non-biological and microbiological processes for the production of plant varieties, compulsory for signatory countries of the World Trade Organization (WTO). TRIPS also requires all WTO members to provide an “effective” intellectual property (IP) protection system for new plant varieties either by patents or a sui generis system or by any combination thereof. The leading alternative to patents is an IP system conforming to the International Convention for the Protection of New Varieties of Plants (UPOV).

The major difference between patents and UPOV can be understood as follows. Patents require innovations, including new plant varieties, to be novel, non-obvious or involving an inventive step, and useful or susceptible of industrial application. However, under UPOV, IP protection can simply be granted to plant varieties that are new distinct, uniform, and stable. This is because UPOV (and, in general, sui generis systems) takes the view that the intrinsic features of improved plant varieties makes them unsuitable for patentability. Unlike manufactured product innovations, most improved plant varieties can be replicated by accessing seeds, cuts, tubers, or other parts. Hence, as innovations, they are reproducible without re-engineering. Further, new plant varieties are not developed only by economic actors or organizations, but are obtained through the accumulation of genetic improvement carried out over centuries by farmers – by selecting the best ones –and further improved by breeders in the public and private sector. Thus, innovation in plant varieties has an unavoidable community and cumulative nature not really suited for the attribution of monopoly rights to a single entity.

Genetic diversity of maize in Peru                   

Furthermore, under UPOV (and any sui generis system), in order to reward innovative activity, while allowing access to genetic material of improved varieties, there are two important types of exemptions. Farmers’ exemption grants farmers the privilege or exception to save and reuse purchased seeds. Similarly, breeders’ exemption permits breeders the possibility of using a protected plant variety to develop breeding activities.

Members of the UPOV before and after TRIPS (2017)

Presently, a few countries (e.g. Australia, Japan, Korea, and the United States) have chosen to allow for full patentability of biological material and even of plant varieties. However, the majority of European and developing countries have opted for UPOV. Initially designed by European countries in 1961, UPOV had a limited number of members until the ratification of the TRIPS, when it was adopted much more widely as it was a more general framework to provide plant breeders exclusive rights on new plant varieties. Among those with UPOV, some countries allow for farmers’ exemption, while others don’t. Similarly some apply breeder’s exemption, while others don’t. Finally, a few countries like India have rejected both patents and UPOV, designing their own sui generis system.

Such diversity in plant IP protection systems adopted in different parts of the world leads us to question the rationale of the different systems as they affect a wide range of interests of stakeholders ranging from heterogeneous farmers, plant breeders, multinational companies, public institutions of research and development, and the whole society as a consumer of agricultural products. Indeed, the design of IPRs should actively involve those interests and the demands of the TRIPS agreement should be complied also taking into account the flexibilities it provides. Quantitative indicators of IPRs for plant varieties would allow an understanding of the effect of IPRs on agriculture – but there is none available at the moment. Hence, our central research questions.

Research Questions:

1. Can we measure the strength of intellectual property right systems vis-à-vis new plant varieties and its evolution over time?
2. Which are the possible impacts of strengthening of intellectual property rights systems vis-à-vis new plant varieties?

Motivation for Research Questions: 

One might ask, why should we care to measure the strength of IPRs on new plant varieties or seeds? The answer is quite obvious. The implications of stronger or weaker IPRs are highly debatable on economic, moral, and ethical grounds. Stronger IPRs (especially patenting) restrict access to use protected plant varieties, which can stifle future developments of better seeds, food security, and the capabilities of countries to provide adequate food crops for their citizens. On the other hand, weaker IPRs may not provide sufficient incentives for innovation. But given the trade-off between providing incentives and allowing access to new developments, breeders’ exemptions facilitate innovation creation by plant breeders by allowing access to protected material. On another plane, farmers’ exemptions give recognition to the incremental contribution of farmers in the development of new crops.

Moreover, the importance of our research queries is reiterated by a new reality. The strengthening and harmonization of IPRs systems on a worldwide scale is raising substantive concerns. IPRs systems in agriculture have dramatically increased concentration in the seed market. In 2011, just ten companies held almost 80% of the world market for seeds. Notably, this trend towards increasing concentration is also fueled by mergers and acquisitions, such as the recent acquisition of Monsanto by Bayer, which will result in just three companies controlling nearly 60% of the world’s seeds market, nearly 70% of the chemicals and pesticides needed to grow food, and nearly all of the world’s genetically modified crop genetic traits. In addition, this concentration at the firm level also implies concentration in a few commercial plant varieties affecting biodiversity and increase vulnerability of the system.

 Data and Methodology Used:

We have studied the historical evolution of plant varieties IP-related legislation in countries, using data from WIPO Intellectual Property Laws and Treaties Database, UPOV Lex, FAO Lex, ECOLex, and The World Law Guide. In addition, when data were not available, we used institutional web pages at country level and consulted with experts of different countries.

 Indicator developed to measure strength of IPRs on new plant varieties:

Our index is composed of five components: (i) ratification of UPOV conventions, (ii) farmers’ exception, (iii) breeders’ exception, (iv) protection length, and (v) patent scope, which considers whether patentability is allowed in five domains related with agriculture – food, microorganisms, pharmaceutical products, plant and animals, and plant varieties.

For any country in a given year, the index can take a score from 0 to 5 with higher scores indicating stronger intensity of IP protection. These are the elements that tend to vary more from country to country and over time within the UPOV/TRIPS framework. This index was applied on the compiled data to measure the relative strength of IP protection on agriculture for 69 developed and developing countries for the period 1961-2011. We are currently extending the index to include IPRs up to 2017 and to around 90 countries.

 Main findings and discussion: 

With TRIPS, worldwide, the strength of IPRs systems on new plant varieties is increasing and converging (see Figure below).

IP protection index for countries of different income level

High-income countries already had stronger systems of IP protection relative to low- and middle-income countries, but the gap is narrowing. As a consequence, dispersion between and within groups of countries has decreased, which obviously reflects a substantial increase in the harmonization of IPRs systems.

2. However, the impact of stronger IPRs on new plant varieties cannot be generalized and seems to be weak in the case of developing countries. For example, in different empirical studies, we observe that:

• Strengthening IPRs increases agricultural value added in developed countries but has no significant effect in developing countries. Likewise, in the case of yields of cereals, stronger IPRs have a positive effect for high- and low-income countries, but no effect for middle-income countries.
• Evidence of nonlinearities seems to confirm a threshold effect of IPRs – i.e. increasing IPRs has a positive effect on agricultural yields until a certain level after which it becomes negative. This threshold also varies for countries of different income level.
• Similarly, stronger IPRs have a negative effect on agricultural trade volumes and developing countries are more negatively affected.

Conversely, strengthening IPRs increases foreign direct investment in the form of mergers and acquisition in the agri-food sector, particularly in developing countries.

