The biggest reductions from 2023 to 2024 are:

• India – 35,000 fewer deaths

• Ethiopia – 26,000

• Pakistan – 11,000

• China – 8,000

• Türkiye – 5,000

• Indonesia – 3,500

The only notable increases were in the Democratic Republic of the Congo (+2,200) and South Sudan (+1,200).

Some key points.

• Under-five deaths have fallen 63% since 1990 and 52% since 2000

• The annual decrease in deaths was:

  • 2019 – 175,000

  • 2020 – 31,000

  • 2021 – 7,000

  • 2022 – 237,000

  • 2023 – 127,000

• Progress stalled in 2020–2021 during COVID, but has since recovered

• Sub-Saharan Africa accounts for 60% of all under-5 deaths

• Just 6 countries (Nigeria, India, DRC, Pakistan, Ethiopia, Niger) account for half of all deaths

• Countries classified as fragile or conflict affected account for over half of all under-five deaths

A note on data revisions

Comparing this year’s visualisation to last year’s, you’ll notice the map has actually gotten bigger, with an extra 209k deaths, despite real progress in 2024.

This year’s release incorporated the UN Population Division’s World Population Prospects 2024 revision, which revised sub-Saharan Africa’s population upward by 16 million (1.3%). More births mean more estimated deaths with the same mortality rates. The 2023 figure went from 4.78m to 4.99m (a 4.4% increase).

The biggest revisions were for Nigeria (+89k), DRC (+76k), Sudan (+21k), Ethiopia (+20k), and Uganda (+18k). A handful of countries were revised downward - Angola (-18k), Mali (-14k), and Indonesia (-10k)

The countries most affected are those with the weakest population data. Nigeria hasn't conducted a census since 2006; the DRC's last was in 1984. There are 23 countries where the most recent census is over 15 years old, meaning the Population Division is projecting forward from old baselines using fertility estimates from periodic household surveys and statistical models. I've written previously about the possibility that Nigeria's population is significantly overestimated, potentially by 50-70 million people. If that's even partially right, this revision could be moving the estimates further from reality rather than closer to it.

This post compiles donation opportunities and project ideas across economic growth, health, migration and meta-level infrastructure. This isn’t deep (or even shallow) evaluation - it’s a selection of leads for further investigation.

I’m still open for more suggestions if you want to add a comment below.

Economic Growth

Two years ago I asked development people and economists for donation suggestions for supporting economic growth. You can read the full list in the link but I’ve listed the ones below that are more likely to have a funding gap.

• Growth Teams - Partners directly with governments to design and implement strategies for generating scalable jobs in poorer states

  • Tija - Uses AI to create personalised growth strategies for SMEs, a project of Growth Teams

• Charter Cities Institute - Advocates for the establishment of charter cities to spur economic development

• Emergent Ventures - A low-overhead fellowship and grant program that supports entrepreneurs with scalable, “zero to one” ideas for improving society

• Prosperiti - Indian think tank focused on economic freedom and job opportunities, targeting labour regulation reform at the state level

• XKDR Forum - Interdisciplinary group that conducts research and policy engagement on macroeconomics, finance, and the judiciary to advance India’s growth

Not in the above list but potential to be impactful.

• African Urban Lab - Research and training centre at the African School of Economics. Training the next generation of African city planners and municipal leaders

  • YIMBY movement for African cities - Implementing urban policies (expansion planning, satellite property tax, curriculum reform)

• The African Tech Futures Lab - Aiming to provide decision-makers with policy strategies to govern emerging technologies like AI, clean energy, and climate engineering

• The Global Prosperity Institute - Volunteer run think tank writing on economic growth, they also run a fellowship where people work with Tanzanian businesses. They are open to small donations but unsure if they could absorb a much larger figure

• Roots of Progress - Attempting to establish a new philosophy of progress for the 21st century. Includes a career accelerator program. Actively fundraising

• Abundance & Growth fund from Coefficient Giving. Most of these are based within institutions, US focused or receiving large grants already

  • Asothia - Funding opportunity database tool for scientists/researchers

• Veddis Foundation vetted

  • Foundation for Economic Development

    • “identify high-impact growth opportunities in areas like labor-intensive exports, housing, etc., and work with the government on creating a value chain of reform”

  • Artha Global

    • “work on building healthier, more productive cities, on ensuring that technology can be harnessed to achieve better societal and economic outcomes, on strengthening data systems to improve decision making and on delivering sustained and inclusive economic growth”

  • TrustBridge

    • “works on improving the rule of law for better economic outcomes for India”

Ambitious Impact

When asking people for hits-based giving suggestions AIM/CE would come up a lot.

I’ve included some of the newer orgs that are more likely to have a funding gap but you can also just speak to AIM to see where they think extra donations will make the biggest difference.

• ACTRA - Implementing community-based therapy (CBT) and crime prevention strategies in Latin America

• Learning Alliance - Supports teachers in Africa to implement evidence-based practices

• No Violence at Home - Uses media to change social norms aiming to reduce intimate partner violence

• Radius Institute for Road Safety - Providing data and technical assistance to reduce road traffic deaths and serious injuries

• Four new charities from the latest incubation round

  • First Embrace - Will establish ‘Kangaroo Mother Care’ wards in Nigerian hospitals to reduce low-birth-weight new born mortality

  • Better Season Project - Will provide asset-collateralised loans to Kenyan smallholder farmers for water tanks and other productive tools

  • Opal Health - Will implement learning and action groups in rural Uganda to reduce maternal and neonatal mortality

  • Better Futures Guide - Will create a GiveWell-style evaluator specifically for livelihood programmes

Migration

• Setuwelt (AIM incubated) - A scholarship program that connects underprivileged Indian youth to Germany’s apprenticeship program

• Kav LaOved - A legal aid non-profit that helps migrant workers recover unpaid wages (from the Maximum Impact research project)

• Malengo - Facilitates educational migration as a poverty reduction strategy. They provide financial support and mentorship to high-potential students from Uganda to complete university degrees in Germany

  • Although recently had grants from The Shapiro Foundation, GiveWell and Coefficient Giving

Health

• Project Resource Optimization (hosted at CGD) - Maintains a database of vetted, mid-implementation aid projects that lost USAID funding, connecting donors with opportunities.

  • HPV Vaccination ($80k funding gap) - Implementation research on scaling HPV vaccination to prevent cervical cancer in Bangladesh, Côte d’Ivoire, Malawi and Nepal

  • Madagascar Vaccines ($230k) -Strengthening urban immunisation systems to reach zero-dose children in Madagascar

  • LIFELINE Syria ($460k) - Emergency response providing necessities and health services in conflict-affected Syria

  • HIV/TB Myanmar ($1m) - Prevention programme for HIV and tuberculosis in Myanmar

• One Day Health - Social enterprise that launches nurse-led primary health centres in remote “healthcare black holes” in Uganda to treat common, treatable conditions like malaria and pneumonia

  • They were also looking for funding for a project called Health AIM - A mapping tool helping health providers reach remote rural areas

• Wells4Wellness - Drills and maintains wells in Niger, recently evaluated via an EA group

• From AIM

  • Access to Medicines Initiative - Works to prevent stock-outs of essential family planning supplies in health clinics in Nigeria

  • Respira Health - Closing the treatment gap for Chronic Obstructive Pulmonary Disease

  • Kaya Guides - Provides evidence-based mental health support (guided self-help) for youth in LMICs

  • Lead Research for Action - Conducting lead exposure research in neglected countries to identify sources and pave the way for advocacy

  • Lead-Acid Battery Recycling Initiative - Aiming to curb lead poisoning caused by the unsafe recycling of lead-acid batteries

• From ACX Grants - 2024

  • Aperture.ai - Pupillometry via smartphone, the team was given $60k

• Manifund Opportunities

  • Screwworm Free Future ($56k funding gap) - Coordinating South American governments toward continental eradication during a rare 12-18 month political window created by barrier collapse

  • AI-assisted low-cost ultrasound scanner ($36k funding gap) - Wearable ultrasound patch with AI diagnostics using off-the-shelf components for home monitoring in settings without hospital access, currently building first prototype

  • Clean Indoor Air for Schools ($350k funding gap) - Developing open-source quiet classroom air purifiers at <$2/student/year with evidence of absence reduction and test score gains

  • mRNA for airway disease ($80k funding gap) - Inhaled lipid nanoparticles for lung disease treatment using AI-designed LNPs, MIT postdoc seeking ferret preclinical studies before company spinout

  • Vaccine manufacturing platform ($50k funding gap) - Cell-based vaccine production replacing egg-based methods for influenza and yellow fever, eliminating adaptive mutations and supply constraints

• Turn.io cohort for a Health & AI Accelerator, startups that may be looking for funding

  • AI Diagnostics - digital diagnostic tools and AI stethoscopes for tuberculosis screening

  • hearX Foundation - accessible hearing care and digital hearing aids for low-resource settings

  • Cuéntame - B2B mental health platform using AI to personalise wellness journeys for Latin American employees

  • MDaaS Global - network of tech-enabled diagnostic centres for low-income patients in Nigeria

  • Helium Health - electronic medical records and hospital management software for West Africa

  • Peek Vision - software and data intelligence optimising eye health surveys and services globally

Funds

I looked into a few different funds to see where they were granting as they will have hopefully done some vetting and analysis. I’ve included examples from different funds where they didn’t receive large grants and don’t look to be based within institutions.

• Founders Pledge have launched a ‘GHD Catalytic Impact Fund’

  • They have funded a bunch of AIM orgs and a few non aim orgs including

    • Research Institute for Compassionate Economics - Child health and human development challenges in India

    • Project Impala - Low-cost patient monitoring device and software platform designed by the social enterprise GOAL 3

    • PrEP4All - Advocacy group fighting for universal access to HIV prevention and treatment, focusing on breaking patent monopolies to lower drug prices

    • Structural Transformation of Agriculture and Rural Spaces (STARS) - A fellowship and research program supporting early-career economists from developing countries to influence agricultural policy

• Giving Green Fund - Climate focused orgs

• The Livelihood Impact Fund seeks to meaningfully and durably improve the lives of the global poor - Here are a few that seemed interesting

  • Wala – Provides solar irrigation equipment and financing to smallholder farmers in Malawi, allowing them to cultivate crops during the dry season

  • Young Farmers Champions Network – Advocacy and peer-to-peer training network for young farmers and aims to change mindsets to view agriculture as a viable business

  • Springboard – Combines organic farming training with business incubation to help rural youth build sustainable agricultural enterprises in Nigeria

  • Wezesha Impact – Delivers vocational and entrepreneurship training to underserved youth, bridging a gap between education and labour market demands

• Dovetail Impact Foundation Acceleration Program - Provides grants and capacity building to high-potential African nonprofits (<$500k budgets) in health, livelihoods, justice and education. Given their funding cut off there may be opportunities to support a smaller org amongst their grantees

• Mental Health Funders (funding circle)

  • $20K for Overcome - Providing free telehealth services to sufferers of mental illness in LMICs

  • $50K for Veneactiva - Stepped care therapy (IPC and G-IPT) for Venezuelan refugees in Peru

• Global Health Funders (funding circle)

  • A Fine Mind

  • Mother Health Global

  • One Day Health

  • Pahle India Foundation

  • PMC360

  • Rice Institute

  • Sanitation and Health Rights in India Foundation

  • Semilla Nueva

  • Shamiri Institute

  • Taimaka - (AIM incubated)

• The Life You Can Save Funds

  • They generally give to GiveWell recommend orgs, but also a slightly wider range including education and quality of life

• Gates Foundation Grand Challenges awards ($100k–$200k) - 2000+ grants over the last 20 years, would require further research into potential impact and room for funding

• Coefficient giving - Formerly Open Philanthropy

  • Effective Giving & Careers

    • Institute for Development Innovation (AIM incubated) - Lobbying for smarter public welfare programs for India’s poor

    • Network for Effective Evidence-based Development - Help public policy master’s students access opportunities in evidence-based development (US based)

  • They also have funds focused on the below areas but I didn’t see any orgs that looked likely to have room for more funding

    • Lead Exposure Action Fund

    • Science and Global Health R&D

    • Air Quality

    • Forecasting

    • Global Health & Wellbeing Opportunities

    • Global Growth

    • Global Aid Policy

• The Agency Fund

  • Several organisations in their AI for Global Development Accelerator may have room for funding beyond their accelerator grants, including

    • Jacaranda Health (maternal care in Kenya)

    • Digital Green (agricultural advisory)

    • Precision Development (farming in India)

  • The Agency Fund also have a list of their investments with funding amount included, which could indicate which orgs are potentially funding constrained

Research & Evidence

• Peace Per Dollar - Aims to establish cost-effectiveness methodologies and norms for peacebuilding interventions. Is a small project but could maybe do something with an early backer

• Rethink Priorities’ GHD department - Can help fund specific research or general support

• Institute for Replication - Reproduces social science research to see which results hold up

• The Metascience Observatory ($65k funding gap) - Building comprehensive database of experimental replications across scientific fields to track reproducibility and enable quality-focused journal rankings

Communication & Advocacy

• In Development - “Dedicated to exploring how progress actually happens in the developing world” - A new project that may benefit from early funding

• Unlock Aid - Advocacy nonprofit that lobbies for bipartisan legislation to reform how America’s foreign aid budget is spent

  • They had a $70,000 funding gap in September 2025, likely to be filled by now but it suggests they will have a funding gap next year

  • They also have an index of global health supply chain organisations that they think are impactful

• Equiano Institute

  • Africa-focused AI research and policy org that builds practitioner communities, develops ethical guidelines and studies the economic impacts of emerging technologies

• VoxDev - “A platform that bridges the gap between development economics research and policy practice”

  • Technically a project for several institutions rather than a standalone charity but maybe could do more with separate funding. I’ve been impressed with their output despite being just two people

• Friends of The Global Fight advocates for full commitments from donor governments to the Global Fund, to support malaria, TB and HIV/AIDS programming globally

• Substack Blogs - Potentially there is value here if a writer could be more influential if they had more time to write, although I suspect they have more counterfactual good in their existing careers

  • Africa’s Bright Future - Magatte Wade - “for entrepreneurs, investors, academics, policymakers, and anyone else who wants informed discussions about the opportunities and challenges that lie ahead for Africa”

  • Yaw’s Brief - Covers economic history, trade and geopolitics, with a focus on structural forces

  • Tech Safari - A tech publication founded by Caleb Maru that connects the dots on Africa’s tech ecosystem, profiling startups and investment trends

Meta/Infrastructure

• High Impact Medicine - Guides doctors/healthcare workers to increase their impact on global health and biosecurity through career planning

• Effective Giving Ecosystem - There are 60+ orgs in this network with varying levels of effectiveness and focus. The entire EG ecosystem grew by ~10% between 2023 and 2024, from ~1.1b to ~1.2b money moved. Roughly 50% is moved towards global development (which is likely to be some mix of GiveWell/TLYCS recommended and AIM organisations)

  • You can see a list of the orgs here

  • Here are some that may be more likely to be looking for funding

    • Albion East - New philanthropic advisory group with a focus on East Asia and government giving

    • Centre for Exploratory Altruism Research (AIM incubated) - Research group looking to find new high-impact cause areas, including within global development

    • doebem - Effective giving platform that evaluates Brazilian charities for cost-effectiveness and directs funds to global top charities

    • CharityBox - Chinese charity incubator and evaluator, focused on metascience and evidence-based philanthropy

    • Impactful Giving (AIM incubated) - “building India’s effective giving ecosystem by making evidence-based, scope-sensitive and counterfactual philanthropy easier for new and emerging HNW donors. We combine rigorous research, funding circles and bespoke advisory to unlock more high-impact philanthropy in India.”

