Abstract A supply chain is only as strong as its weakest link. Firms are constantly managing uncertainties, including unexpected delays in the provision of a critical input that can slow down or halt the production process, possibly making the manufacturer miss a delivery deadline. As most exporters are also importers of intermediate goods, supply chain unreliability related to import processing times at the border could impact downstream export dynamics. The role of unpredictability in border-clearance times for imports in manufacturing firms’ entry, exit, and survival in export markets is investigated using the PPML estimator on a rich dataset built on firm-level information for 48 developing countries over 2006–2014. Uncertainty in the time to clear imported inputs impacts neither the entry nor the exit rate, but translates into lower survival rates for new exporters, reducing the number of firms that continue serving the foreign market beyond their first year of entry. This effect grows larger over time, owing to rising reputational costs to input-importing exporters and is mainly driven by South-North trade, possibly reflecting the time-sensitivity of buyers in developed countries. Results also reveal heterogeneous effects across export industries, and the mediating role of sunk costs of entry in foreign markets, which attenuate the negative effect of uncertainty on survival rates as firms delay exiting the export market.

BackgroundSmall and sick newborn care (SSNC) is critical for national neonatal mortality reduction targets by 2030. Investment cases could inform implementation planning and enable coordinated resource mobilisation. We outline development of an investment case for Tanzania to estimate additional financing for scaling up SSNC to 80% of districts as part of health sector strategies to meet the country’s targets.MethodsWe followed five steps: (1) reviewed national targets, policies and guidelines; (2) modelled potential health benefits by increased coverage of SSNC using the Lives Saved Tool; (3) estimated setup and running costs using the Neonatal Device Planning and Costing Tool, applying two scenarios: (A) all new neonatal units and devices with optimal staffing, and (B) half new and half modifying, upgrading, or adding resources to existing neonatal units; (4) calculated budget impact and return on investment (ROI) and (5) identified potential financing opportunities.ResultsNeonatal mortality rate was forecast to fall from 20 to 13 per 1000 live births with scale-up of SSNC, superseding the government 2025 target of 15, and close to the 2030 Sustainable Development Goal 3.2 target of <12. At 85% endline coverage, estimated cumulative lives saved were 36,600 by 2025 and 80,000 by 2030. Total incremental costs were estimated at US$166 million for scenario A (US$112 million set up and US$54 million for running costs) and US$90 million for scenario B (US$65 million setup and US$25 million for running costs). Setup costs were driven by infrastructure (83%) and running costs by human resources (60%). Cost per capita was US$0.93 and the ROI is estimated to be between US$8–12 for every dollar invested.ConclusionsROI for SSNC is higher compared to other health investments, noting many deaths averted followed by full lifespan. This is conservative since disability averted is not included. Budget impact analysis estimated a required 2.3% increase in total government health expenditure per capita from US$40.62 in 2020, which is considered affordable, and the government has already allocated additional funding. Our proposed five-step SSNC investment case has potential for other countries wanting to accelerate progress.

This study investigates the effects of public transfers and taxes on the wellbeing of children in Ethiopia. It applies the Commitment to Equity for Children (CEQ4C) methodology to examine the burdens of taxation and the benefits from government transfers and spending, and their differential wellbeing impacts on children. The study integrates data from the Ethiopia Socioeconomic Survey 2018/19, which also collected data on taxes and transfers, with administrative data. Measuring its distribution by child monetary and multidimensional wellbeing, the study finds, on average, a progressive, poverty-reducing and equalizing fiscal system. However, there are important differences in the distribution of some of its elements. Indirect taxes, comprising of VAT and excise taxes, are regressive. Similarly, primary education spending, the largest of in-kind transfers, is only progressive in urban areas. With regards to poverty and inequality, the fiscal system reduced the monetary child poverty headcount by 21% and the poverty gap by 33%. The effect is stronger for girls and children in rural areas than for boys and children in urban areas, therefore reducing inequalities in poverty rates. However, this is only the case when in-kind transfers for education and health are considered. Without the inclusion of in-kind transfers, the study finds that the fiscal system is not well calibrated to reduce poverty. This highlights the essential role of public services, not only in delivering fundamental child rights, but also in reducing poverty amongst children.