Large-scale export-oriented production in Argentina 

These heterogeneous effects are not surprising if we consider that countries differ in terms of capabilities, production systems, market structure, institutions, and, more generally, development levels. Likewise, agricultural systems are very diverse around the world in terms of organization, technology adoption, farmers’ size and characteristics, just to name a few dimensions. It is not tough to imagine the differences between a large-scale export-oriented agriculture such as the one existing in some regions in Argentina, the United States, and Brazil, and the agricultural production mainly developed by small-scale farmers for self-consumption or for domestic markets in many regions of Latin American, Asian, and African countries. In this context, the idea of a one-size-fits-all system as the one promoted by the UPOV and the TRIPS is unlikely to be adequate.

Small-scale farmers offering their products at local markets in Colombia

 

Policy Recommendations:

1. At least for developing countries, the recent drive towards the strengthening and harmonization of IPRs systems in agriculture may actually represent a suboptimal configuration and, therefore, a less sanguine and more cautious approach towards IPRs reforms ought to be in order. (See our findings for the case of agricultural value added, agricultural productivity, agricultural trade, and mergers and acquisitions in the agri-food sector).
2. This implies that countries should consider the specific characteristics of their agricultural systems and design and adopt IPRs systems that are consistent with these features. An agricultural system characterized by large-scale export-oriented farmers who usually buy seeds from breeders will most probably need a different IP protection system than one of mainly small farmers that are used to improve and exchange their own seeds. Not considering these differences can lead to serious inefficiencies and social conflicts.

 

Note: All photographs taken by Mercedes Campi.

‘Too hungry to learn? Inequalities in adolescent learning achievements by timing and persistence of household food insecurity in India’

Elisabetta Aurino, Imperial College London

 

Jasmine Fledderjohann, University of Lancaster

and

Sukumar Vellakkal, BITS Pilani Goa

 For Citation: SITE4Society Brief No.12-2018

Related to SDG Goals and Indian National Programmes: #SDG2 (Zero hunger) #SDG4 (Quality education) #SDG10 (Reduced inequalities) #NFSM (National Food Security Mission)

Economics sub-disciplines: Development economics, Economics of education, Health economics.

SITE focus:  Need for better Engagement

Country focus: India and, more broadly, low- and middle-income countries

Based on: Elisabetta Aurino, Jasmine Fledderjohann, Sukumar Vellakkal (2018). Inequalities in adolescent learning: Does the timing and persistence of food insecurity at home matters? Department of Economics, Ca’ Foscari, University of Venice Working Papers No. 9.

Context

Food insecurity at home—that is, difficulties consistently accessing safe and nutritious food–can shape children’s cognitive, health and general development trajectories in multiple ways. For instance, being food insecure at home can influence children’s choice between continuing school or leaving school for employment, their focus in school, their psychological well-being, and their ability to participate in family and community life without worry.

India is a particularly relevant setting in which to study food insecurity, in part because it is home to one out of three people globally suffering from hunger, and to the largest share of chronically malnourished pre-schoolers globally (about 50 million). This reality has long-term consequences in terms of impaired human development. Given the sheer magnitude of food insecurity in India, it is hardly surprising that it has been ranked at the “top of India’s policy agenda”.

At the same time, despite the striking improvements in access to basic primary and secondary education of the past few decades, learning achievements have not followed: for instance, only 27% of a sample of about half a million rural Indian students were able to perform a 2-digit subtraction in Grade III.

Could food insecurity in childhood and early adolescence be an explanation for child learning inequalities? This query paved the way for the present work.

 Research Questions

 Our recently published working paper addresses the following questions:

1. Is there an association between household food insecurity in childhood and educational outcomes in early adolescence?
2. (How) do timing and persistence of food insecurity in childhood matter for educational outcomes? And does this vary by type of skill considered?

Motivation for Research Questions

Food insecurity may shape adolescent[1] learning through multiple pathways: first, faced with food insecurity, households may prioritise the purchase of basic foodstuffs as compared to non-food items, and consequently may invest less in educational inputs (e.g. school fees, private tuition, educational materials, uniforms). Second, children may be more likely to work within or outside the household as part of a household’s response to food insecurity, which may lead to increased absenteeism, less time to study, and earlier dropout. A further channel is health-related: hunger and morning fasts have adverse effects on cognition, particularly through slower working memory, fatigue and distraction.

Importantly, the timing and persistence of food insecurity may matter, too: for instance, early childhood food insecurity may most strongly affect vocabulary development, as this skill is usually built in the early years, while continuous spells of food insecurity may have larger repercussions on maths learning due to the cumulative nature of the curriculum.

These aspects have been seldom investigated, particularly in low- and middle-income countries and with a focus on adolescents.

© Young Lives/Sarika Gulati

Methodology Used

We used data from the Young Lives study in India (in the states of Andhra Pradesh and Telangana), which is a longitudinal study of child poverty. A longitudinal sample of about 2000 children and their households were followed over time in 2002, 2006, 2009, and 2013[2], when the children were aged about 1, 5, 8 and 12 years. In this paper, we focused on 2006-2013 data for whom data on child learning achievements and household food insecurity were collected. The longitudinal nature of the data allowed us to examine how timing and persistence of food insecurity at different stages of childhood (at 5, 8 and 12 years) are associated with children’s learning achievements at 12 years.

How do we measure household food insecurity trajectories?

Household food insecurity is a multidimensional phenomenon, which includes limited food availability and/or access, nutrient loss through food preparation techniques, and inconsistency of these dimensions over time. In this study we focused on the food access dimension, measured through a specific experience-based scale of food insecurity. The scale captures the extent to which households cope with situations of food insecurity, including cutting food quality and quantity, skipping meals and going hungry. Similar scales are currently used by the UN Food and Agriculture Organisation as one of the measures to assess global food insecurity.

Based on the household food insecurity scale methodology, we categorised a household as food secure or food insecure in each survey round. We were then able to track household food insecurity dynamics over time–that is, whether the household was never food insecure, whether it was always food insecure, or whether it transitioned in or out of food insecurity at specific periods in children’s lives. Based on the possible combinations of moving into and out of food insecurity, we ended up with six categories capturing these pathways over time. These categories are show in the table below.

Table 1. Categories of food insecurity variable capturing pathways into and out of food insecurity over time

 

The outcomes we were interested in were adolescent learning outcomes at age 12 across four domains: reading, vocabulary, maths, and English. These were measured by scores on separate learning tests related to each of these domains. Tests were developed by educational specialists to be linked with the local curriculum at different ages.