    • Maximum Impact - Offers access to global top charities alongside evaluations of local Israeli non-profits

      • Suggestions from the ‘Maximum Impact’ Program by EA Israel

        • Smoke-Free Israel - Tobacco taxation and legislation

        • NALA - Delivering WASH interventions in Ethiopia

• Health Progress Hub - Fellowship placing LMIC professionals with global health orgs (mainly AIM incubated) via training + project work

• 80,000 Hours for global development - Still in the idea stage but they are open to discussing with funders

• I was also planning on running one or more of these projects in 2026, if anyone is interested in funding these let me know

  • A forecasting tournament tracking key global health & development metrics for 2025-2026, providing ongoing data points to see how forecasters think policy/funding changes affect future outcomes

  • Virtual program focused on broad GD topics (health, governance, private sector, growth, AI)

    • An expanded version of what I ran earlier in 2025

  • Virtual program focused on just AI & GD, mostly aimed at potential founders/technical/funders

  • A meta organisation filling in various gaps in the GD & EA ecosystem

    • Coordinating events for leaders in the GD space to help the best ideas get circulated faster

    • Connecting relevant people in this space to other people/orgs

    • Collecting, synthesising and disseminating relevant research and ideas

      • Interviews, podcasts, case studies, structured debates

    • Mapping out the landscape of existing organisations and services

This conclusion depends heavily on the accuracy of current population baselines and UN demographic projections. For several key countries, particularly those with weak statistical infrastructure and infrequent census data, both may be substantially overstated.

Population baselines may be inflated

Nigeria’s official population figures have long been contested. The country’s last census was conducted in 2006, and subsequent population estimates have been based on extrapolations rather than actual counts, with researchers using satellite imagery and geographical information systems suggesting the last census considerably overstated Nigeria’s urban population and that current population may be closer to 170-180 million rather than the official 220-230 million.

Similar issues could affect DRC and Ethiopia.

• DRC has not had a census since 1987

• Ethiopia’s official statistical service estimated the population at 109 million in 2024, substantially lower than the 132 million cited by the World Bank

Nigeria alone could account for a significant share of SSA’s projected poverty increase. If its population is overstated by 50 million and roughly 40% live below the international poverty line, that’s ~20 million fewer people in extreme poverty than current figures suggest. Extending similar corrections across other countries with poor statistical capacity could materially lower the global baseline.

GDP per capita calculations depend on accurate denominators

Inflated population figures distort poverty measurement in two ways.

• First, they overstate the number of people in poverty

• Second, they understate GDP per capita, making economies appear more stagnant than they are

If Nigeria’s actual population is 175 million rather than 230 million, the same total GDP divided by fewer people means per capita income is roughly 30% higher than official figures suggest1.

A country with 2% GDP growth and 3% population growth looks like it’s getting poorer, but if actual population growth is 1.5%, it’s achieving modest per capita gains.

Fertility is declining faster than UN projections assume

Recent analysis by Jesús Fernández-Villaverde highlights significant discrepancies between national vital statistics and UN estimates. For Colombia, Türkiye and Egypt, actual 2022-2023 birth counts from national registries fall substantially below what UN projections anticipated.

Recent projections suggest fertility may be declining faster than anticipated, with Nigeria’s total fertility rate falling to 4.6 in 2021 from 5.8 in 2016, a 20% drop.

This has led to repeated downward revisions, the 2024 UN World Population Prospects report lowered Nigeria’s 2100 projection to 477 million, down from 914 million in the 2012 report.

Fernández-Villaverde estimates that correcting for these discrepancies suggests the world’s total fertility rate in 2024 is likely around 2.17 rather than the UN’s 2.25 estimate, meaning humanity may have already fallen below the global replacement rate of 2.21 (higher than the typical 2.1 when taking into account child mortality rates globally).

Urbanisation

The fertility decline accelerates through urbanisation. Women in urban areas of Sub-Saharan Africa typically have fewer children than those in rural areas. As the proportion of people who live in urban areas is projected to increase, this compositional shift will drive fertility down faster than national-level projections suggest. This effect is compounded if more population overcounting has occurred in rural areas (although without accurate census data it’s difficult to determine where overcounting has happened or if it has happened at all).

As well as lower fertility, urban areas have higher average incomes. The combination of faster urbanisation than expected and lower urban fertility means poverty should decline faster than current projections indicate.

What this means

Our World In Data looks at projections that assume 2015-2024 growth trends continue, using UN demographic forecasts as the baseline. If those inputs overstate current populations, rural composition and future growth rates, the projections will be systematically pessimistic.

I’m not claiming these countries are doing well or that stagnation isn’t a serious problem. It means the specific claim that progress will reverse after 2030 rests on demographic assumptions that may be materially wrong in a potentially consistent direction.

If actual populations are lower and growing more slowly than official figures suggest, several things follow.

• Current extreme poverty headcounts are overstated

• GDP per capita growth has been understated (making recent performance look worse than reality)

• Future poverty trajectories may be less pessimistic than current projections indicate

The case for urgency in addressing economic stagnation in the poorest countries remains. But the timeline and magnitude of the challenge may be different than current data suggests. We should be cautious about declaring “the end of progress” based on demographic data that carries substantial uncertainty, particularly when that uncertainty is potentially directionally biased.

Better census data and population indicators in these countries would reduce the uncertainty. Until then, projections should be interpreted with appropriate scepticism.

This happened in 39%1 of villages that already had a government worker. The NGO arrived with funding and good intentions, but the likelihood that villagers received care from any health worker declined by ~23%.

Welcome to unintended consequences of the development aid ecosystem.

Brain Misallocation

“Brain drain”, - the movement of people from poorer countries to wealthier ones, has been extensively discussed for decades2. But there’s a different dynamic that gets far less attention: “brain misallocation”.

In many low- and middle-income countries (LMICs), the brightest talents are being incentivised towards organisations that don’t utilise their potential for national development. They’re learning how to get grants from multilateral alphabet organisations rather than build businesses or make good policy. This isn’t about talent leaving the country. It’s about talent being misdirected and mistrained within it.

Examples

A health worker in northern Uganda describes the talent drain:

Last year, one of our best nurses left one of our rural health centres. With no warning and without telling anyone. It was the 3rd nurse that year who left for an NGO job. We rushed to replace him, but it put the only remaining nurse there under a lot of stress, and I’m sure patients weren’t cared for as well in the meantime. Our replacement wasn’t as good. I didn’t hear the nurse who left again until 6 months later, last week. He came to apologise for leaving abruptly. He said he felt really bad about it, that he had let his fellow staff and the patients down. He’s a great guy and it was good to catch up and reconcile everything. When I asked him why he left for the NGO job, he looked at me as if it was a stupid question.

“The money was too much, of course”

This same dynamic affects would-be entrepreneurs and private sector workers, not just government employees and local health centres.

The wage differential driving this is substantial. Ivan Gayton’s experience with Médecins Sans Frontières in Burundi illustrates the scale. In 2003, MSF paid unskilled labour $1/day when the local market rate was 25 cents.

Ivan: …I mentioned…this back of the envelope calculation that we were 75% of the local economy…we destroyed and distorted the local economy completely; as development practice that would’ve been utterly and completely unethical.

The only justification for doing something like that is an acute emergency, which it was, it was nigh on a hundred thousand people with literally no access to healthcare whatsoever. The amount of avoidable suffering and death that was going on that we could actually alleviate was something that, you know, in sort of humanitarian practice, I guess we arrogate to ourselves the idea that we can, in a sufficiently emergency situation, justify doing things that would be unethical development practice.

Elizabeth: Do you think the village was worse off for having the hospital located in their village?

Ivan: oh yeah. Because we obviously brought this flood of money in, but where does the money go? The doctors and nurses, they’re not even local. They’re from the capital city. So you’re bringing in people from the capitol who then lord it over the local people, price of food jumps up, price of accommodation goes insane. The trickle down opportunities are to be sex workers and cleaners and, you know, servants for these, for these newly created royalty.

Elizabeth: you might hope that if the price of food goes up, but their wages are also going up because they’re working for the hospital or tangentially, then that would compensate?

Ivan: Well yeah. For the people who are already, you know, have access to the labor market and are already able to sort of get in on that. Sure. I mentioned that I actually, I deliberately kind of rotated through the villagers to give lots of people a chance, but still, if you’re not one of the people who gets a chance or even ever had a chance, or was somebody who’s, you know, on the outs with the local powerful people, then we, as these foreigners providing these jobs, we never even see those people.

They don’t even get to apply for a job with us. We never even know of their existence. So those people, now, the price of everything is jumped. There’s a bunch of newly, much more wealthy people around them, and they’re excluded from that. They don’t see any of the benefit and all of the harm. So it’s, it’s terrible.

While MSF could justify this as an acute emergency response, the economic distortion was huge. These wage premiums, sustained over time across thousands of NGOs, fundamentally reshape who works where and develops what skills.

Kenya alone has over 11,000 NGOs employing 70,000+ people. That’s roughly equivalent to staffing 15 mid-sized hospitals, 700 secondary schools or hundreds of larger companies. Instead, it’s distributed across thousands of small projects, many of which are likely less effective than the services they replace.

The Incentive Trap

This isn’t about NGOs being malicious, they’re responding to incentives. So are workers. But rational individual decisions can create collective dysfunction.

No one is making deliberately bad choices. A talented graduate earning $150/month gets offered $600/month by an international NGO. She takes it. Why wouldn’t she? An NGO needs skilled staff and can afford to pay. Why wouldn’t they hire her?

But multiply this by thousands of decisions, and you get a system where the brightest people learn to write grant proposals instead of build businesses and satisfy donor reporting requirements instead of navigating local politics.

When a significant chunk of a country’s most educated young people end up in the NGO ecosystem, several patterns might emerge.

• Accountability runs upward, not downward

  • Staff learn to focus on reporting metrics, not respond to community needs or political/business realities. The skills for navigating aid bureaucracy don’t transfer to navigating citizen or customer demands

• Scattered impact

  • Rather than concentrating intellectual capital in sectors that could drive economic growth, talent gets distributed across numerous small initiatives with limited scale

• Skills mismatch

  • The skills NGOs cultivate such as grant writing, donor reporting, international frameworks, aren’t the ones most needed for building competitive local enterprises or effective public institutions

• Wrong networks for local impact

  • Career advancement in NGOs means building relationships with other international organisations, donors and expatriate staff. The connections that matter for building local institutions are less developed

• Sector hopping following funding waves

  • When donor priorities shift from health to education to climate, talented people follow. There is less deep expertise in one sector because career incentives reward flexibility to chase funding trends

When Help Becomes Harm

A study in Ghana found that when NGOs entered communities, government funding decreased by 6.8% in NGO-active sectors (even as it increased by 7.4% in areas where the NGO was not focused). Money flowed away from government institutions that villagers had previously relied upon and into new programs sponsored by the NGO.

This les to overall villager well-being (measured across food security, education, health, nutrition, environment and economic livelihood) decreased by 0.1 standard deviations after the NGO’s arrival. These villagers had historically relied more on government institutions, so when the NGO displaced those without providing better alternatives, they suffered most.

One theory for the underperformance was that the NGO encouraged citizens to spend more time engaging with relatively powerless local authorities rather than the higher-level political work that could actually improve wellbeing.

Conclusion

This could be wrong. Maybe NGO experience provides valuable skills people later use elsewhere. Maybe in contexts with few good jobs, NGOs are the best available option for keeping talented people in-country and employed.

There are also variations in government pay as well with some countries having relatively high pay for government workers with very little extra productivity to show for it.

But if there’s something to the idea of brain misallocation, it could reframe how we think about development aid effectiveness. Not just “does this project work?” but “what is this doing to local human capital allocation?”

I think NGOs and donors need to ask uncomfortable questions. When you pay staff 2x local rates, where are those people coming from? What would they be doing otherwise? Are you strengthening or weakening regional capacity? What role are you playing in the broader talent ecosystem?

Also job seekers in LMICs facing this choice deserve better options. The problem isn’t that NGOs pay too much, it’s that private sector opportunities pay too little or don’t exist. This is ultimately about governance and economic development failures, with NGO salaries as a symptom not a cause.

I wondered how much of this was US-specific, especially after seeing there's been a ~25% drop in homicides in London so far this year.

So I started looking for 2025 news on homicide rates and began seeing several large drops, Jamaica down 42% and Mexico down 16%, which made me wonder if this was a global trend.

I also think homicide is underdiscussed as part of broader global development even though there are annually more deaths from homicide (~400k in 2021) than conflict, terrorism and natural disasters.

And for 15-49 year olds specifically, it is the 9th leading cause of death globally, above malaria, drowning and drug overdoses.

Here's what I found when I looked at the most recent data, though it was pretty difficult to find current statistics, only 12 countries had data for some part of 2025, a few more had 2024/2023 figures, and many either don't publish homicide data or the figures are just too unreliable.