Modern inputs and mechanization are promoted across Africa to raise smallholder labor productivity and broker the structural transformation. Yet, adoption has remained low and the implications for returns to labor and labor allocation remain poorly understood. This paper explores the effects of different intensification packages on farm performance, market orientation, and food security using data from lowland rice farmers in Côte d'Ivoire. Employing a multinomial treatment effect model, the findings reveal that intensification increases land and labor productivity, especially when agro-chemicals and mechanized land preparation are combined. Returns to labor more than triple, inducing greater market orientation as well as greater food security. This opens opportunities to productively release agricultural labor for other activities (on and off the farm). Labor in rice production becomes more waged and slightly more male, but child labor input does not decrease. The findings call for greater attention to labor productivity and confirm that agricultural intensification can pay and enhance rural transformation.

This study examines household welfare dynamics during the COVID-19 pandemic, using harmonized data from over 300 phone surveys in 80 countries during 2020 and 2021, representing more than 2.5 billion people. The analysis traces out the evolution of employment and income across and within countries as restrictions on economic activity were relaxed. We show some groups initially experiencing higher rates of employment loss – including women, informal workers, and those with less education – also recovered jobs at a slower pace. Based on panel regressions, changes in policy stringency were associated with unequal employment outcomes. Labor market transitions were toward jobs of inferior quality on average, especially for workers with less education. Household income dynamics suggest uneven impacts in the intensive margin of employment consistent with these transitions. Lower wages were not offset by additional social assistance. Taken together, these dynamics may amplify the inequality impacts of the pandemic over the medium to long term.

Abstract Background: Mental, neurological, and substance abuse (MNS) disorders describe a range of conditions that affect the brain and cause distress or functional impairment. In the Middle East and North Africa (MENA), MNS disorders make up 10.88 percent of the burden of disease as measured in disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) is one of the main providers of mental health services and one of the largest contributors to mental health research in the region. Within the past decade, mental health resources and services has increased. Methods: We employ a needs-based workforce estimate to arrive at the total number of psychiatrists, nurses, and psychosocial care providers needed to meet the epidemiological need of mental health conditions of the population of KSA. Estimates for a potential mental health workforce gap were calculated using five steps: Step 1– Quantify target population for priority mental health conditions. Step 2 – Identify number of expected cases per year. Step 3 – Set target service coverage for each condition. Step 4 – Estimate cost-effective health care service resource utilization for each condition. Step 5 – Estimate service resources needed for each condition. Results: There is an epidemiologic need for a total of 17,128 full-time-equivalent (FTE) health care providers to treat priority MNS disorders. KSA appears to have a need-based shortage of 10,402 health workers to treat mental disorders. A total of 114 psychiatrists, 5,729 nurses, and 4,559 psychosocial care providers would be additionally needed (that is, above and beyond current levels) to address the priority mental health conditions. The shortfall is particularly severe for nurses and psychosocial workers who make up 98.9 percent of the shortfall. This shortage is substantial when compared to other high-income countries. Overall, the workforce needed to treat MNS conditions translates to 49.2 health workers per 100,000 population. Conclusion: Challenges to addressing the shortfall are Saudi specific which includes awareness of cultural customs and norms in the medical setting. These requisites are compounded by the lack of Saudi nationals in the mental health workforce. Saudis make up 29.5 percent of the physician workforce and 38.8 percent of the nursing workforce which means that foreign-trained staff must supplement the shortfall and be mindful of Saudi specific cultural considerations. Potential solutions to reducing the shortfall of mental health care workers includes nurse task shifting and training of general practitioners to screen for, and treat, a subset of MNS disorders.