Our analysis comprised:

1. A descriptive look at which households were at risk of food insecurity, and whether there were bivariate associations (that is, associations not controlling for any potential confounders) between food insecurity and our childhood and pre-adolescent learning outcomes of children at 12 in reading, vocabulary, maths, and English.
2. Multivariate regression models were estimated to identify the associations of household food insecurity trajectories and child learning after controlling for other potential drivers of achievements. For example, it could be hypothesized that household food insecurity doesn’t matter, but rather it is poverty that affects both food insecurity and children’s learning. Thus, a variety of possible drivers of learning  such as socio-economic status and child, caregiver, and household attributes (e.g. child age, caregiver age and education, household size, household wealth, living in an urban area and so on) were included in the estimates. All models also included controls for early childhood test scores in vocabulary and grasp of quantitative concepts to account for unobserved differences between children and families such as child ability, early investments in child education and health, and parental preferences for education.
3. As a further step, we explored in more refined models additional potential explanations of adolescence learning such as: (i) educational inputs (e.g. school enrolment and type of school (private/Government); (ii) health inputs (nutritional status as measured by height-for-age z-scores); (iii) and adolescent and parental psychosocial skills (e.g. educational aspirations, self-efficacy and self-esteem scores), which were all measured at 12 years old.

Main Findings

Descriptively, the data show:

• 12-year-olds who experience household food insecurity have poorer learning outcomes across the board (see Figure 3).
• Those experiencing food insecurity at age 5 years, and experiencing it for a longer period of time over childhood have particularly negative learning outcomes at 12 years.
• Even some of the wealthiest household experienced food insecurity, but poorer households faced a much higher risk.

Our multivariate models indicate:

• Food insecurity in childhood is associated with worse learning outcomes in adolescence; early and chronic food insecurity are the most consistent predictors of impaired cognitive skills at age 12.
• Temporary spells of food insecurity (i.e. transitioning into and back out of food insecurity) are not associated with negative vocabulary and reading outcomes, suggesting children may bounce back from short-term food insecurity in some learning domains.
• However, transitory food insecurity does matter for maths. This may be due to the cumulative nature of maths learning, which may make catch-up learning more difficult.

Figure 3. Food insecurity and adolescent learning outcomes, Young Lives India, 2006-2013. Mean cognitive achievements by household food insecurity trajectory

Some concluding ‘food for thought’

Our findings suggest that pursuing the Sustainable Development Goal 2 on ending hunger and achieving food security for all is not only critical to tackle the burden of hunger and food insecurity, but also because it may have ripple effects and foster progress on other SDGs, such as reducing inequalities (SDG #10) and ensuring inclusive and quality education (SDG #4).

© Young Lives/Sarika Gulati

Food insecurity at home during childhood matters for learning achievements in early adolescence. Moreover, when food insecurity occurs and how long it lasts for can also have important implications for learning outcomes.

We do not claim any causality in this research, but we do provide rigorous findings on the relation between food insecurity and learning. Based on our results, and complementing existing research and policy recommendations, the following points provide some “food for thought” to policymakers:

1. Intervene early. Because some curriculum is cumulative, it may be difficult for children who experience childhood food insecurity to catch up on learning later. Early intervention is therefore essential. Increased budget allocation and effective implementation of India’s early childhood health program (ICDS), especially for revising and reforming the ‘supplementary nutrition provision’ to ‘full feeding’, could be beneficial too.
2. Offer remedial learning opportunities for groups at higher risk of food insecurity (e.g. tribal populations), particularly for those skills for which catch-up is more challenging (e.g. maths). Children who are in situation of chronic household food insecurity are at particular risk of falling behind their peers, with a cumulative effect over the lifecourse in terms of lower learning outcomes and increased probability of drop-out. Teaching at the right level and remedial education programmes can help children who have fallen behind to catch-up with peers.
3. To improve learning, (also) address food insecurity. Children in food insecure households fare worse across a range of learning domains. This is true even after more commonly-cited culprits such as household socioeconomic status or earlier investments in child cognition are taken into account. Efforts to raise learning levels may be more effective when paired with a focus to address food insecurity.
4. Improve targeting, monitoring and nutritional contents of food-based social protection (e.g. Mid-day Meal Scheme (MDMS), public distribution system (PDS), etc). Studies have shown that the MDMS can improve learning and classroom effort. Expanding this programme to include breakfast for children at higher risk of food insecurity or in the lean season may prevent hunger and its negative repercussions on child cognition. Also, the nutritional value of the PDS could be enhanced by provisioning eggs or traditional cereals such as millet.
5. Make children’s work work for children. While it is tempting to advocate strict child labour laws in order to ensure that food insecure children stay in school, this is only efficacious where adequate social protection exists. Findings based on interviews with more than 28,000 rural adolescents aged 14-18 years across India revealed that the vast majority of them work. Emphasis on creating decent and safe employment opportunities during school breaks might minimise the risk of disruptions to schooling. Also, improving the quality of vocational training can incentivise them to stay at school for longer and transition to better employment later on.

Acknowledgements

EA would like to acknowledge the “Guido Cazzavillan” and the Imperial College London research fellowships that supported this work. Also thanks to Shyama Ramani and Nanditha Mathew for their encouraging support and feedback. Thanks to Anastasia Bow-Bertrand and the Young Lives team to share their pictures with us and a very special thanks to the children and the families of the Young Lives India sample for their time and their insights.

Notes

[1] We use the WHO definition of adolescence, which refers to the period between 10 and 19 years.

[2] A further round was collected in 2016 but are not yet publicly released.

Democracy: Do African women really like it less than the men?

By: Maty Konte, UNU-MERIT, konte@merit.unu.edu

For Citation: SITE4Society Brief No.11-2018

Related to SDG Goals: #SDG5 (Gender Equality & Empowerment of Women and Girls)

SITE focus: Engagement and Governance

Regional Focus: Africa

Based on: Konte, M., and S. Klasen “Gender difference in support for Democracy in Sub-Saharan Africa: Do social institutions matter?”  Feminist Economics, 2016, Volume 22, pp. 55-86

Context: The level of democracy and its stability depend strongly on their legitimacy. In other words, the level of democracy in a country is determined by the degree to which its citizens support democracy. Using public opinion surveys in Africa, scholars have attempted to identify the determinants of support for democracy in this region, where democracy has had a relatively short history and has not yet been fully consolidated. Surprisingly, results have shown that women are less supportive of democracy than men. There are two possible explanations of this observed gender difference. First, it may be due to the socioeconomic differences between the two genders. However, it has been demonstrated that results remain true even after controlling for education, employment status, and many other individual socioeconomic characteristics that may explain this gender gap, leading us to question what the underlying factors are that explain this political preference difference between men and women. Second, it could be caused by the non-egalitarian institutional and contextual environment where women live. A representative feature of this would be ‘social institutions’. Social institutions can be defined as long-lasting norms and codes of conduct rooted in traditions, customs, and cultural practices. They can be formal or informal and guide individuals’ behavior and interactions (Branisa et al. 2014), leading to the following research question.  

Research Question: Does gender discrimination in social institutions (e.g., family code, inheritance, access to resources, access to public spaces, and physical integrity) tend to reduce women’s degree of support for democracy in Africa?