United States - 16,940 homicides, a rate of 5 per 100,000 people in 2024.

Following 2024's 15% drop (from a local peak), homicides have fallen another 20% through May 2025.

The rate of 5 per 100k was the lowest rate since 2015, if this decrease continues, 2025 will be the lowest rate ever.

Mexico - 25,469 homicides, 19.3 per 100k in 2024, a 19.6% drop compared to 2023.

So far in 2025 there is an additional 15.9% drop, reaching the lowest levels of violence since 2016.

Jamaica - 1,139 homicides, 40.1 per 100k in 2024, an 18.7% drop from 2023.

As of August 9th 2025, there were 415 homicides, a 42% year on year drop.

South Africa - 27,621 homicides, 43.5 per 100k in 2023/24.

27,494 in 2022/23, 43.8 per 100k. In Q1 2025 there has been a 12.4% drop compared to the same period in 2024. Although still high compared to a decade ago.

England and Wales - 535 homicides, 0.88 per 100k in 2024/2025 (year ending March 2025).

A 6% decrease from 23/24 and the lowest count since 2014 (533 homicides, 0.94 per 100k). Interestingly this is almost converging with the Japanese rate which has had a recent spike (0.73 per 100k).

In London up to August 31st 2025, there has been a ~25% drop compared to 2024 at the same point (55 homicides vs 74 last year). This is a bigger drop then recent years which has generally been 2-3% a year. With a population of ~9 million1, that would be a rate of 0.9 per 100k (if it is still 25% lower by the end of the year).

Canada - 788 homicides, 1.9 per 100k in 2024.

Canada has had a 23% drop2 through August 2025 compared to the same period in 2024, if this continues the projected rate is 1.36 per 100k.

Costa Rica - 880 homicides, 16.6 per 100k in 2024, a 3.5% drop from 2023 (still the second-most violent year on record).

As of July 31st 2025, the rate stands at 16 per 100k, a slight decline from 2024.

Honduras - 2,503 homicides, 25.3 per 100k in 2024, down 26.5% from 2023.

For the first 5 months of 2025, ~900 people have been killed, which would be a ~19% drop if this rate continues.

Ecuador - 6,986 homicides, 38.8 per 100k in 2024.

Despite a 12.8% drop from 2023, this was still the second-most violent year in Ecuador's history.

Between January and June 2025, Ecuador recorded a 47% increase in homicides compared to the same period in 2024, with an average of 25 murders per day

Spain - There were 84 homicides in the first three months of 2025. This is a decrease of 11.6% compared to the 95 recorded in Q1 of 2024, but not much of a change from 3-5 years ago.

The Philippines ~5k homicides in 2023.

Direct national reporting showed murder cases dropping from 1,535 to 1,243 in comparative 70-day periods between late 2024 and early 2025.

Bangladesh - 4,114 (2.38 per 100k), an increase from 3,023 (1.76 per 100k) in 2023. The spike in 2024 may have been due to political unrest as well as older homicides being filed.

The 2025 projection based on the first 6 months would suggest a rate of ~2.2 per 100k.

Out of the 12 countries I found with 2025 data, 10 had decreases larger than 5%, and only Ecuador had an increase (although a big increase).

Even though I couldn’t find more recent data for most countries, I found info from 2024/2023 for a lot of countries and thought it may be useful to see what the relatively recent trends have been like, going region by region.

Latin America and the Caribbean

A very useful resource for this research has been the Insight Crime 2024 Homicide Round Up article, I wish there was an organisation covering each of the other regions, it would have made this process a lot easier.

They also have a 10 year lookback to see how homicide data has changed in the last decade.

• Central America and Mexico - 58% decline from 38 per 100k in 2015 to 16 per 100k in 2024

• South America - Average rate declined by 22.6% over the last decade

• The Caribbean - Average rate rose by 19% over the last 10 years (although a much smaller population than the other two regions)

Going back to changes in the last couple of years, ~120k people were murdered in Latin America and the Caribbean3 during 2024, putting the median homicide rate at around 20 per 100k. This is a reduction of ~7% from 2023.

• Central America and Mexico: 18% decline from ~39k in 2023 to ~32k in 2024

• South America: 5% decline from ~81k in 2023 to ~77k in 2024

• Caribbean: 25% increase from 9.6k in 2023 to 11.6k in 2024 (mainly driven by Haiti, which contributes to over 60% of the homicides in the Caribbean)

Brazil - 44,127 homicides, 20.5 per 100k in 2024.

A 5.4% drop from 2023, and the lowest number since 2012.

Colombia - 13,341 homicides, 25.8 per 100k in 2024.

A 1.9% decrease from 2023.

Haiti - 7,302 homicides, 60.9 per 100k in 2024.

A 51.6% increase from 2023, although the data is very unreliable.

Venezuela - 6,884 homicides, 24.4 per 100k in 2024.

Down 2.2% from 2023, although about 10% higher than 2022.

The other countries in the region are all below 5,000 homicides per year, although with a wide range of rates.

Europe

Europe seemingly has good data on homicides but they take their time in releasing it. Data for 2023 was released in April 2025, and it’s hard to tell if anything has happened to homicide rates in the last 18 months.

The European Union recorded 3,930 homicides in 2023, 0.88 per 100k, up 1.5% from 2022 but 15.2% lower than 2013.

It can be a bit tricky comparing with a specific year, as it could have been a recent high or low, especially in smaller countries, although I think the picture from the biggest countries roughly matches the trends shown in the table above. Relatively stable in France and Germany, small decline in Spain and big declines in Italy, Poland and Romania.

A couple of countries do have more recent data than 2023:

• Sweden, 92 homicides in 2024, 29 fewer than 2023, and the lowest number since 2014

• Germany is a bit strange as they record attempts of "Murder, Manslaughter, and Killing on Request." You have to dig into their pdfs to see how many of those murder and manslaughter attempts were "vollendet" (completed)

  • Of the 2,303 attempted homicides in 2024, 584 were completed, which would give a rate of 0.7 per 100k, a drop of 14% and the lowest number since the 90’s and probably way before then, although data is harder to get from before reunification

I guess we’ll find out whether there has been a larger drop in homicides in Europe this year some time around spring 2027.

Asia

Asia has the most varied data quality with some good PDFs, but many governments provide limited statistics and I’ve had to rely on the United Nations Office on Drugs and Crime for a lot of these figures.

I’m already a little bit suspect of UN data given their population projections (Nigeria could be potentially somewhere between 120 million and 240+ million people, and they still use DRC projections from a likely dodgy census done in the 1980’s), so it’s hard to take them at face value, and I won’t attempt to estimate how the region as a whole has changed.

In order of number of homicides (where there was data):

India - Roughly 40,000 homicides in 2022, from UNODC estimates with no recent national updates available.

Pakistan - 10.7k homicides in 2023 (4.33 per 100k) from UNODC aggregation.

China ~6k homicides, 0.44 per 100k in 2024, down from 0.5 in 2023, a 12% decline.

0.44 would rank among the world's lowest rates. However, with the frequency of mass murder incidents reported, suggests these official figures may be understated. The apparent decline could still be genuine if historical data suffered from similar underreporting.

Iran ~3.6k in 2023 giving a rate of 3.95 per 100k.

Thailand - According to UNODC, no data since 2011 when it was 3307 homicides. Wikipedia claims that the murder rate was 2.6 per 100k in 2024 but I couldn’t find any sources for that.

Iraq - A 22% drop in homicides in 2024 with 1,200 (2.58 per 100k) compared to 1,540 in 2023 (3.42 per 100k).

Indonesia - 1129 in 2023 (0.4 per 100k), a 32% increase from 2022. These numbers are so low for a recent middle income country that they are hard to believe.

Vietnam showed a drop from 1,461 homicides in 2023 to 911 in 2024, after relatively stable years averaging ~1,000 from 2008-2021 and a spike post COVID. Given the increase in population of ~10 million over this time the rate has decreased to 0.9 per 100k.

Japan - 2023 there were 912 homicides at 0.73 per 100k ( 853 in 2022, 0.62 per 100k).

South Korea - 265 homicides, 0.5 per 100k (preliminary data) in 2024. In 2023 there were 261 murders completes (they include attempts in their stats, even ones where no injury has happened, which was 801 attempts in 2023).

Malaysia - 215 up to November 2024, 261 in 2023.

Australia - 262 homicides between July 2023 and June 2024, an increase of 30 from the 232 recorded in 2022–23.

Africa

Reliable homicide data in Africa remains scarce and it’s hard to know how much of reported changes is just a sign of more accurate reporting.

Nigeria - According to UNODC there were 35,800 homicides in 2023.

The Nigeria Police Force recorded 3,219 homicides in 2017 (a rate of 1.6 per 100k).

The WHO estimated that the rate was 8.8 per 100k in 2021, which could be anywhere between ~10k and ~22k homicides depending on how large you think Nigeria is.

Uganda - 4,329 in 2024 (9.4 per 100k), up 2% from 2023

Kenya - 3,031 in 2023 (5.48 per 100k), down from 3,281 in 2021

Tanzania - 2,193 in 2024 (3.27 per 100k), 5% down from 2023

Caveats

Several countries likely to have high homicide counts are missing due to ongoing conflicts or unreliable data. This includes Afghanistan, Syria, Yemen and parts of the Sahel region where state capacity has collapsed. Russia, Ukraine and Ethiopia have conflict-related gaps, while countries like DRC, Chad, Algeria and Angola have limited reliable crime statistics even in peacetime.

While homicides typically far outnumber conflict deaths globally, the UN noted that in 2022 the ratio of homicides to conflict deaths was 2:1.

With major conflicts in Ukraine and Ethiopia, combined with (potentially) declining homicide rates globally, it might soon be the first time since World War II that conflict deaths exceed homicide deaths in a single year.

It wasn’t that easy to find current, reliable homicide statistics. Many countries don't publish data regularly or they do but it’s in a PDF in a language I don’t understand and can’t easily translate on a website made in the 2000s.

This makes it challenging to assess whether the apparent global decline is genuine or simply reflects better data from countries that were already relatively peaceful.

If you do know of any good aggregators or individual sources of good data, please let me know, I feel like this is something that should be tracked more regularly than a UN report every few years.

Conclusion

While I spent more time CTRL-F’ing 400 page documents than thinking about why homicide might be dropping I do have a few rough guesses.

• Ageing populations and declining youth cohorts (since violent crime peaks among teenagers and young adults)

• The electricity → internet → smartphone (and/or) social media theory

  • For richer countries maybe just the last two, but for poorer countries, they’ll need electricity and internet first

  • This mechanism could either be

    • Smartphones providing better things to do with your time (like watching YouTube, playing games, social media)

    • Smartphones providing entertainment that makes homicides a less attractive idea (watching people live better lives/or the consequences of being a murderer appearing worse)

    • Social media allowing people to make more friends and not rely on gangs for that

    • Social media punishing people who commit these types of crimes with a higher likelihood of losing social status

• Better law enforcement through surveillance, tech, etc. This may have been the case for the decline of serial killers

But I’m not really sure, and more data could come out later this year saying that actually there was an increase.

Side Track

I also got side tracked and looked at the global prison population. It looks like the number of incarcerated people grew from 11.1 million in 2013 to 11.7 million in 2023.

But the imprisonment rate declined from 150 to 145 per 100k as population growth outpaced incarceration, a 3.3% decrease in per capita terms.

The most interesting question isn't whether AI delivers services more efficiently. It likely already does, and increasingly so. The interesting question is whether AI breaks the traditional development pathway entirely.

Historically, countries climbed the income ladder through a fairly predictable sequence:

• Agricultural productivity gains

• Then manufacturing

• Then services

Lower labour costs plus strategic industrial policy helped Bangladesh dominate textiles and Vietnam become an electronics hub, lifting tens of millions from poverty. But that model depends on human labour costs mattering. If AI and automation make them less relevant, production could shift back to richer countries, and the ladder that built modern Asia might get pulled up.

Alternatively, if AI delivers personalised education, healthcare and cheaper energy at scale, we might see unprecedented acceleration in human development and massive reductions in the cost of goods and services. Much like WhatsApp unexpectedly becoming a foundation of commerce in LMICs - AI’s impact could be similarly unpredictable.

There could even be a decoupling of GDP from welfare with poor countries able to attain a much higher standard of living without increasing GDP.

I think both dynamics are likely to play out simultaneously, which makes this harder to reason about than most technology and development questions. What follows is my attempt to map the terrain. The real applications already working, economic scenarios for what comes next and what it might mean for LMICs.

Real World AI Applications: Transforming Development

AI is not a future concept in LMICs, it's a present reality, already being deployed to address pressing development challenges. These examples demonstrate AI's tangible impact across sectors, offering glimpses into how it can drive efficiency and improve access to goods and services.

Healthcare

AI is already a powerful diagnostic and research tool in healthcare, making higher quality services more accessible and efficient.

• Computational Vaccine Design (AlphaFold & others)

  • Using AI to virtually design and optimise vaccine structures

  • A computationally designed COVID-19 vaccine induced approximately three times more neutralising antibodies than the Oxford/AstraZeneca vaccine, even at smaller doses

  • Radically reduces research and development time and cost, vital for rapid responses to health crises

• AI Powered TB Diagnostics

  • Smartphones that analyse cough sounds (acoustic biomarkers) to screen for tuberculosis

  • Offers rapid, low cost screening without specialised equipment or extensive training, achieving up to 95% accuracy in clinical validations. This significantly improves the identification of presumptive TB cases and expedites referral for confirmation and treatment

  • Makes early, accessible diagnosis possible in remote areas, preventing further transmission and disease progression where diagnostic infrastructure is lacking

• Jacaranda Health PROMPTS

  • An AI enabled SMS service providing personalised pregnancy advice to mothers, processing 10,000+ daily questions and triaging high risk cases

  • Reached 2.74 million mothers across 1,200+ health centres in Kenya. Mothers were 22% more likely to achieve recommended antenatal care visits and 3.5 times more likely to seek care for danger signs, contributing to a 27% reduction in neonatal deaths at partner facilities

  • A scalable solution leveraging widespread mobile phone penetration to deliver health information and improve maternal and child health outcomes1

• GiveDirectly's AI for Targeted Aid

  • Using AI to analyse mobile phone data for more accurate targeting of cash transfers for humanitarian relief

  • In Togo, this approach reduced the exclusion of eligible individuals by 8-14% for COVID-19 relief, ensuring aid reached those in poverty

  • Enhances the efficiency and accuracy of humanitarian aid and social protection programmes, ensuring limited resources reach the most vulnerable populations with less waste

Agriculture

AI is changing farming by providing above average insights, automating tasks and expanding access to resources for smallholder farmers.