Motivation for Research Questions: It seems paradoxical that women should prefer democracy less than men. This raises the question of whether women’s preferences and choices may hinder the much-needed legitimacy of democracy in Africa. However, previous research strongly indicates that gender discrimination in social institutions has negative economic and social repercussions. For instance, discriminatory social institutions have been shown to slow down the achievements of some of the Millennium Development Goals, including food security, fertility and education (See, OECD(2010, 2012), Branisa et al (2013), and Asian Development Bank (2013).On the other hand, little is known about the possible impact of gender discrimination in social institutions on politics. It is thus of major importance to assess how discriminatory social institutions affect women’s attitudes and choices in politics to inform policies for women’s full and effective participation in political life.

Methodology Used: The empirical analysis is based on a dataset that merges information from the Afrobarometer data with data from the Social Institutions and Gender Index (SIGI) provided by the Organisation for Economic Co-operation and Development (OECD). The Afrobarometer data is a collection of nationally representative surveys in Africa that provides a wide range of information that measures public attitudes on economic, political, and social matters. The study starts with evidence using the data from round four and then extends the analysis with a dataset that combines rounds two, three, and four, covering over 67,000 observations across nineteen African countries. Variables taken from this data are at the individual level, including people’s responses to the question of whether they think that democracy is the best political regime. The main indicators of gender discrimination in social institutions are the SIGI and its five sub-components. The SIGI is an aggregate index based on discrimination in the family code (such as inheritance rights), physical integrity(domestic violence), women’s civil liberties (women’s freedom to move alone and access public space), women’s access to resources (access to land), and finally the extent to which sons are preferred to girls in a given country.

In the empirical specification, the dependent variable is a dummy variable indicating whether a respondent supports democracy or not. The key explanatory variables are a dummy gender for the sex of the respondent and the indicators of gender discrimination in social institutions measured at the country level. In addition we include a term of interaction between the dummy gender and the SIGI index. Adding the term of interaction helps to test whether women who live in countries with lower levels of gender discrimination in social institutions show  a higher degree of support for democracy than women who live in countries with higher levels of discrimination in social institutions. To figure out which of the subcomponents of the SIGI are more relevant in explaining the gender gap in support for democracy, we also use the five subcomponents of the SIGI separately.

Because of the nature of the dependent variable which is a dummy and the structure of the data that merge individual information with country-level data, we estimate a multilevel logit model with random intercept. This model allows us to take into account the double structure of the model where individuals are clustered within countries. The multilevel logit model with a random intercept allows us also to control for different country-level variables while having controlled for the country-specific effects.

Results:

1. Being a woman decreases the probability of supporting democracy compared to being a man. This result is apparent regardless of the individual socioeconomic characteristics that are controlled for. This confirms the previous findings in the literature.

2. However, most interestingly, the impact of gender on support for democracy becomes insignificant once gender discrimination in social institutions is accounted for! This indicates that the observed gender gap in support for democracy in Africa can be explained by the environment in which women live.

3. In fact, women who live in countries where discriminatory social institutions constrain them to live under autocracy at home are less supportive of having democracy outside the home.

4. The term of interaction between gender and discriminatory social institutions indicates that women who live in countries with a high degree of discrimination in the family code have a lower degree of support for democracy than women who live in countries with lower discrimination in the family code.

5. Similarly, women in countries where their civil liberties are restricted as well as women in countries with a high incidence of physical integrity tend to be less supportive of democracy than other women from countries with egalitarian social institutions. 

Policy Insights and Recommendations: 

1. Policies for stronger legitimacy of democracy in Africa should target the factors that offset support for democracy for each segment of the population, including women, who represent roughly half of the population in Africa.
2. The way women are treated in a society determines their political participation and their degree of support for democracy. When women live in a friendly environment that protects their rights and freedom, they have a high degree of support for democracy. However, institutions that are discriminatory toward women could decrease the level of support that a country needs to promote democracy.
3. Countries that implement effective laws friendly to women, that are against harmful practices such as early and forced marriage, will nurture democracy better.
4. Measures to ensure free movement of women and safe access to public spaces will promote a stable democracy.

 

Photo sources

Source: https://goo.gl/images/VFA7Qh

What’s good for the goose ain’t good for the gander! On cock-eyed counterfactuals and the R&D performance effects of Indian firms

By: Alex Coad, CENTRUM Católica Graduate Business School, Santiago de Surco, Lima, Peru, acoad@pucp.edu.pe

Nanditha Mathew, Sant’Anna School of Advanced Studies, Italy, n.mathew@santannapisa.it

Emanuele Pugliese, Institute of Complex Systems, CNR, Rome and Department of Economics, University of Bath, emanuele.pugliese@gmail.com

For Citation: SITE4Society Brief No.10-2018

Related to SDG Goals and Indian National Programmes: #SDG8 (Decent Work and Economic Growth) #SDG9 (Industry, Innovation and Infrastructure) #IIGP (India Innovation Growth Programme) #AIM (Atal Innovation Mission)

Economics sub-disciplines: Industrial organization, Development economics, Economics of innovation.

SITE focus: Innovation

Country focus: India

Based on: Alex Coad, Nanditha Mathew and Emanuele Pugliese, “What’s good for the goose ain’t good for the gander:cock-eyed counterfactuals and the performance effects of R&D” LEM Working Paper, No. 2017/21.

Context: In developed and emerging countries, government policies target firms in the manufacturing sector to encourage them to engage in innovation. Even though there is a consensus at a macro level that innovation is a main driver of economic growth, at a micro level, the relation between innovation and growth is not clear. Previous empirical studies at the micro-firm level have revealed confounding results concerning this relationship, and thus, there is no consensus on whether or not R&D undertaking improves firm performance. Such lack of clarity questions the policies that assume that innovation is beneficial for all firms that engage in innovation. Moreover, most of the studies deal with firms in developed countries and it is not clear whether such results hold for emerging country firms.  Hence, in this work, we investigate the innovation-firm performance relationship of Indian manufacturing firms, keeping in mind the findings of previous studies that have highlighted the firm characteristics that distinguish ‘innovative’ from ‘non-innovative’ firms. Finally, with respect to Indian manufacturing firms, we explore the counterfactual story: what would have been the performance effects of firms that did not invest in R&D, if they actually did and vice-versa.

Research Questions: Which kinds of firms spend on research and development? Do all firms benefit from research and development spending?

Motivation for Research Questions:  It is indeed crucial to disentangle and understand clearly the relationship between innovation and performance at a micro level, given the interest in the topic from both firm managers and policy makers.  It is noteworthy that several studies investigating the relationship between R&D and firm performance in terms of growth, productivity or profitability have shown conflicting results including – a positive relationship (Hall, 1987; Singh, 1994; Del Monte and Papagni, 2003), no relationship (Geroski et al., 1997; Bottazzi et al., 2001; Stam and Wennberg, 2009) or a negative relationship (Brouwer et al., 1993; Freel and Robson, 2004).