• Farmer.CHAT by Digital Green

  • Combines farmer-to-farmer videos with AI tools to deliver personalised agricultural advice through extension agents

  • Used by over 8.2 million farmers across India, Kenya and Ethiopia. RCTs show the approach is 10 times more cost-effective than usual services, reducing cost per adoption from $35 to $3.50, reaching 30% more farmers, and delivering a 43% gain in practice adoption rates

  • Democratises access to expert agricultural knowledge, allowing smallholder farmers to increase yields and income efficiently, a critical step for food security and poverty reduction

    

• Agricultural Drones

  • Drones configured to scatter seed, spray pesticide or spread fertiliser, operated via mobile phone app or AI automated

  • Cuts the requirements for managing some aspects of crop production by at least half. For one Vietnamese farmer, what took five days manually to spray a 30-hectare farm now takes four hours, using 30% less chemicals

  • Significantly boosts agricultural productivity, reduces labour needs and minimises chemical use, making farming more sustainable and profitable, even for smaller operations

• Apollo Agriculture (Credit for smallholder farmers)

  • Uses machine learning and alternative data (like GPS) to provide loans, high quality inputs, agronomic training and insurance

  • Helped nearly 400,000 farmers in Kenya and Zambia achieve 2-2.5 times higher yields, boosting incomes and food security without requiring collateral

Manufacturing and Logistics

AI is optimising complex operations and cutting costs in critical industrial sectors.

• Mathematical Optimisation for Cargo Ships

  • AI powered API for optimising shipping network design

  • Able to double the profit of a container shipper, deliver 13% more containers with 15% fewer vessels

  • Improves the efficiency of global supply chains, lowering trade costs, which benefits economies reliant on exports and imports

• Driverless Mining Trucks

  • 100 driverless electric mining trucks that autonomously load and unload materials in harsh conditions

  • Projected to improve transport efficiency by 20% compared to manned trucks, contributing to an 8% reduction in operational costs across China's coal mining sector

    

• Jetstream Africa (Trade Finance)

  • Uses AI enabled tools, including optical character recognition, to streamline assessing credit risk and providing trade finance for businesses

  • Reduced credit decisioning time from an industry standard of around one month to less than one minute, resulting in loans and financial guarantees to hundreds of businesses in Nigeria and Ghana with a loss rate less than half the regional industry average

Education

AI is changing learning by personalising content and enhancing teacher effectiveness.

• Rocket Learning (Early Childhood Learning, India)

  • An AI coach via WhatsApp supporting parents and childcare workers in low income communities by creating localised content and automating gradings

  • Reached 2.5 million children, with 75% hitting developmental milestones versus a 57% national average

  • Provides scalable, accessible early childhood education support, critical for foundational learning in contexts where formal schooling is limited or stretched

• English Language Learning (Nigeria)

  • An AI powered tutoring programme for English language learning

  • An RCT found a significant overall improvement of 0.23 standard deviations in English language learning over six weeks, equivalent to 1.5 to 2 years of schooling. This positions it among the most cost-effective educational programmes

Science

AI is accelerating scientific discovery and forecasting critical environmental events, offering new tools for research and disaster preparedness.

• Protein Structure Prediction (AlphaFold)

  • An open access AI model that predicts protein structures

  • Provides ~214 million predicted protein structures utilised by 1.6 million researchers across more than 190 countries, significantly speeding up research in areas from drug discovery to fundamental biology

• Flood Forecasting (Google AI)

  • AI model predicting floods 7 days ahead

  • Covers 100 countries and 700 million people, sending over 115 million alerts in 2021 across India and Bangladesh. The World Bank estimates upgrading flood early warning systems could save 23,000 lives annually

• Earthquake Prediction

  • Accurately predicted 70% of earthquakes a week before they happened during a seven month trial period in China

  • Offers the potential for disaster preparedness in earthquake prone regions, allowing for evacuation and mitigation efforts that could save lives and reduce economic damage. Earthquakes have been the deadliest natural disaster in the last few decades given how hard they have been to forecast

    

As these examples show, AI is already delivering results2 and improving lives across LMICs. However, the true breadth and depth of AI's economic implications, and whether it will fundamentally reshape development pathways, remains a subject of debate.

The Future of Economic Growth

The economic implications of AI sit at the heart of a central debate in modern economics. While there's broad consensus that AI will have meaningful effects, economists are divided on the magnitude, distribution and timeline of these changes, ranging from modest productivity gains to dramatic economic transformation.

Three Scenarios for AI's Economic Impact

This wide spectrum of uncertainty manifests in varying projections for AI's productivity impact, which typically cluster into three scenarios:

• Conservative

  • This outlook anticipates AI will bring incremental, but still valuable, improvements

  • OECD projects 0.25-0.6 percentage points in annual total factor productivity growth3

  • Daron Acemoglu predicts a modest increase in GDP between 1.1 to 1.6% over the next 10 years (or ~0.1% increase a year)

• Moderate

  • This perspective foresees substantial, but still manageable, boosts to productivity and economic output

  • Goldman Sachs envisions labour productivity (output per worker) boosts of up to 1.5 percentage points and a 7% increase in GDP over 10 years

  • Wiseman and McClements predict an additional annual economic growth boost of 3-9% in the near future

    • How much economic growth from AI should we expect, how soon?

• Transformative

  • This scenario suggests that AI could become self improving, capable of automating knowledge production itself

  • AI transcends its role as a mere tool, evolving into an economic resource that compounds growth exponentially, potentially leading to explosive, unprecedented economic acceleration

  • Tom Davidson suggests there is a 1 in 10 chance of 30% annual growth rates by the end of the century4

  • Epoch AI - Erdil and Besiroglu estimate even odds of explosive growth by 2100

    

For those interested in exploring this in greater depth, BlueDot Impact offers a free course focused on the economics of transformative AI.

A Modern Solow Paradox

Yet, despite optimistic projections for AI's transformative potential, a confusing reality persists. Aggregate productivity growth remains low. This echoes Robert Solow's 1987 observation regarding computers - “You can see the computer age everywhere but in the productivity statistics.” Several explanations have been proposed for this:

• Measurement Problems

  • Traditional economic metrics might struggle to capture AI's true value, missing improvements in service quality or the consumer surplus from free digital services

  • The value of personalisation or enhanced user experiences, central to many AI applications, frequently doesn't appear in GDP statistics

• Implementation Lags

  • Historical patterns show that general purpose technologies, like the steam engine, electricity or computers, take decades to generate measurable productivity impacts

  • These technologies require significant complementary investments in skills and organisational restructuring, implying AI's full economic benefit is yet to materialise

• Complex Propagation

  • Productivity gains from AI may propagate indirectly through intricate supply chains, appearing in downstream sectors rather than at the immediate point of AI adoption

  • A manufacturing firm using AI for logistics, for instance, might not show direct productivity gains itself, but enables efficiency improvements throughout its broader network

• Threshold Effects

  • AI's systemic impact might only become visible once it reaches a critical mass across interconnected systems and industries, suggesting we are still in the early stages of economic transformation awaiting a tipping point for broad, measurable productivity acceleration

Distribution of Benefits

Beyond economic growth projections, a question concerns how AI's economic benefits could be shared. Economists hold differing views on whether AI will broaden prosperity or concentrate gains.

The Distributive View: AI as a Catalyst for Broad Prosperity

Rooted in historical precedent, this view sees AI as a general purpose technology that will broaden prosperity. Market mechanisms and falling costs are expected to distribute benefits widely, leading to a new era of abundance.

• Augmentation Over Replacement

  • AI will augment human capabilities, fostering new, human centric industries and roles. Work will evolve, shifting towards uniquely human cognition, creativity and interpersonal skills

• Market Driven Diffusion

  • As AI becomes cheaper and more ubiquitous, its benefits, like improved service access and reduced production costs, will diffuse through the economy, benefiting a broad consumer base. This could lead to a significantly higher standard of living due to drastically reduced costs of goods and services

• Human Economic Value Endures

  • A core economic argument against extreme wealth concentration is the role of broad human consumption, without it, the economic pie could shrink. This implies an incentive for wealth distribution to maintain demand

The ‘Normal Technology’ View: Benefits Not Guaranteed

This perspective also positions AI as a general purpose technology, but one whose benefits are not automatically guaranteed to be widely distributed. It suggests that AI's integration will be gradual, and its impact will depend heavily on institutional responses.

• Controllable Tool, Gradual Impact

  • Transformative economic and societal impacts will unfold slowly, over decades, bounded by organisational and institutional adaptation

  • This innovation diffusion lag stems from regulatory speed limits in safety critical domains, the ‘capability-reliability gap’ between benchmarks and real world utility, and the challenge of incorporating tacit knowledge. Benchmarks often measure methods progress, not actual utility

• Systemic Risks

  • The primary concern is systemic risks common to large, interconnected systems (governments, large firms, oligarchies) which can be amplified by AI

    • These include exacerbated inequality, concentration of power and erosion of social trust

  • These arise from organisational choices, mirroring disruptions from past technology revolutions

  • Specific occupational displacement (copywriters, translators, etc) is a known risk

• Institutional Capacity for Mitigation

  • Optimism lies in institutional capacity to respond

  • Policy can mitigate risks and distribute benefits through the usual regulations, investment in resilience and proactive redistribution

The Intelligence Curse: A Concentrated Resource

Another view suggests AI might behave less like a plough or steam engine (which augmented people and created new human centric industries) and more like coal or oil, a concentrated resource that can be more easily used to yield rent to its owners rather than broad prosperity

• Diminished Incentive for Human Capital

  • If AI can reliably and cheaply perform most economically valuable work, powerful actors (states, corporations) may lose their incentives to invest in human capital

  • In a world where revenues flow primarily from AI systems rather than human productivity, the conventional drivers for widespread education, employment, and social safety nets (citizens' ability to generate taxes or profits, or their power to pose credible threats to a regime) could diminish

• Resource Curse Analogy

  • This scenario mirrors the ‘resource curse’ seen in rentier states that derive wealth from natural resources rather than a diversified, human centric economy, often leading to concentrated wealth for a few and poverty for the general populace

  • If AI becomes the ultimate resource, its benefits could overwhelmingly flow to capital owners and those who control AI companies, displacing middle income employment without creating equivalent alternatives, leading to growth that does not translate into widespread prosperity

• Challenging this Outlook

  • Governance Quality

    • The resource curse has been more prevalent in countries with poor institutions and high corruption

    • Nations like Norway and Australia have successfully leveraged resource wealth for broader benefit, suggesting that robust governance quality could mediate AI's distributional impact

  • Consumer Demand

    • If the general populace loses economic power, who will consume AI produced goods and services? A few wealthy individuals cannot sustain a large scale economy, potentially limiting profitability for AI owning entities

  • Lower Costs of Living

    • Additional mitigating factors include the potential for dramatically lower costs of providing a high quality of life with advanced AI, even with less traditional employment

  • Social & Political Agency

    • Society might designate certain ‘nostalgic’ jobs (priests, judges, etc) as exclusively human to preserve labour scarcity

    • Political action in response to job displacement could force redistributive policies to maintain social stability and avoid unrest

Implications for Development

The historical development trajectory, where countries typically progress from agriculture through manufacturing to services, faces disruption from AI. This transformation is simultaneously reshaping global trade patterns in ways that challenge conventional economic theories.

• Technology Adoption

  • AI presents the potential for LMICs to leapfrog development stages by adopting AI enabled services (advanced diagnostics, automated governance) without first establishing conventional industrial infrastructure

  • The success of mobile banking and satellite internet shows this is possible

  • Effective adoption and widespread benefit rely upon infrastructure - reliable internet connectivity, affordable data and stable electricity

  • Many LMICs currently lack these elements, which risks creating a new 'digital divide' both within and between countries, marginalising rural areas or poorer populations who cannot access these services

    • This could slow down development but also insulate against potential job losses

• Export Strategies

  • Automation poses a threat to the export oriented models prevalent in many countries heavily reliant on routine manufacturing

  • Bangladesh's textile industry or Vietnam's electronics assembly will see their competitive advantage erode as AI powered automation makes nearshoring or reshoring economically attractive for richer nations

  • This may compel these countries to focus on higher value niche services, creative industries, or human centric labour

  • Fostering economic resilience may involve prioritising the lowering of intra-regional trade barriers, for example, within Africa and Asia, and forming strategic partnerships, rather than relying solely on historical global market access which may be shifting

• Digital Services

  • AI enables the emergence of new categories of tradeable digital services (data labelling/annotation, content moderation and other sectors that require human in the loop roles like medicine or law) offering a potential pathway that bypasses industrial development

  • A country could conceivably export AI generated content, automated customer service or data processing services without needing to establish a conventional manufacturing base

• Concentration Effects

  • The development and deployment of advanced AI depend on computational resources, highly specialised talent pools and access to data

  • These advantages are concentrated in the richest economies, fostering winner takes all dynamics

  • This risks increasing global inequality, potentially locking countries out of lucrative and transformative sectors of the future economy and amplifying existing disparities

  • LMICs could benefit from forming coalitions to negotiate more effectively with global AI developers to ensure that technology supports national development agendas

• Domestic Labour Markets

  • Beyond export oriented jobs, AI could impact domestic labour markets within LMICs, affecting service sectors, agriculture and the informal economy

  • Widespread job displacement in routine tasks could lead to increased internal inequality, particularly between those able to adapt and those unable to do so

• Human Capital Development

  • The skills demanded in an AI driven economy are likely different from those normally required in manufacturing. LMICs face a challenge in retraining existing workforces and fundamentally reorienting their education systems

  • A failure to address this skills gap could inhibit the 'leapfrogging' potential AI offers

• Governance

  • AI offers tools for improved governance, such as enhanced public service delivery, more efficient resource management or crime prevention

  • It also could be used to help entrench authoritarian regimes, and make bad regulations easier to monitor even if they are damaging to an economy

• Broader Societal and Ethical Risks

  • Models are often predominantly trained on data from a few high income countries, reflecting their specific social categories and labour market structures

  • When deployed internationally, such systems risk importing these biases, which may interact unpredictably with local social hierarchies and norms which could lead to a homogenisation of hiring practices globally or less useful/more harmful applications

• Environment

  • While the direct energy use of AI queries is low for individuals, the overall electricity consumption of data centres for AI is a substantial and increasing concern

  • Intensive mining of minerals like copper and lithium can cause ecosystem damage, water depletion and pollution

  • At the same time, AI can be used to reduce energy costs and accelerate research into solar, battery, nuclear technologies, etc

AI models and associated applications can be very different month to month, posing a challenge for academic research cycles to keep pace. To remain relevant, development research may need to focus more on identifying underlying mechanisms and principles that outlast any single AI model or interface or for academia to significantly speed up research cycles.

AI Strategies for LMICs

Given these implications, the question for LMICs becomes how to strategically engage with AI and related policies to benefit their countries which may trade off with the risk of increased harms.

• Infrastructure and Connectivity

  • Internet access reaches only 27% in low income countries versus 93% in high income nations, with broadband costs accounting for 31% of monthly income in low income countries compared to just 1% in wealthy ones. Some countries have regular power outages and internet failures/blackouts

  • These constraints suggest developing tools that rely on less energy/internet access or focusing more on building up energy infrastructure and utilising satellite internet

• Foundational AI vs Applications

  • Some people suggest that countries should develop their own foundational models to have more control over their future

  • But the resource gap is huge. The US secured $67.2 billion in AI investments in 2023 and is one of few countries that could develop frontier models

  • Building foundational models from scratch costs tens if not hundreds of millions of dollars and requires a lot of pre existing infrastructure whilst adapting existing models is far less costly

  • The choice mirrors LMIC startup strategies. Just as companies like Jumia became ‘Africa's Amazon’ without reinventing ecommerce infrastructure, AI applications can solve local problems using existing models. Technologies like mobile based commerce and banking have been adopted faster in LMICs compared to high income countries, supporting the idea that countries can leapfrog in AI adoption with the right conditions

• Avoiding Hype

  • Governments may announce ‘AI transformation’ programmes but no clear theory of change linking AI deployment to improved outcomes. These initiatives often exist primarily for political signalling rather than addressing concrete policy problems

  • Funders may mandate AI quotas (‘allocate 15% of your programme budget to AI solutions’) creating incentives to retrofit AI onto problems that may be better solved in other ways

• Talent and Brain Drain Challenges

  • The global talent distribution is heavily skewed, nearly 60% of all top tier AI researchers reside in the US, six times the number in China and Europe, whilst India has ~400 people out of the 22,000 PhD educated AI scientists globally

  • This reinforces the application focused strategy. Rather than competing for scarce foundational AI talent, countries can build practical expertise in adapting and deploying AI solutions. The skills needed for effective AI application development are more about understanding local contexts and navigating regulatory environments

• Regulatory Environment

  • Major tech companies including Google, Apple and Meta have delayed AI product launches in Europe due to regulatory uncertainty, whilst offering full features in less regulated markets

  • The EU's AI Act creates compliance burdens that extend time to market and give competitive advantage for providers operating in jurisdictions with lower regulatory standards

  • Unlike the extractive compliance typical in LMICs (where regulatory systems often serve elite interests rather than development goals), AI regulation presents a different dynamic that may not be captured by elites yet

  • Success stories like Ghana's minohealth AI Labs, which developed radiological diagnosis systems now used globally, demonstrate how LMICs could move faster than Europe to deploy and export AI solutions. This represents a genuine first mover opportunity for practical applications

• Data Quality

  • LMICs often rely on models developed by large tech companies with training data that might be less useful in their country, whilst facing challenges like a lack of access or even a lack of data in the first place

  • These limitations create opportunities as well. Local applications can address specific cultural and linguistic needs that global models might miss. The key is building solutions that work with available data whilst gradually improving local data collection capabilities

Career Pathways in Emerging Technology

For people motivated to contribute to ensuring AI benefits global development and LMICs, there are various pathways available across technical, policy and implementation.

Frontier AI Companies

Working at major AI companies to influence how foundational AI systems are developed and deployed globally.

• Paths to Impact

  • Help ensure that foundational models work effectively in multiple languages and can be deployed in low resource environments

  • Work on making AI models more efficient so they can run on basic hardware and limited internet connectivity

  • Influence product development to consider applications that could dramatically improve healthcare, education or agricultural productivity

• Example Roles

  • Research scientist roles focusing on model efficiency or multilingual capabilities, product manager positions for global AI deployments, technical roles working on reducing computational requirements, business development roles identifying beneficial use cases in emerging markets

• Pros

  • Working with the most advanced AI systems and largest budgets for R&D. If you can influence foundational models to work better, the scale of impact could be enormous since these models underpin many applications

• Cons

  • Your influence on company priorities is likely to be quite limited unless you reach senior levels. Most frontier AI companies are primarily focused on high value markets in wealthy countries

AI Startups & Businesses

Building commercially viable AI solutions in sectors like agriculture, healthcare, education or financial services for LMIC markets.

• Paths to Impact

  • Create businesses around AI applications that help farmers increase yields, enable better healthcare diagnosis or improve educational outcomes

  • Develop approaches to reach populations that most tech companies don't serve

  • Build solutions that work offline or with limited infrastructure

• Example Roles

  • Founding teams focused on agricultural technology, health tech, or fintech, technical roles building AI tools that work on basic smartphones, business development roles expanding AI solutions to new markets, product roles designing for low resource environments

• Pros

  • Market incentives align with user needs - if your product doesn't actually help people, they won't pay for it

  • You can iterate quickly and get direct feedback

  • Commercial sustainability means you're not dependent on donor funding cycles

• Cons

  • The people who most need help are often the least able to pay for it, creating a fundamental tension

  • Many AI applications require upfront investment with uncertain returns.

  • Operating in LMICs often involves infrastructure challenges, regulatory uncertainty and currency risks that make businesses harder to scale

Government & Policy

Shaping how AI is regulated and deployed to maximise benefits for economic development.

• Paths to Impact

  • Help governments create policies that enable beneficial AI applications whilst avoiding regulatory barriers that prevent innovation

  • Work on strategies that help countries leapfrog development stages using AI

  • Support efforts to ensure AI deployment increases rather than decreases economic opportunities

• Example Roles

  • Policy advisor roles in country governments working on digital strategy, positions at international organisations like the World Bank or USAID working on AI and development, roles helping navigate AI regulation across different countries, positions working on trade policy that affects AI deployment

• Pros

  • Governments have significant influence over whether beneficial AI applications can actually be deployed at scale

  • Policy work can have large multiplier effects if you get the frameworks right

  • There's relatively little expertise in this intersection, so individual contributions may matter more

• Cons

  • Government decision making is often slow and influenced by political rather than evidence based considerations

  • Your impact depends heavily on political stability and whether the people you're advising remain in power

  • Many governments have limited implementation capacity even when they have good policies

Academia, Think Tanks & Nonprofits

Conducting research, generating evidence and implementing AI solutions in development contexts.

• Paths to Impact

  • Generate evidence on which AI interventions improve people's lives and livelihoods

  • Bridge the gap between what's technically possible and what works in practice

  • Train people to work effectively at the intersection of AI and development

• Example Roles

  • Researchers studying AI's impact on poverty reduction, field implementation roles with organisations deploying educational technology or agricultural advice systems, positions at think tanks studying AI's economic effects, programme roles at foundations funding AI applications in health, education, or agriculture

• Pros

  • You can work on neglected questions that other sectors won't fund

  • Academic and nonprofit environments can allow for longer term thinking and risk taking

  • Direct connection to outcomes and evidence of what works

• Cons

  • Limited resources mean you often can't implement solutions at the scale needed to significantly impact poverty

  • Publication incentives in academia may not align with practical impact

  • Many pilot projects fail to achieve sustainable scale

  • Grant funding is competitive and often project based rather than allowing for sustained work

Key Considerations

The intersection of AI and development offers opportunities, but success requires understanding both technical capabilities and practical constraints.

The field is evolving rapidly, and many challenges are not necessarily AI specific, they're about deployment, adoption and fitting into existing systems.

Evidence on what works is still limited, and there's significant risk that AI applications may not deliver the promised benefits or could even create new problems. However, the potential upside is substantial if AI can help accelerate development.5

Further Resources

• Dylan Matthews - How AI could explode the economy

• Frontier Tech Hub - AI as a tool for International Development professionals

• SSIR

  • How AI powered nonprofits could make health care more effective

  • Mapping the Landscape of AI Powered Nonprofits

• Alice Evans - Crafting AI Complementary Skills and Bulletproof Assessments (at universities)

• Google

  • Health AI Developer Foundations is a new suite of open weight models to help developers more easily build AI models for healthcare applications

  • 1000+ real world AI use cases from organisations

• Peter Breitbart - AI for Doing Good: Lessons from the Frontlines

• VoxDev - collection of AI articles

• Nature - Can AI help beat poverty? - Measuring poverty is the first step to delivering support, but it has long been a costly, time intensive and contentious endeavour

• Turn.io looking at how chat and AI has been used to achieve impact in 2024

These examples reflect a broader historical pattern. Agricultural revolutions enhanced food security, the internet connected billions to information, and smartphones put powerful computing in the hands of people worldwide. Innovation has consistently lifted societies and expanded opportunity, demonstrating a capacity to alter the trajectory of well-being on a large scale. For anyone concerned with global development, supporting such change offers valuable pathways to solve large problems.

Whilst the impact of successful innovation is clear, the process of generating and scaling it effectively is complex. Norman Borlaug's work on disease-resistant wheat, a cornerstone of the Green Revolution, was the culmination of decades of prior research and required coordination across international organisations, governments and farmers. Innovation typically depends on a confluence of factors, including scientific research, practical implementation strategies, contextual understanding and an enabling environment for adoption.

To better navigate this landscape we turn to metascience. Metascience is the study of science and innovation itself. Seeking to increase the quality of research by analysing how knowledge is created, validated, disseminated and implemented.

Metascience researchers typically focus on areas such as:

• Methods: How researchers design studies and analyse data

• Reporting: How scientific findings are communicated

• Reproducibility: Whether studies can be replicated by independent researchers

• Evaluation: How scientific work is assessed through peer review

• Incentives: What motivates researchers and institutions

When we look at innovation successes and failures through this lens, we sometimes find surprising outcomes. Much research can't be replicated. Brilliant ideas often take decades to spread. Funding sometimes flows to popular but unproductive areas while neglecting promising alternatives. By studying these patterns, metascience could help us understand what works and what doesn't.

Sections

• How Innovation Transforms Development

  • Electricity

  • Containerisation

  • Biomedical Breakthroughs

  • Mobile Communications

  • The Green Revolution

• This all sounds great, but what’s the counterfactual?

• Metascience

• The Scope of Metascience

• The Innovation and Metascience Landscape

  • Academia

  • Government

  • Private Sector

  • Philanthropy

  • Cross-sector examples

  • Metascience

  • Progress Studies

How Innovation Transforms Development

The few centuries have seen innovations completely transform human life. Cities built sewage systems and provided clean water sources, drastically reducing waterborne diseases like cholera and typhoid. Vaccines eliminated smallpox. The Green Revolution doubled crop yields, preventing mass starvation. Electricity extended productive hours beyond sunset. The printing press, then the telegraph, then telephones, then the internet dramatically reduced the cost of sharing information.

Today, billions still face challenges that have been solved in many parts of the world. Farmers struggle to access markets, mothers die from preventable causes, villages lack reliable power. Yet new innovations are addressing these old problems in novel ways, and continuing to reshape our world. Here are some prominent examples of how innovation drives development.

Electricity: Powering Modern Life and Productivity

Electricity is an undisputed lifeline of a modern economy and stands as one of history's most profound innovations. The positive relationship between energy and economic growth is stark: income and energy consumption are tightly correlated across every continent and time period.

Whilst causality can run both ways, mounting evidence indicates that energy consumption is a necessary enabler, and a powerful driver, of economic growth, critical for providing the necessities of human life - education, healthcare, food and jobs.

Access to reliable electricity fundamentally reshapes economic and social possibilities. Research from Ghana suggests that a doubling in electricity power consumption will cause real GDP per capita to increase by ~52%. Conversely, power outages, a common challenge in many regions, significantly curtail manufacturing output and business profitability.

In India, districts with low electricity access exhibited two times higher rates of age-standardised premature mortality in women, with one in five such deaths linked to poor electricity access. Reliable power is essential for functioning health clinics, refrigerating vaccines and medicines, and reducing reliance on polluting indoor cooking fuels.

Looking ahead, the innovation driving energy's impact continues at pace. Breakthroughs in renewable energy sources like solar and wind, advancements in energy storage such as improved battery technologies, the ongoing development of next-generation nuclear power and the rise of electric vehicles are all poised to further transform how we generate, distribute and consume energy. These technologies hold the promise of not only expanding access to affordable power globally but also mitigating climate change and air pollution.

Containerisation: Enabling Global Trade

Few innovations have had as dramatic an impact on the architecture of the global economy as the standardised shipping container. Introduced in the 1950s, this seemingly simple metal box revolutionised the movement of goods across oceans by drastically reducing costs and complexity. The expense of loading and unloading cargo plummeted to 2% of the costs pre 1960.

Econometric studies suggest that containerisation boosted bilateral trade by 900% over a 15-year period. By making long-distance shipping economically viable, containerisation enabled the rise of global supply chains. This facilitated the shift of manufacturing to more countries, creating millions of jobs and providing new development pathways for export-oriented economies.

Containerisation also highlights how some innovations aren’t necessarily academic, highly technical or scientific but can come from business and cultural practices.

Biomedical Breakthroughs

The pace of innovation in biomedical science has transformed human health and longevity. Foundational discoveries like antibiotics and vaccines laid the groundwork.

The rapid development and deployment of mRNA COVID-19 vaccines are estimated to have saved nearly 20 million lives in their first year alone. Beyond vaccines, gene editing tools like CRISPR hold promise for treating inherited diseases and potentially tackling infectious diseases.