Furthermore, studies have identified that innovators have some characteristics that are distinctly different from non-innovators (Hall et al., 2010; Audretsch et al.,2014), but ironically, much of the studies have not properly empirically accounted for them and this could be the reason for contradicting results observed by previous studies.

Indeed, the effectiveness of technological investments such as R&D investment is likely to depend on innovative capabilities that are correlated with both the R&D decision and the expected performance benefits. Firms without these capabilities would be ill-prepared to invest in R&D and would probably not benefit from R&D if they did. The irony of the standard econometric approach, however, is that performance benefits from R&D are evaluated by assuming homogeneous effects for innovators and non-innovators. In this work, we demonstrate and emphasize that a non-R&D investor need not be a good counterfactual for an R&D investor.

Methodology:  The Prowess database, provided by the CMIE (Centre For Monitoring Indian Economy Pvt. Ltd.) was used. Firm performance was measured using two variables: sales growth of the firm and firm profitability. The R&D expenditure of firms was taken as their investment in innovation.

The innovation performance linkage was evaluated by performing an OLS and Fixed Effect estimation. This gave us inconsistent results: the R&D dummy did not have any significant effect on firm growth, and furthermore had significant negative effects on relative profitability.

However, as we pointed out before, innovators and non-innovators could be different from one to the other, and considering them the same could have been the reason for the poor results.

We empirically investigated this using  econometric techniques suited for dummy dependent variable, like Linear Probability model (Logit), Probit and a random effects Probit estimation and confirmed this to be the case.

Hence, we faced two issues: first the issue of selection, i.e, the firms that invest in R&D are different from those that didn’t, and second, the issue of censored data, i.e R&D spending can only be a positive value. To tackle these issues, we applied the endogenous switching regression which allows to compute the counter-factuals in order to calculate the effect of investing in R&D for firms that actually did R&D and the effects of R&D investment for those that did not. In other words, using this method we could confirm the benefits of R&D investment for the two firm clusters separately. The results we obtain with this method are clear and sharp.

 Main findings: 

1. Firms that invest in R&D and those that don’t differ significantly in terms of several observed firm characteristics. Firms performing R&D are bigger, younger, exporters, with high capital investments and financial leverage (i.e. total borrowings over total assets).
2. This leads to a self-selection bias, i.e. when a firm is bigger, exporting and has a lot of capital equipment – it probably has to engage in R&D.
3. Once controlled for the selection bias, it is possible to make a causal interpretation of the results. Our results indicate that both firms that invest in R&D and those that do not are making a rational decision.
4. Indian firms investing in R&D would have had less growth and less relative profitability if they had not invested in R&D and firms that did not invest in R&D would not have had better performance if they had done so. This implies that even if policy makers observe performance benefits of innovative activity among innovative firms, nevertheless this should not be taken to imply that there might be any benefits from encouraging non-innovative firms to invest in R&D.
5. Our approach and results provide a possible explanation for why there is no consensus in the existing literature on the performance benefits of innovative activity. This could have been either because of the nature of the information available on firms or because the studies did not distinguish between low and high R&D investors.
6. Our study demonstrates that firms investing in R&D can be making a rational decision and that firms that are not investing in R&D can also be making a rational decision. This should remind econometricians that firms are not as irrational as we might sometimes think, and that their decisions are based on much more information than are included in standard econometric specifications.

Policy Relevance: 

In academic and policy debates, it is often assumed that for all firms, R&D spending is beneficial in all circumstances. But this is not true – what is good for the goose might not be good for the gander!

For example, our study indicates that in the Indian manufacturing sector, R&D spending is good for firms, which are younger, exporters, with high capital investments and low financial leverage, while R&D spending might not yield much benefits for firms that have never done R&D before.  In short, R&D investment is not for everyone!

 

Hence, firms that do not do R&D could be having good reasons to do so and vice-versa. This would indicate that a homogeneous economy wide tax breaks on R&D might not be an optimal policy. Innovation policies should be sector and technology specific, and any incentive should be shaped considering the characteristics of the firms involved. This is important to maximize the effects of the incentives, to ensure that firms do not undertake R&D for mere tax benefits, without any innovation output.

Sources of images:

1. https://commons.wikimedia.org/wiki/File:Manufacturing_line.jpg
2. https://commons.wikimedia.org/wiki/File:Manufacturing_Line.jpg
3. http://www.fforce.in/impact-of-gst-on-manufacturing-industry/
4. http://economictimes.indiatimes.com
5. https://colordarcy.com/how-to-earn-20-return-on-your-property-investment/

Should traditional medicines based health care be promoted to plug gaps to access to allopathic heath care? Insights from a case study of a public private partnership experiment

By S. Manasi, Associate Professor, Institute for Social and Economic Change, manasi@isec.ac.in

For Citation: SITE4Society Brief No.9-2018

Country focus: India

Site Focus: Engagement, Governance

Based on: Manasi, S., &  Raju, K. V. (2015). Holistic approach to improve community health- The AYUSH approach. Journal of Holistic Healthcare, 12(2) pages 33-38

Related to: # SDG3(Good Health and Wellbeing), National Health Mission, AYUSH and Public Health

Context: Healthcare is the right of every individual but the lack of infrastructure and qualified professionals, as well as poor access to basic medicines and facilities, thwarts its reach to about 60% of the Indian population. In rural India, where access to healthcare is particularly a challenge, traditional medicine practitioners serve to plug the gap. Traditional medicine is a synthesis of therapeutic experiences from generations of practicing physicians of indigenous medical systems. India has a rich heritage of traditional medicine with these modes of health care flourishing through many centuries. To build upon this strength and also address the healthcare challenge, the Indian government established the Ministry of AYUSH (i.e. Auyurveda, Yoga, Unani, Siddha and Homeopathy – which are the diverse approaches in traditional medicine to improving health). AYUSH promote the concept of AYUSH Gram wherein where villages are selected for AYUSH interventions of healthcare by setting up facilities including hospitals under the scheme of ‘AYUSH and Public Health’.

The AYUSH Gram project in Karnataka is an example of such a Government-sponsored programme under the public-private partnership (PPP) model. Soukya is a luxury Ayurvedic spa located in a suburb of Bengaluru which has an international clientele, including famous ones like Prince Charles of England. Alongside, Dr. Mathai, its founder, runs a number of charities, among which is ‘Dr. Mathai’s Rural Health Care Centre’ or DMRC. The Government of Karnataka, under the AYUSH gram central scheme, provided Rs.34.95 lakh (1 lakh=100 000 INR) and 3 acres of land  in  Jadigenhalli Gram Panchayat. To this, Soukya added its own funds to set up Soukya-DMRC providing quality treatment free of cost to the villagers (see figure 1). It is 25 km from Bangalore and has 7 villages under its purview. This centre, initiated in 2012, is the first of its kind in rural India with different systems of medicine like Ayurveda, Unani, Siddha and Homeopathy integrated under one roof and is one the ten organisations selected under the State Government’s AYUSH Programme. Presently, Soukya-DMRC is entirely run by Soukya Foundation.