In pharmaceuticals, the development of antiretroviral therapies transformed HIV/AIDS from an almost certain death sentence into a manageable chronic condition. Innovations in production and distribution saw treatment costs in low-income countries drop from over $10,000 per person annually in 2000 to under $100 in 2016, saving an estimated ~16.5 million lives.

More recently, new classes of drugs like GLP-1 agonists (Ozempic, Wegovy, etc) are showing remarkable efficacy in treating obesity and type 2 diabetes, offering new hope for tackling the growing global burden of non-communicable diseases and their associated economic costs.

Matt Reynolds - Salt, Sugar, Water, Zinc: How Scientists Learned to Treat the 20th Century’s Biggest Killer of Children

• One of the most transformative yet underappreciated healthcare innovations of the 20th century is oral rehydration therapy (ORT). A simple solution of salt, sugar and water that has saved over 70 million lives since its introduction in the 1970s

• Before ORT, diarrhoeal diseases were the leading killers of children worldwide. Treatment required intravenous fluids administered by trained medical professionals with sterile equipment - resources unavailable in most places where cholera and other diarrhoeal diseases struck hardest. As one of ORT's developers, observed: "It's better to reach 80 percent of people with something that's 80 percent effective than five percent of people with something that's 100 percent effective."

• The key breakthrough came when scientists discovered that even during severe diarrhoea, the gut could still absorb water, salt and glucose when they were present in specific proportions. This simple solution slashed child deaths from diarrhoeal diseases from 4.8 million in 1980 to about 500,000 in 2023

• What makes ORT remarkable isn't just its effectiveness but its accessibility, it can be prepared by anyone with access to clean water, sugar and salt, making it a key example of frugal innovation designed for maximum impact in resource-constrained settings

Mobile Communications: Connecting Billions

Few innovations have increased access to information and opportunity as swiftly as the mobile phone, particularly the smartphone. This device has rapidly rewired global communication and economic participation. By the end of 2023, mobile internet was in the hands of an estimated 4.6 billion people worldwide.

This explosion in connectivity ignited a powerful economic engine. In 2024, mobile technologies and services contributed ~5.8% to global GDP, ($6.5 trillion). In 2022, mobile services contributed ~$170 billion to economies in Sub-Saharan Africa, driven mostly by improvements in productivity and efficiency.

The smartphone also serves as a platform for other innovations. With mobile finance, health consultations, remote learning resources, real-time agricultural market data, accessible digital government services, etc.

The Green Revolution & Modern Agricultural Science

Ensuring global food security in the face of a growing population and environmental challenges remains a paramount development goal, and agricultural innovation is central to achieving it. The original Green Revolution of the mid-20th century, spearheaded by scientists like Norman Borlaug, introduced high-yield crop varieties that dramatically increased food production, particularly in Asia, and are credited with saving up to a billion lives from starvation.

Modern agricultural science continues to deliver advancements. Genetic improvements have yielded crops with enhanced resilience, such as drought-tolerant rice varieties. Disease-resistant crops, like Bt cotton, have increased yields and farm profits, helping lift people out of poverty.

Innovations also focus on sustainable intensification. Precision agriculture techniques can save on inputs, whilst machine learning-based fertiliser recommendations show potential for significant yield gains.

The Haber-Bosch process for synthetic nitrogen fertiliser production, a 20th-century innovation, broke natural constraints on food production and is estimated to underpin the food supply for roughly half the world's population today.

This all sounds great, but what’s the counterfactual?

The transformative power of innovation is undeniable, from ships to computers to the internet. But this still raises a question: compared to what? How do we know if channeling resources into innovation is more impactful than alternative approaches to improving lives?

Consider the challenge of reducing childhood mortality in sub-Saharan Africa. Any of the below options sound reasonable.

• Direct intervention - Distribute malaria treated bed nets

• Economic growth support - As countries gets richer, there will be more funding for healthcare systems, better roads to transport medicine, more energy to power hospitals, and many more improvements that make it easier to eliminate malaria completely

• Innovation - Fund research into malaria vaccines that could eliminate malaria within years of discovery

Each pathway has merit and opportunity costs. The $100 million spent developing a new vaccine is $100 million not spent on proven interventions that could save lives today. Yet without innovation, we'd still be treating diseases the same way we did centuries ago.

There is also a difference between innovation focused directly on issues faced mainly by LMICs and general innovation.

• Directly-targeted innovation

  • Focuses explicitly on challenges faced in LMICs. The development of heat-stable vaccines, for instance, directly addresses the cold chain challenges in tropical regions. These innovations follow a clear theory of change from laboratory to lives saved

• General advancement

  • Creates technologies without specific development goals that later prove transformative. Mobile phones weren't designed to bank the unbanked, yet mobile finance now serves millions. The internet wasn't created to educate rural students, yet online learning platforms now reach the most remote communities

Determining a more impactful allocation of resources and talent for these different paths has considerable uncertainty. Should we prioritise the immediate and tangible benefits of direct interventions, the systemic uplift of economic growth or the potential of innovation? Even if we lean towards innovation, the choice between funding a specific malaria vaccine versus foundational research, both with potential global benefits but via different mechanisms and timelines, is not clear.

The answer likely depends on several factors, here are a few that could impact those decisions.

• Time horizons

  • Direct interventions help people today, innovation might help far more people tomorrow

• Risk tolerance

  • Proven interventions have predictable impact, innovation involves many failures for each success

• Comparative advantage

  • Some individuals and institutions are better positioned for discovery than delivery

• Neglectedness

  • Markets often undersupply innovation for diseases of poverty but may oversupply it for profitable conditions

On a personal level, your background and interests provide important context. A biochemist might contribute more to vaccine development than to distributing bed nets. Someone with logistics expertise might save more lives optimising supply chains than pursuing laboratory research. And how much uncertainty can you tolerate? Innovation often means working for years on problems that might prove unsolvable.

We can also acknowledge what we don't see, the innovations that didn't happen because our research systems failed. How many potential breakthroughs languished because academic incentives rewarded quantity over quality? How many promising discoveries had very delayed impact because we lack mechanisms to bridge the lab-to-field gap?

This is where metascience enters the picture, as a multiplier that could improve returns across all pathways. If better research practices could accelerate discovery by even 10%, the cumulative impact over decades could dwarf almost any individual intervention.

Metascience

Metascience (or meta-research) is the use of scientific methodology to study science itself. Metascience seeks to increase the quality of scientific research while reducing inefficiency.

Early efforts can be traced back to the 1960s when researchers began examining the methodological foundations of scientific practice. In 1966, an early meta-research paper had examined the statistical methods of ~300 papers published in medical journals, finding that

“in almost 73% of the reports read…conclusions were drawn when the justification for these conclusions was invalid.”

A 1976 paper called for dedicated funding for “research on research,” recognising that “the very nature of research on research, particularly if it is prospective, requires long periods of time.” These early investigations revealed widespread methodological flaws and inefficiencies across numerous scientific fields, laying the groundwork for what would later become the formal discipline of metascience.

The replication crisis is an ongoing methodological issue in which it has been found that many scientific studies are difficult or impossible to replicate. While the crisis has its roots in the meta-research of the late 20th century, the phrase "replication crisis" was not coined until the early 2010s as part of a growing awareness of the problem.

Other issues discovered include:

• Widespread misuse of p-values and abuse of statistical significance

• Perverse incentives that have created a publish-or-perish environment promoting junk science

• Bias in peer review and funding decisions

Whilst concerns about scientific quality have existed for decades, modern metascience largely traces its origins to a 2005 paper by John Ioannidis titled "Why Most Published Research Findings Are False." This essay became the most-accessed article in the history of the Public Library of Science with over 3 million views and served as a catalyst for broader scrutiny of research practices.

Metascience gained institutional momentum in the 2010s. Stuart Buck at the Laura and John Arnold Foundation allocated over $60 million to metascience starting in 2012, funding metascience entrepreneurs including the Centre for Open Science.

Stuart Buck - Metascience Since 2012: A Personal History
(I would really recommend reading this post, it covers a lot of the history of modern metascience).

• 2012 - Arnold Foundation enters metascience after John Arnold asks about psychology replication crisis, leading Buck to investigate widespread irreproducibility across fields

• 2013 - Launch of Center for Open Science with Brian Nosek and METRICS at Stanford with Ioannidis to drive research on reproducibility

• 2014 - Academic resistance emerges, with replicators being called ‘shameless little bullies’ as replication efforts gain momentum

• 2015 - Reproducibility Project: Psychology published in Science, showing only ~40% replication rate - becomes most cited paper in the initiative

• 2016 - TOP Guidelines launched with 5,000+ journal adoptions

• 2018-2020 - Major infrastructure scaling with Chris Chambers' Registered Reports expansion and continued growth of Open Science Framework

As Buck notes “A decade ago, not many folks talked about 'metascience' or related issues like scientific replicability. Those who did were often criticised for ruffling too many feathers.” Today, the situation seems far different: pre-registration has become much more common across many fields, the American Economic Association employs a whole team to rerun data and code from every published article, and national policymakers at NIH and the White House have launched numerous initiatives on reproducibility and open science.

The Scope of Metascience

Metascience it not just about replication and pre-registration. Researchers tackle questions across several domains.

Research methods

• How scientists design experiments, collect data and draw conclusions. Poor methodology can lead to false discoveries that waste resources and mislead future research

• Which research designs are most likely to yield reliable results and how statistical practices can be improved to reduce bias

• Investigating optimal sample sizes, exploring novel analytical techniques and understanding when different research approaches are most appropriate

Scientific communication

• How findings are reported in academic papers, presented at conferences and shared with the public

  • Research shows that studies with more accessible titles and abstracts are more likely to be cited and potentially translated into practice

• How scientific language and presentation affect interpretation, and how findings move from academic journals to broader public understanding

Evaluation systems

• How scientific work is assessed through peer review, citation metrics and tenure decisions

• These evaluation mechanisms shape what research gets funded, published and rewarded, ultimately determining the direction of scientific progress

• Are there systematic biases in peer review?

• Explores alternative models for evaluating research quality, and investigates how current systems may inadvertently discourage innovative or interdisciplinary work

Incentive structures

• What motivates individual researchers, laboratories and institutions

• Misaligned incentives can encourage quantity over quality, novelty over replication and publication over practical application

• Studying how promotion criteria, funding mechanisms and professional recognition shape researcher behaviour, often in ways that may conflict with broader scientific goals

Research organisation and funding

• How scientific institutions operate and allocate resources

• Optimal research team sizes, the effectiveness of different funding models, the role of collaboration networks and how bureaucratic processes affect scientific productivity

• Whether current models for organising science maximise discovery and innovation

Knowledge integration and translation

• How scientific findings are synthesised across studies and translated into practical applications

• Includes understanding why some discoveries rapidly translate into impact whilst others remain confined to academic literature, and developing better systems for integrating knowledge across fields and linking research to societal needs

There are plenty of suggested interventions but I would like to highlight1 this post by Brian Nosek from the Center for Open Science - Strategy for Culture Change.

Individual motivation and ability to change behaviour are insufficient when cultural barriers exist. Researchers operate within systems that provide incentives and impose policies that may conflict with desired behaviours. Despite researchers generally valuing transparency and having motivation for reproducible practices, academic culture rewards novel, positive results through publications and career advancement, creating incentives that discourage showing work and sharing materials

In other words, if you want scientists to change their behavior by sharing more data, you need to start at the bottom by making it possible to share data...Then try to make it easier and more streamlined, so that sharing data isn’t a huge burden. And so on, up the pyramid.2

You can’t start at the top of the pyramid (“make it required”) if the other components aren’t there first. For one thing, no one is going to vote for a journal or funder policy to mandate data sharing if it isn’t even possible. Getting buy-in for such a policy would require work to make data sharing not just possible, but more normative and rewarding within a field.

That said, I might add another layer at the bottom of the pyramid: “Raise awareness of the problem.” For example, doing meta-research on the extent of publication bias or the rate of replication can make entire fields aware that they have a problem in the first place.

-Raise Awareness: fundamental research on the extent of irreproducibility

-Make It Possible and Make It Easy: the development of software, databases, and other tools to help improve scientific practices

-Make It Normative: journalists and websites that called out problematic research, and better standards/guidelines/ratings related to research quality and/or transparency

-Make It Rewarding: community-building efforts and new journal formats

-Make It Required: organisations that worked on policy and advocacy

The Innovation and Metascience Landscape

Research and development (R&D) has annual investment reaching ~$2.75 trillion in 2023. The United States leads with $784 billion invested, while China follows closely at $723b. This funding flows through an interconnected ecosystem of businesses, academia, government agencies, and philanthropy, with the private sector contributing both the majority of funding and conducting most research activities.

R&D can include a wide range of activities ranging from basic science, specific innovations that would help with global development and research that may only have profit motivations and could be neutral or even negative for humanity.

National Science Foundation -R&D: US Trends and International Comparisons

The business sector dominates the U.S. R&D landscape, performing $693b (78%) of total R&D in 2022, while also providing the majority of funding at $673b (76%). Higher education institutions performed $91.4b (10%), and the federal government performed $73.3b (8%).

• Federal government funding accounted for 18% of US R&D funding ($159.8b) with 40% of its funding directed toward basic research and higher education institutions receiving the largest share (30%)

• Five industries dominated US business R&D in 2021, accounting for 79% of the total

  • Information (25%)

  • Chemicals manufacturing (18%)

  • Computer/electronic products (17%)

  • Professional/scientific services (11%)

  • Transportation equipment (8%)

• The semiconductor industry increased ~10% in 2021 to $47.4 billion after a ~23% increase in 2020

Global Trends

Global R&D expenditures have more than tripled in real terms since 2000, reaching approximately $2.75 trillion in 2023. With R&D as a percentage of GDP increasing from under 1.5% to 2% in 2023.

Asia now accounts for approximately 46% of global R&D (up from 25% in 2000). North America's share has declined to 29%, followed by Europe at 21%.

The United States ($784b) and China ($723b) now dominate global R&D spending, with a substantial gap to the third-placed Japan ($184b), followed by Germany ($132b), South Korea, the UK ($88b) and India ($71b). When considered as a single entity, the EU's R&D expenditure ($410b) is approximately half that of the US or China.