Furthermore, to help in rural development, Soukya-DMRC gives training in AYUSH knowledge based routines of preventive care to ASHA and Anganwadi workers (government appointed nurses for mothers and infants; government crèche workers), Panchayats (village councils), self-help groups and government schools.

Research Question: Can access to healthcare be improving by providing quality traditional medicine based therapies in rural India? If so, can public-private partnerships be vehicles for the same?

Motivation for Research Questions: The challenge of providing effective health care in rural India, with high costs and infrastructure challenges makes the development of traditional medicine based healthcare a possible solution. However, how far can or should it be promoted under the public-private partnership model?

Methodology Used:

1. Analysis of data sets from AYUSH Grama DMRC project and SOUKYA-DMRC containing information on number of patients visiting Soukya-DMRC over time, frequency of visits, type of ailments for consultation and follow up visits

2. Focus group discussions villages under Jadigenahalli Gram Panchayat for getting an overview of the situation.

3. Design of structured questionnaire covering socio-economic aspects, AYUSH activities, preferences and perceptions of healthcare centres, access to healthcare, drivers of health such as: water resources, sanitation and hygiene, cropping patterns, food and life-style habits, user satisfaction, drivers of beliefs: religious beliefs, growing and using medicinal plants, ecology and cultural traditions/practices.

4. Survey implementation and analysis of responses from 102 households (10% of the sample) across 5 villages of the Jadigenahalli Gram Panchayat

Main Findings 

1. Village level problems
– Ground water depletion resulting in water scarcity for agricultural purposes and changing cropping patterns.
– Water scarcity for drinking purposes, particularly during the summer months.
– Solid waste dumping into the village farm lands from the cities. The local plastic burning is a major menace.
– Majority of the households have toilets but the villagers also practice open defecation.
– Overall hygiene in the villages is poor.

2. Health problems of rural poor: There has been a change in life style of all – rich and poor in India. Thus, chronic diseases like diabetes (16.7%), hypertension (2.9%) and respiratory problems (1.96%) are common among rural poor also. Furthermore, a majority of the patients visiting Soukya-DMRC, complain of body pain (22.5%), followed by diabetes (16.7%) fever (11.8%) and gastric ailments (11.8%). The doctors observe that villagers are more prone to body pain because of physical work. Gastric problems and weakness problems are due to irregular food intake.  

3. Solution approach offered by Soukya-DMRC: The approach to health care is very different from that of an allopathic health care system. The Health care services are based on traditional medicine systems such as Ayurveda, Yoga, Naturopathy and Homeopathy.  Treatment is based on the patient’s response and stand-alone treatments or a combination of treatments involving the four schools are offered according to the problem.  (a) Homeopathy; (b) Homeopathy and Ayurveda; (c) Homeopathy, Ayurveda and Yoga; (d) Homeopathy, Ayurveda, Naturopathy, Yoga. Within each, a variety of holistic healthcare services are offered as shown in Figure 1.

4. Impact on poor households: On the whole, the impact has been majorly positive. Patients believe in the efficacy of the treatment and hence are regular in their follow-up visits. Within a short period, the foundation has been able to draw attention through an integrated approach in healthcare. Clientele is increasing by word of mouth. Overall, 66.66% of the people have influenced others, 41.17% have influenced their family members, and 15.68% have influenced their relatives to avail of the services. The drivers of success can be summarized as follows:

• Individualized attention: In government hospitals the doctors do not have time to listen to patients, besides, it is not the allopathic approach. In contrast, doctors in DMRC strive to understand the drivers of health of a patient from the patient’s narrative of her/his problems in life.
• Geographical and financial accessibility to health care: Prior to this initiative, patients from low income groups had to travel 12kms for availing treatment at government health centres or pay at the private health clinics. It has also reduced monthly medical expenditure because of the free medication provided.
• Awareness of health problems: Several poor were not even aware that they were suffering from diabetes and hypertension. Since DMRC Soukya does free checkup, several patients were identified and it was found that diabetes and hypertension are the two most common ailments.
• Experience of good results from life style change: More women and children are practicing Yoga regularly and have become aware about the benefits of Yoga. Yoga is taught by Yoga experts from Soukya Foundation. The importance of healthy eating is also spreading.

Children practicing Yoga in Schools, Jadigenahalli village

  

 

Eating Healthy – Promoting Nutritious Food Habits among children by Ayush Grama Soukya Foundation.

5. Challenges of Soukya-DMRC

• Getting doctors to stay in villages.
• Providing free services and maintaining funds in the long run.
• Influencing implementation of lifestyle change and dietary habits among all, especially diabetic patients.
• Approaching people to enrol for de-addiction programmes.
• Follow up visits by patients continues due to busy schedules and negligence.

Policy insights and recommendations:

1. Quality traditional healthcare units are extremely useful. They would not only improve access to health care but  due to teaching of better lifestyle can contribute to preventive care.

2. However, these health care units are not sufficient for improvement of health status of rural residents, unless other related problems in the villages are taken care of. In this context, problems of water scarcity, sanitation, hygiene, environmental pollution and solid waste management of village and other garbage dumping from cities have to be solved.

3. Public-private partnerships or PPP cannot survive in the long run without financial sustainability. To become self-financing there are two possibilities:
– Make the patients pay. Possible financial options could be the charges could be free / priced among varied economic groups – BPL (free medicines), MIG (small fee) and HIG (standard amount).
– Build a corpus of funds from donors like corporate houses under Corporate Social Responsibility (CSR) programs, religious institutions and philanthropists

4. The Soukya-DMRC initiative is a shining example of how luxury spas offering services based on traditional medicines can also run hospitals for the rural poor as a part of their corporate social responsibility program. 

In sum, provision of quality traditional medicines based healthcare seems a very good option to improve access to health care in rural India and other developing countries. Public-private partnerships can be an effective vehicle to promote the same. However, their financial sustainability after the period of the partnership has to be reflected upon, and even decided, before implementation.

BT cotton: A quick fix for the yellowing Green Revolution or the way of greening to come?

By Praachi Kumar, UNU-MERIT (praachi.kumar@gmail.com)

For Citation: SITE4Society Brief No.8-2018

Country Focus: Developing countries and especially India

SITE Focus: Innovation, Technology, Environment, Innovation and Technology Governance

Sub-Disciplines: Agri-Biotech, Multinational Enterprises, Agriculture, Genetically Modified Varieties, Emerging Economies

Based on: Shyama V. Ramani,  Ajay Thutupalli,  Mhamed-Ali El-Aroui,  Praachi Kumar, (2017), MNE Led New Market Creation in Emerging Countries: The Case of Bt Cotton, in Pervenz N Ghauri, Xiaolan Fu, Juha Väätänen (ed.) Multinational Enterprises and Sustainable Development (International Business and Management, Volume 33) Emerald Publishing Limited, pp.131 – 150

Related to Sustainable Development Goals (SDGs): #SDG2 (Zero Hunger), #SDG9 (Industry Innovation and Infrastructure), #SDG12 (Responsible Consumption and Production), #SDG15 (Life on Land), #SDG17 (Partnerships for the Goals)

Context: Farmers in developing countries are burdened with an ever-pressing need to increase productivity, and hence, they are forced to apply more chemical inputs such as fertilizers and pesticides that ultimately lower soil fertility. Morbidity and death due to imbibing of sprayed chemical pesticides are also major health hazards. Genetically modified plant varieties (or GMVs) with inbuilt traits such as pest resistance, offer a technological solution to these problems. Nevertheless, concerns are being voiced worldwide that scientific uncertainty about the long term impact of GMVs is real, and cultivation of GMVs could engender risks of irremediable problems in the future. Thus, even while new genetically modified plant varieties (GMV) continue to be constantly produced, the diffusion of existing GMV remains limited on a global scale. For instance, 38 countries have simply banned GMV in all their forms. India is not one among them.

Source: https://grist.org/article/2009-12-15-seed-behemoth-monsanto-stumbles-into-antitrust-trouble/

In March 2002, the GEAC (Genetic Engineering Approval Committee) of the Ministry of Environment of India approved the commercialization of three varieties of insect-resistant genetically modified Bt cotton hybrids (Mech-12 Bt, Mech-162 Bt and Mech-184 Bt, under the brand name Bollgard® in the central and southern cotton growing zones for the 2002-03 growing season. Bt cotton is so called because it contains the cry1Ac gene transferred from a bacterium called Bacillus Thuringiensis. This gene is responsible for expressing a toxin that kills insect pests popularly known as bollworms, which feed on flowers, buds and leaves. Thus, whenever a pest eats any part of a Bt plant variety – it dies, thereby limiting losses in yields.  By switching to Bt cotton hybrids, farmers have the possibility of reducing yield loss due to pest attack, lowering pesticide spraying and saving on labour costs. Over the next decade, Bt cotton became tremendously popular with Indian farmers. Presently, India ranks fifth in the world (after USA, Brazil, Argentina and Canada) in terms of acres devoted to GMVs, in this case Bt cotton.

Research Questions

• What are the drivers of adoption of Bt cotton worldwide?
• What are the outcomes of Bt cotton adoption worldwide? Have any systemic externalities been noted?
• To what extent do these results hold for the Indian context, and what are the inferences therein for India?

Motivation for Research Questions:  The Green Revolution saved India from famine, but it turned out to be a poisoned chalice in the long run poisoning the earth with agrochemicals in the very zones where it was most successful, due to its inappropriate implementation by farmers and lack of strong remedial measures taken by public agencies and other systemic actors. The lessons of the Green Revolution cannot be forgotten.

Fruits of the biotechnology revolution, namely GMVs are being pushed worldwide by agri-biotech multinational enterprises like Monsanto, Du Pont, and Syngeta as a technological solution for sustainable development. Multinational enterprises being powerful instruments of change, the world also seems to be yielding. The moratorium against marketing of GM based food products ended in Europe in 2004, but since then a strict and comprehensive system of regulation has been developed to permit complete traceability in terms of cultivation practices, GM organism levels and labelling along retail chains. However, in emerging countries, like India, regulation and compliance measures to ensure human and environmental safety without decreasing the economic returns to the actors along the supply and demand chains are not so effectively enforced.

Source: https://thenib.com/gmos-are-making-an-agricultural-crisis-in-india -even-worse

Thus, there is a crucial need to understand how emerging country systemic actors can address two types of concerns: the economic risks faced by farmers while using existing low yielding conventional seed varieties, in the face of inadequate institutional mechanisms to provide them insurance; and the long term environmental risks and other possible social-economic-ecological externalities engendered by the adoption of GMV.

Methodology: In order to identify the drivers and outcomes of Bt cotton adoption worldwide, a research query with the terms: ‘Bt AND cotton AND adoption’ was applied on SCOPUS, the standard abstract and citation database of peer-reviewed literature. The search was limited to articles, in the social sciences, economics, econometrics and/or finance subject areas. Articles were manually filtered for fit with research query and read. Thereafter, the Indian case study was constructed through a study of a variety of secondary sources, including academic literature, government reports and articles in Indian newspapers.

Main findings

1. Foci of academic literature on Bt cotton: The analysis of the literature revealed five broad themes: economics of farming, non-economic returns to farmers, institutional impact on farmer, systemic economic impact and systemic ecological impact. All articles implicitly or explicitly assumed that farmers are profit-maximizers, as economic agents operating in markets are usually supposed.

2. Global drivers of Bt cotton adoption: The main drivers are the higher profits and lower chemical use associated with Bt cotton cultivation. The drive to adopt is independent of farm size, farmer income and farmer experience. Both information seeking and imitative farmers are attracted to it. Indeed, there are no results on which kind of farmer would not benefit from adopting Bt cotton.

3. Farmer and systemic impact: Bt cotton farmers enjoy include higher profits, higher household incomes and lower poverty. The higher price of Bt cotton seed, however crowds out some of this surplus. Systemic externalities include health improvements and contamination reduction. Negative externalities observed were the rise of secondary pests, and shrinkage of local varieties.

4. Market Penetration Challenges: Even if GMVs can be redesigned without problem for an emerging country via collaboration with local firms, because of their intrinsic nature, as a radical innovation that can trigger systemic ecological externalities, a variety of hurdles can obstruct successful commercialization. Systemic challenges can be triggered if GMV legitimacy is not accepted by key stakeholders. Indeed, Monsanto faced direct challenges in India from public agencies and NGOs due to concerns about the long term impact of Bt cotton on human health and the ecology.

   

   Source: http://www.cyberounds.com/elements/resources/508/figure6.jpg

5. Agri-multinational legitimacy creation strategies: Monsanto concentrated on product performance to create a product that would reduce the cost of production of farmers the most. The objective of the innovation design strategy was to maximize the quality improvement of the seed so that it could be sold at the highest possible price to farmers and still displace the available seeds in the market developed by local breeders and public research institutions. Here, the product value was embodied in the benefits to the environment and the health of farmers and it helped to justify a high price of Bt cotton. Further, through an astute mix of strategic patience and compromise with public agencies and NGOs and fruitful collaborations and agreements with local firms, Monsanto was able to successfully commercialize Bt cotton in India.

 

Source: Unknown, Author: Stamp

Policy recommendations:

1. Societal confrontation of GMVs has three components: uncertainty, ideology and controversies. It is difficult if not impossible, to ascertain with precision, the long term risks (or even benefits) of GMVs from laboratory or field trial data. Thus, a variety of ideologies or subjective beliefs can prevail. In this turn means that policy makers should focus only on the third factor i.e. resolving controversies or differences between diverse ideologies. Efforts must be made towards consensus building via information sharing and participatory debates.