Academia

Academic institutions provide spaces for fundamental research and serve as training grounds for future scientists and innovators. Universities occupy a position between theory and application where researchers can pursue questions that may lack immediate commercial application but hold potential for long-term impact.

Scale

Higher education institutions perform ~13-17% of global R&D. Within the US, in 2022, academic institutions performed ~$91.4b (10% of the US total). Whilst it isn’t a high percentage of R&D the academic sector performs roughly 60% of basic research in the US. Governments remain the primary supporter of academic research globally, though industry partnerships and philanthropic grants are increasingly happening.

Examples

• The World Wide Web originated at CERN but was developed into its recognisable form through Tim Berners-Lee's work at MIT

• Though building on earlier research, developments at the University of Aberdeen led by John Mallard produced the first full-body MRI scanner and useful images in 1980, allowing non-invasive medical diagnosis without radiation exposure

• Recombinant DNA Technology - Developed in the 1970s at Stanford University this technique for enabled the production of human insulin from bacteria

Challenges

• The pressure to secure external funding can direct research toward short-term, applied goals over fundamental science

• Academic incentive structures often prioritise publication quantity, sensationalism and statistical significance over quality, replicability or practical implementation

• Many published studies lack statistical power to detect meaningful effects, leading to systematically inflated effect sizes in the literature

• Research transparency is inconsistent, with fewer than half of published papers in some fields having fully reproducible code and data

• Technology transfer processes between universities and industry can be bureaucratic and inefficient, hindering the practical application of academic discoveries

Government

Government plays both a direct and indirect role in the innovation landscape as a performer and funder of R&D. Public investment often addresses research areas where market incentives may be insufficient but societal benefit is substantial. Government agencies can identify strategic priorities, maintain research infrastructure, coordinate large-scale initiatives and create the regulatory framework within which innovation occurs.

Scale

Globally, governments directly perform around 10-15% of total R&D activities, but their influence extends further through funding provided to universities, research institutes and businesses. In the US, the federal government performed 8% of R&D while funding 18% across all sectors. The role varies significantly between countries, in some nations, government institutions perform the majority of research activities.

Examples

Government research has yielded numerous innovations with far-reaching impact. The Internet originated from ARPANET, a project of the U.S. Department of Defense's Advanced Research Projects Agency (DARPA). GPS technology, has become essential to navigation and countless location-based services. The Human Genome Project, led by the National Institutes of Health and Department of Energy, established the foundation for modern genomics and personalised medicine.

Challenges

• Political cycles can create funding instability and shift priorities

• Bureaucratic processes may slow innovation

• Government agencies sometimes struggle with mechanisms for technology transfer to industry

• Risk-averse culture may favour safe, incremental projects over transformative but uncertain research

Private Sector

The private sector constitutes the largest component of the R&D landscape in most advanced economies, focusing primarily on applied research and development activities with commercial potential. Companies invest in innovation to develop new products and services, improve efficiency and maintain competitive advantage in global markets.

Business R&D typically excels at translating research into marketable products and services. Private sector innovation is more responsive to market demands and customer needs, with clearer metrics for success and resource allocation.

This sector generally tends to emphasise shorter time horizons and clearer paths to market applications than academic or government research, as seen by the pharmaceutical industry's focus on late-stage drug development rather than basic disease mechanisms, and technology firms' prioritisation of product improvements over theoretical computing advances.

Notable exceptions to the short time horizons include Microsoft Research's decades-long commitment to fundamental computer science and Bell Labs' historical breakthroughs in transistors and information theory.

Scale

Businesses perform approximately 70% of global R&D, with the private sector's role particularly dominant in richer economies. The concentration varies significantly by country, from over 90% of total R&D to less than 20% in some LMICS . In the US, businesses perform 78% of total R&D, and globally, the pharmaceutical, automotive, and technology sectors represent the largest corporate R&D investors.

R&D spend by Amazon, Alphabet, Microsoft, Apple, Meta in financial year 23-24 was nearly $229 billion collectively.

Examples

• Bell Labs, the research arm of AT&T, developed the transistor, the laser and information theory fundamentals

• Xerox PARC pioneered the graphical user interface, Ethernet networking and laser printing technologies

Challenges

• Intellectual property protections can sometimes impede knowledge sharing

• Market incentives may result in underinvestment in areas with significant social benefits but limited commercial potential

• If a market is dominated by a monopoly they may have less incentive to innovate

• Companies may attempt to influence regulators through lobbying, payments to experts, or selective data disclosure to favour their commercial interests (when the research isn’t for their own internal benefit)

• Commercial incentives may lead to selective reporting of results, rushed timelines, or research designed primarily to support marketing rather than scientific advancement

Philanthropy

Philanthropic organisations can provide funding that supports novel, high-risk research areas that may fall between the priorities of government agencies and commercial enterprises. Foundations can operate with greater flexibility than public institutions and longer time horizons than businesses, allowing them to seed emerging fields and support unconventional approaches.

Scale

While representing less than 5% of global R&D funding, philanthropic contributions play an outsized role in particular fields, especially biomedical research, climate science and emerging technologies. In the US, philanthropic sources account for approximately 3% of total R&D funding but contribute over 10% of funding for basic research at universities. Major scientific foundations direct billions toward research priorities they identify, often catalysing additional investment from public and private sources.

Examples

• The Rockefeller Foundation played a central role in the Green Revolution

• The Howard Hughes Medical Institute has supported breakthrough research in genetics, neuroscience and structural biology through its investigator programme

Challenges

• Philanthropic funding can be unpredictable and subject to donor priorities rather than systematic assessments of societal needs

• The sector has limited resources compared to government or industry

• Foundation priorities may not always align with broader scientific consensus

Some cross sector examples

There are also many examples of innovations (including most of those mentioned above) that have had funding from multiple sources and were discovered in a mix of universities, industry labs and government departments over many years.

CRISPR-Cas9 Gene Editing

• Initial observations of clustered repeats in bacterial DNA (later named CRISPR) were made by researchers at Osaka University in 1987 and University of Alicante in 1995

• A breakthrough came from private industry when food scientists at Danisco (a Danish company) demonstrated in 2007 that bacteria acquire CRISPR-based immunity against viruses, leading to early commercialisation for "vaccinating" bacterial cultures

• The technology's adaptation for gene editing in human cells involved academic researchers at institutions including UC Berkeley, the Broad Institute and the University of Vienna, with Jennifer Doudna and Emmanuelle Charpentier receiving the 2020 Nobel Prize in Chemistry for their contributions

mRNA Vaccines

• The development of mRNA vaccine technology that enabled rapid response to COVID-19 resulted from decades-long collaboration across sectors

• The breakthrough came from academic researchers Katalin Karikó and Drew Weissman at the University of Pennsylvania, who discovered how to modify mRNA to avoid triggering inflammatory immune responses

• Their 2005 paper, initially rejected by top journals, laid the groundwork for mRNA therapeutics

• The technology's development into viable vaccines required private sector investment from companies like BioNTech (where Karikó later worked) and Moderna, along with government funding through agencies like DARPA and BARDA

Metascience

This field draws from multiple disciplines including statistics, sociology of science, research methodology and science policy to address challenges like reproducibility, publication bias and incentive misalignment in the research enterprise.

Scale

As a relatively new field, metascience receives a small fraction of global research funding, primarily through philanthropic sources and targeted programmes at public funding agencies. Estimated annual funding specifically dedicated to metascience research and infrastructure development is in the range of tens to hundreds of millions of dollars globally.

Organisations & Links

• Events

  • Metascience Annual Conference - London in 2025

  • International Conference on the Science of Science and Innovation - Denmark in 2025

• Organisations

  • Center for Open Science - Key organiser in the space

  • Metascience Working Group - Policy-focused science funding experiments

  • Research on Research Institute

  • J-PAL - Science for Progress Initiative

  • Innovation Growth Lab

  • UK Metascience Unit

  • The UK Reproducibility Network

  • Incentivizing Collaborative and Open Research

  • African Reproducibility Network

  • Open Research Funders Group

  • Association for Interdisciplinary Meta-Research and Open Science

  • Global Research Initiative on Open Science

  • Accelerator For Innovation & Research Funding Experimentation

• Science/Biology Initiatives

  • Convergent Research - Incubates focused research organizations (FROs)

  • Astera Institute - Supports promising innovators during their earliest stages of exploration

  • New Science - aiming to enable researchers who would’ve been working in traditional academia to work on problems they could not work on in academia

  • Speculative Technologies - nonprofit industrial research lab for public good

  • Future House - non-profit building AI agents to automate research in biology and other complex sciences

• Research Infrastructure & Tools

  • Some Are Useful - a living literature review on how ideas from ML/AI are influencing scientific and technological progress

  • Institute for Replication

  • MetaResearch Open Review

• Blogs

  • Macroscience Blog

    • Metascience 101 is a set of interviews on the debates and ideas driving the metascience movement

    • Metascience Episode 9 - How to get involved with metascience

  • The Good Science Blog by Stuart Buck

  • Scientific Discovery by Saloni Dattani

  • What’s New Under The Sun by Matt Clancy

• Academia

  • UCL - Science and Technology Studies

  • Leiden - Centre for Science and Technology Studies

  • Tilburg - Meta-Research Center

  • Meta-Research Innovation Center Berlin

  • Zurich - Center for Reproducible Science

  • Meta-Research Innovation Center at Stanford

  • Wikipedia also has a list of metascience research organisations

• Funders

  • Templeton World Charity Foundation

  • Open Philanthropy

  • Navigation Fund

  • Schmidt Sciences

  • Arnold Ventures

  • Alfred P. Sloan Foundation

  • Renaissance Philanthropy

  • The Science Philanthropy Alliance

  • Advanced Research + Invention Agency (ARIA) - UK R&D funding agency built to unlock scientific and technological breakthroughs

  • Novo Nordisk Foundation - Life science ecosystem support

  • Wellcome

  • UK Government

    • UK Research and Innovation (UKRI)

    • Department for Science, Innovation and Technology (DSIT)

Progress Studies

Emerged as an intellectual movement focused on understanding the drivers of technological, economic and social advancement and developing frameworks to accelerate beneficial change. The field was formally proposed in 2019 by economist Tyler Cowen and Stripe CEO Patrick Collison in their Atlantic article "We Need a New Science of Progress", though it draws on earlier work in economic history, innovation studies and the history of science.

Scale

As a recently established field it’s relatively small in terms of dedicated funding and institutional support compared to established disciplines. The movement primarily operates through think tanks, online publications and informal networks of researchers rather than through traditional academic departments.

Funding comes predominantly from technology entrepreneurs and innovation-focused philanthropies, with estimated annual support in the tens of millions of dollars.

Organisations

• Roots of Progress Institute

• Works in Progress Magazine

• The Progress Network

• Institute for Progress

• Open Philanthropy - Abundance & Growth Focus Area

• Inclusive Abundance

• Emergent Ventures

• Asimov Press - focused on the science and technologies that promote flourishing

• ARC Institute - gives scientists no-strings-attached, multi-year funding, mainly in biomedical science and technology

• The Up Wing - covering progress related news

Further Resources

• Ryan Briggs - Can We Trust Social Science Yet? - “Everyone likes the idea of evidence-based policy, but it’s hard to realise it when our most reputable social science journals are still publishing poor quality research”

• Nature - Is science’s dominant funding model broken?

• Bottlenecks for Evidence Adoption (in government)

• 80,000 Hours podcast - Matt Clancy on whether science is good

• The University of Chicago - The Market Shaping Accelerator

• The Innovation in Government Initiative helps LMICs implement evidence-based policies, and provides assistance for effective policy scale-up initiatives to improve the lives of people living in extreme poverty

• Jano Costard - Can we implement learnings from Fast Grants in public institutions that face different rules?

• Nature - Scientists rise up against statistical significance

• Sophie Gulliver and Tom Drake - The $1 Trillion Paradox: Why Reforming Research Publishing Should Be a Global Priority

• Stuart Buck - Why Are We Screwing Over Researchers Who Make Innovative Discoveries? - the University of Pennsylvania has made $1.2 billion in royalties from patents on Katalin Karikó’s work after forcing her out

• Adam Mastroianni - The rise and fall of peer review

• Saloni Dattani, Rachel Glennerster & Siddhartha Haria - Why we didn’t get a malaria vaccine sooner

• Ulkar Aghayeva - What groundbreaking discoveries might have already been made, and how can we uncover them faster?

• Jason Crawford - Accelerating science through evolvable institutions

• Matt Clancy - Boosting innovation by teaching people to be tech entrepreneurs?

Questions

Overall Reflection

• Was there anything surprising from this week's post?

• Innovation is presented as a key driver of development alongside direct interventions and economic growth. How do you weigh these different pathways for impact?

• How can you balance supporting directly-targeted innovation (malaria vaccines) versus general advancement (smartphones) that later finds development applications?

• What are the risks of over-emphasising innovation versus improving delivery of existing solutions?

• What would a development ecosystem optimised for breakthrough innovations look like?

• How could innovation benefits reach those who need them most rather than just those who can afford them?

Innovation

• What role could countries play in their own innovation systems versus technology transfers from wealthier nations?

• How can we better identify which innovations have transformative potential before they're widely adopted?

• When evaluating innovation opportunities, how should we weigh solutions that help millions moderately versus those that transform lives completely for fewer people?

• Who should decide research priorities? Scientists, governments, companies, universities, funders or the communities that interventions are supposed to help?

• How should we handle innovations that have both positive impacts and significant negative externalities?

• How do we evaluate whether an innovation is truly beneficial when its full impacts may not be visible for decades?

• Should development funders completely pivot away from direct interventions and just fund basic science instead?

• Oral rehydration therapy (salt, sugar, water) saves millions but took decades to spread globally. What does this say about our innovation distribution systems, and what should we do differently

• Are we over rating or under rating university research compared to private sector innovation?

• Is the goal of innovation to solve problems or to create new possibilities? Does this distinction matter for how we fund research?

• Should innovation be culturally neutral, or should solutions be designed specifically for different cultural contexts?

Metascience & Research

• Which metascience interventions seem most promising?

• Should we be more sceptical of interventions that cite scientific evidence?

• When is it better to focus on improving research quality versus simply doing more research?

• If we study how to do science better, are we just creating a new academic field that will have its own problems? What are they likely to be?

• Should science funders completely pivot away from basic science and just fund metascience instead?