2. The ideological clashes between agri-biotech MNEs and societal stakeholders are centred on possible ecological externalities as well as loss of sovereignty of farmers over seeds as they are forced to buy seeds from market to have plant varieties with maximum vigour. Partnerships with local seed firms and public laboratories can reduce this anxiety.

3. The agriculture extension service, which is presently in shambles in most developing countries, must be re-invigorated to educate and accompany farmers to maximize their livelihood, while preserving the ecological sustainability of their farm lands to mitigate systemic externalities.

4. Policy makers must also be alert to minimize innovation rent-seeking by agri-biotech multinationals.

Policy myth: Build toilets and watch open defecation vanish! Evidence from selected villages in West Bengal, India

By Dr. Arijita Dutta, Department of Economics, University of Calcutta,
dutta.arijita@gmail.com

Gitanjali Hajra, PhD research scholar, Department of Economics, University of Calcutta,
gitu.hajra@gmail.com

For Citation: SITE4society Brief No. 7-2018

Related to: #SDG3 (Good Health and Well Being) #SDG6 (Clean Water and Sanitation) #SBM (Swachh Bharat Mission) #TSC(Total Sanitation Campaign)

SITE Focus: Infrastructure,  Environment, Governance

The context: Evidence-based research on medical and social science has confirmed without doubt that improved sanitation has a crucial positive impact on human health and development. According to the World Bank, the economic cost of inadequate sanitation in India amounts to a loss of INR 2,180 (US$ 48) per person, which is equivalent to 4% of GDP. This is why, India, like other developing countries, has implemented national programs to reduce open defecation (OD) through installation of toilets and inducing behavioural change. For instance, sanitation coverage has increased continuously from 1997, especially after the ‘Total Sanitation Campaign’ (TSC) in 1999, that evolved into the Swachh Bharat Mission (SBM) in 2014.  Households living below poverty line are fully subsidized to construct the toilet, while the households above poverty line are motivated by information and education campaigns to construct them with funds out of their own pocket. But, these programs are supply-driven, with a top-down approach, assuming that building of toilets will automatically lead to their usage. However, Census 2011 highlighted that half of the population in India still defecated in the open. Moreover, Swachhta Status, MOSPI 2016-17, indicates that the percentage of open defecation (or OD) still stands at 52.1% and 7.5% at individual level for rural and urban areas respectively. Thus, building toilets has clearly not made OD vanish in India.

Research Questions: 

• Does OD occur by necessity or by choice?
• For those with toilets, what are the factors, across and within households that determine OD?

Motivation for Research Questions:  OD can occur due to lack of access to a functioning toilet or due to other socio-economic and cultural features. While the former is self-evident, the latter is a puzzle. To date, scholars have noted that cultural beliefs, poor knowledge and foul smell from toilets can lead to non-usage. For instance, there is an belief in Uganda that the use of latrines could affect womens’ fertility and cause miscarriage. Another study on Orissa showed that people defecated openly on and beside the road connecting the area to Bhubaneshwar, because of their belief that, God resides at home. However, there are pockets of results and no systematic study has been conducted on toilet usage or non-usage, when they are available at home.

Methodology: We collected primary data during the month of August-September, 2014 on 300 households on information related to socio-economic status of the households, access and usage of toilet facilities, sources of drinking water, hygiene behavior and awareness, morbidity profile among the all members in households from four selected

Source: https://goo.gl/images/AFqAoK

villages of Jalpaiguri district of West Bengal. For collection of data, we used three stages stratified random sampling: at the first stage two blocks were chosen according to literacy rate, namely Nagrakata with lowest literacy rate and Jalpaiguri with highest literacy rate, then at the second stage two big villages from each block were chosen according to highest concentration of Scheduled Tribe (ST) population. The chosen villages were Gatia Tea Garden and Grassmore Tea Garden (with share of ST population being 79.4% and 72.39% respectively) from Nagrakata block and Barpatina Nutanbus (ST share 27.19%) and Patkata (ST share 24.82%) from Jalpaiguri. Finally we selected 75 households from each of the two villages randomly to run the survey.
Ordered Logistic Regression was run on 1425 individuals (above one year of age who are able to use toilets) residing in 300 households with the dependent variable being the usage of toilets divided in four categories: No access to sanitation and always OD; Having access to toilet and always OD, Having access to toilet and mixed use (using both home toilet and OD) and Having access to toilet and using only Home toilet exclusively. These categories are ordered from the worst to better to best practice of defecation: from no toilet and OD to having toilet and always using it. Ordered logistic model is a special case of binary limited dependent regression model, where the dependent variable has more than two categories and they can clearly be ordered in a sequence gradually.

Main findings:

• Out of 300 households only 45% households had toilet within their house.
• In the 55% of households with toilets:
  • Only in 11% of households all the adult members use home toilet exclusively.
  • Exclusive use of household toilet is higher than average in Scheduled Tribes being 25%.
  • 5% practice only OD, despite having a toilet,  i.e. the toilet is not used by any member of the household. Exclusive OD with toilet is higher among poor households compared to non-poor and in households having pit latrines.

source: https://goo.gl/images/JZ37Cw

• With respect to individuals in the 55% of households with toilets:
  • nearly 27% use home toilet exclusively, 16% choose mixed type (both home toilet and OD) and 5% openly defecate in spite of having toilets at home.

 

• According to our empirical model, the significant drivers of OD for individuals in households without a toilet are:
  • Religion: Other factors being similar, the odds of better sanitation behavior (i.e. mixed practice or exclusive toilet) vis-a-vis exclusive OD due to no access is 0.43 times lower for Muslims.
  • Gender: females have 5.48 time higher probability than male in choosing higher sanitation preferences, that is avoiding OD.

Source: https://www.nationalgeographic.com/

• According to our empirical model, the significant driver of OD for individuals in households with a toilet is the physical condition and functioning of a toilet. Non-functioning toilets or those with physical defect trigger OD.

 

Policy Recommendations:

1. Building toilets is necessary but not sufficient to reduce OD.
2. Toilets should be structurally and functionally sound and long lasting.
3. Education and Motivation campaigns to promote toilet usage have to be inclusive across income groups and social groups. In particular non-Muslims and males may need more accompaniments.

   

   Source: https://goo.gl/images/qDKLzg

4. Media campaigns should avoid gender stereotyping as males need more motivation than females. Initially, campaigns such as the famous Vidya Balan advertisement, exhorted investment in toilets to protect daughters and daughters-in-law from the shame and risks of OD. However, the campaign left the message that toilets are for women only, thus creating a serious gender bias in the entire issue. Even in the much acclaimed movie ‘Toilet Ek Prem Katha’ the trigger for toilet construction is to protect women’s convenience and dignity. However, this is also changing and becoming more inclusive (see Darwaza Band – or close the door campaign).