Careers & Future Impact

• Which innovation-related career paths seem most impactful?

• Would you rather work on fundamental research with uncertain applications or applied research addressing specific development challenges?

• What skills seem most valuable for contributing to innovation or metascience over the next decade?

• How might emerging technologies change innovation processes?

• What's one innovation you think will likely transform development in the next 20 years that others are sleeping on?

• How could AI impact the metascience field? And the rest of science?

Sustained economic growth has fundamentally reshaped the world, driving dramatic improvements in health, education and access to goods and services previously unimaginable. Consider the scale of change: in 1820, around 75% of the world lived in extreme poverty; today, that figure is closer to 8.5%. Global average life expectancy has more than doubled in the same period. At its heart, growth involves an economy producing more of what people value, leading to higher incomes and resources for individuals and societies.

However, the pursuit of growth is complex, raising critical questions about sustainability, fairness and what constitutes progress.

What is Economic Growth & Why Does it Matter?

Economic growth typically refers to the increase in the market value1 of the goods and services produced by an economy over time. It's most commonly measured as the percentage rate of increase in real Gross Domestic Product (GDP) or Gross National Income (GNI). While total GDP reflects the overall size of an economy, GDP per capita2 is often more useful for understanding development, as it indicates the average resources available to individuals within a country.

Growth and Poverty Reduction

For centuries, sustained economic growth has been strongly correlated with dramatic improvements in human welfare. As countries get richer, they tend to see significant reductions in extreme poverty, lower child mortality, higher education levels and longer life expectancies. Global average life expectancy, for instance, has more than doubled from 29 years in 1820 to over 73 years today, largely driven by growth enabling better health, sanitation and nutrition.

Even modest incomes today grant access to goods and services unavailable to the wealthiest individuals just a few generations ago. As highlighted by Our World in Data below, economic growth is fundamentally about increasing the quantity and quality of these tangible goods and services that people need and want for a better life, from food and housing to healthcare, education, transport and communication. These goods and services are not just there; they need to be produced, and growth means their availability increases.

Historical accounts vividly describe the scale of poverty before such growth took hold, with widespread hunger, low life expectancy and vulnerability even to small economic shocks, highlighting the urgency of increasing productive capacity.

China is a prominent recent example. Since reforms began in the late 1970s, prioritising private business and exports, China experienced decades of rapid growth. This lifted nearly 800 million people out of extreme poverty, accounting for a significant portion of global poverty reduction in that period and transforming lives on an unprecedented scale. Although, this rapid growth sometimes involved significant social costs and challenging working conditions.

Despite progress, extreme poverty persists for nearly 700 million people, largely in sub-Saharan Africa and South Asia. Growth in these regions is likely to yield disproportionately large welfare gains. A small percentage increase in income for someone living in extreme poverty can have a life-changing impact on their ability to afford food, healthcare or send a child to school.

• Our World in Data - What is economic growth? And why is it so important? (15 minutes)

  • Key innovations and productivity increases (the printing press or those from the industrial revolution) have dramatically increased the availability and affordability of goods and services over time

    

  • Measures like GDP per capita or average income track the value or real income associated with this increased production and access. They are measures of growth, not the definition itself

  • Despite measurement challenges (like capturing quality changes or non-market production), these metrics show a clear picture of historical transformation

    • Average incomes were stagnant for centuries before rising dramatically, especially in the last 200-250 years

  • This era of growth coincided with an unprecedented decline in extreme poverty globally and improvements in health outcomes and education

  • Today, despite significant progress, global inequality is vast, and billions still live in poverty

    

  • Ending poverty requires further increases in the production and distribution of essential goods and services

  • Economic growth represents a crucial shift from a historical zero-sum economy to a positive-sum one, where widespread prosperity becomes possible

  • While the rate of growth is important, the direction (what is produced, how and for whom) is also key

While GDP per capita is a powerful indicator strongly correlated with these historical improvements it doesn't capture everything that contributes to human welfare (like leisure time or environmental quality). However its historical link to large-scale poverty reduction and improvements in health and education makes it a useful metric when discussing global development over the long term.

Engines of Growth: What Drives Economies?

Economists generally attribute long-run economic growth to a combination of fundamental factors that increase a society's capacity to produce goods and services.

• Capital Accumulation

  • Increasing the stock of physical capital (machinery, factories, roads, power plants)

• Labour Force Growth & Quality

  • Having more workers contributes to overall production

  • Improving the health and education of existing workers (enhancing human capital) makes each worker more productive

• Technological Progress & Innovation

  • This is often seen as the most important driver of sustained per capita growth in the long run

  • It involves discovering more efficient ways to produce existing goods and services, creating entirely new products or improving the quality of what's produced

  • Think of the impact of electricity, the internet or new agricultural techniques

• Institutions & Governance

  • Stable political systems, secure property rights, predictable rule of law, effective regulation and low levels of corruption create an environment where businesses are willing to invest, entrepreneurs are willing to innovate and people trust the economic system

  • Weak institutions can stifle growth, even if other factors are present

These broad factors manifest in specific areas that are particularly important for fostering growth in LMICs.

• Infrastructure

  • Reliable transport networks, communications systems and energy supply are essential for businesses to operate and for people to access markets and services

• Trade (Import/Export)

  • Engaging in international trade allows countries to specialise in producing what they are relatively best at, access larger markets beyond their domestic size (enabling economies of scale) and gain access to new technologies and ideas from abroad

  • Export-oriented manufacturing has historically been a key pathway for many economies to integrate into the global market and accelerate growth

• Finance

  • A well-functioning financial sector (banks, markets) directs investment to productive uses and manages risk, facilitating business expansion and innovation

• Innovation Ecosystems

  • Creating environments that support research and development, encourage entrepreneurship and facilitate the adoption of new technologies is key for long-term productivity gains

One perspective on how these elements combined to drive rapid development in East Asia proposes a three-part model (from How Asia Works).

• First, land reform, taking farmland from large landowners and giving it to peasant farmers. This is argued to address inequality and productivity, as small farmers may work the land more intensively to maximise yield per unit of land, which is vital in labour-abundant economies

• Second, focused industrial policy combined with export discipline. This involves state support for specific manufacturing industries (often infant industries protected by tariffs) coupled with requirements for firms to sell a significant portion of their products internationally. This push for exporting is argued to force firms to become competitive and reveal which ones are succeeding at learning their industry

• Third, financial policy designed to serve the needs of agriculture and manufacturing. This includes directing finance towards productive investments rather than speculation and often involves strict capital controls to manage flows and maintain incentives

Other models of development exist, but this highlights a specific proposed sequence and combination of interventions.

Criticisms & Complexities of Growth

While the historical link between economic growth and improved living standards for billions is strong, the pursuit of growth faces significant criticisms.

Growth vs. Distribution: Who Benefits?

A major criticism is that economic growth doesn't automatically benefit everyone equally. Growth can sometimes coincide with rising income inequality, leaving certain groups behind or even worse off. The impact depends heavily on how the wealth generated by growth is shared through wages, social spending and tax policies. Accounts of pre-growth poverty, marked by extreme inequality in land ownership and exploitative practices, underscore this challenge.

• Inequality is largely a result of policy choices and structural factors within an economy, rather than an inevitable consequence of growth itself

  • Global inequality (between countries) has decreased over the past few decades (largely due to growth in countries like China/India), while inequality within many countries has increased

The world is far too poor to end poverty without large growth.

• 85% of the world's population lives on less than $30 per day, with 77% living in countries where over 90% are poor by this standard (in 2017 when this chart was made)

  

• To reduce global poverty substantially (to Denmark's level of 14% living below $30/day), the global economy would need to grow by at least 410%, or become 5.1 times larger

• Ethiopia's average income of $3.30/day would need to increase 16.7-fold to reach Denmark's $55/day average

• This calculation assumes perfect redistribution from rich to poor countries and equality improvements everywhere, real-world growth needs would be even higher

• If we were able to redistribute the wealth of the richest 500 people (~$10 trillion) globally, that would be approximately $1,220 per person (as a one off payment)3

Environmental Costs

Economic activity, historically powered by fossil fuels and resource extraction, has led to environmental consequences, including climate change, air and water pollution, and biodiversity loss. Critics argue that continued growth is unsustainable.

• While the link between historical growth and environmental damage is clear, it's important to note that economic growth is not inherently tied to environmental destruction

• Decoupling, increasing economic output while reducing environmental impact (like CO2 emissions), is technologically possible and being demonstrated in some countries through shifts to cleaner energy, increased efficiency, and technological innovation. The challenge is accelerating this decoupling globally to meet environmental targets, not that any form of growth is impossible or must be environmentally damaging.

• OWID - Many countries have decoupled economic growth from CO2 emissions, even if we take offshored production into account

  

Measurement Issues

GDP per capita is a powerful summary statistic, but it was never designed to be a perfect measure of overall human welfare or progress. It omits many things that contribute to wellbeing, such as unpaid work (like childcare or household chores), the value of leisure time, the health of the environment (counting cleaning up pollution as positive GDP) and the distribution of income within a country.

Research attempts to quantify these limitations, showing that welfare can be significantly different from GDP per capita once factors like health, leisure, and inequality are considered

Also the reliability and accuracy of GDP data itself can be questionable, particularly in LMICs with underfunded statistical capacities. This means we sometimes have less reliable data than we assume.

• Acknowledging GDP's limitations is essential, but these limitations don't render it useless, especially in contexts where its correlation with fundamental welfare gains is strong. Measurement issues highlight the need for better data collection and alternative or complementary metrics, rather than invalidating the concept of economic progress entirely

• Oliver Kim - How Much Should We Trust Developing Country GDP?

  • African GDP statistics are often highly unreliable due to severe data collection limitations, Zambia's national accounts are prepared by a single person, and Nigeria hasn't conducted a census since 2006

  • Statistical artifacts can create false economic narratives, as demonstrated by Tanzania's apparent 33% GDP collapse in 1986 (larger than the Great Depression) which was likely just a measurement error when accounting methodologies changed

  • Major GDP revisions are common, Nigeria's GDP jumped 89% overnight in 2013 when they revised their estimates

Other Concerns

Beyond these major points, growth can be associated with other complex issues:

• Animal Welfare

  • Rising incomes often correlate with increased consumption of animal products, potentially exacerbating the harms of factory farming

• Corporate Influence

  • Powerful economic interests can exert undue influence on government policy, leading to regulations that benefit specific companies/monopolies/oligarchies rather than promoting broader growth

• Unforeseen Consequences

  • Rapid economic transformation can cause social disruption or create new problems that weren't anticipated

Beyond GDP: Alternative Measures of Progress

Given the limitations of GDP, a range of alternative metrics have been suggested. These aim to provide a broader picture of development by incorporating factors that GDP might miss.

• Human Development Index (HDI)

  • Created by the UN Development Programme, the HDI is a composite index that combines life expectancy at birth, years of schooling and Gross National Income (GNI) per capita

• Wellbeing Metrics

  • These approaches try to measure people's subjective experiences of life satisfaction and happiness (through surveys like those used in the World Happiness Report)

  • Other related metrics, like Quality-Adjusted Life Years (QALYs) or Wellbeing-Adjusted Life Years (WALYs) often used in health economics, attempt to quantify the quality as well as the quantity of life

• Dashboards of Indicators

  • Rather than trying to combine everything into a single number, dashboards present a collection of diverse indicators across various domains

  • The Sustainable Development Goals (SDGs) framework uses a large set of indicators to track progress across a wide range of development objectives

• How development has disappeared from today's 'development' discourse - Video

  • Ha Joon Chang argues that the modern definition of development has shifted from focusing on the transformation of productive structure to poverty reduction and individual betterment (education, health)

  • He believes that true development involves upgrading a country's productive capabilities, moving into more difficult industries, and transforming social structures, typically achieved through industrialisation and strategic state intervention

Can We Reliably Promote Growth?

While economists understand the key factors driving long-run economic growth in theory, translating this into predictable, effective interventions to boost a specific country's growth rate has proven difficult in practice.

Identifying reliable levers for growth is complex. Economies are influenced by a vast interplay of internal factors (institutions, geography, culture, history) and external forces (global trade, technology trends, commodity prices).

It appears that transformational, sustained growth spurts are often episodic and seem to emerge from complex, context-specific interactions rather than simple, replicable recipes. This makes finding a single best policy, or even a set of policies guaranteed to work everywhere, probably impossible.

This difficulty presents tractability challenges. Even with good intentions, it's hard for policymakers within a country to reliably engineer growth, let alone for external actors like aid agencies or philanthropies to influence it significantly or predictably. Global forces and deep-seated domestic issues can easily overwhelm well-meaning interventions. New challenges like the potential impact of automation on traditional manufacturing pathways for developing countries add further complexity.

Governments and international bodies continue to pursue common policy approaches aimed at fostering growth. These typically include.

• Maintaining macroeconomic stability (low inflation, stable currency)

• Implementing structural reforms (improving property rights, liberalising markets, reducing red tape)

• Investing in public goods (education, health, infrastructure)

• Pursuing more targeted approaches like industrial policy (strategic government support for specific industries), although the effectiveness and risks of this are widely debated and highly context-dependent

The Atlantic - What Really Fueled the ‘East Asian Miracle’?

• Conventional wisdom often credits Taiwan's significant land reform in the 1950s with directly boosting agricultural productivity, fueling its later industrial growth

• New data analysis suggests this key land redistribution (Phase 3) did not significantly increase farm productivity as widely believed

• The reform's positive impacts were more likely driven by complex political factors (like the ruling party securing support and preventing communist movements) and potentially unintended social shifts (like pushing people into manufacturing as small farms became less viable)

• This illustrates that historical narratives about development success can be oversimplified, and identifying the true, complex drivers of growth is challenging, highlighting why simple policy recipes based on historical examples may not be reliable or easily replicated elsewhere

Stefan Dercon - Development through Economic Growth

• Lack of growth is less about a deficit of technical economic knowledge and more about the underlying political economy and the incentives facing powerful elites

• Many poor countries may be in a political equilibrium where elites benefit more from rent-seeking and control of resources than from broad-based growth

• Promoting growth effectively requires understanding and potentially shifting these complex political dynamics and elite bargains

• Specific intervention areas from this perspective include making 'bad' alternatives (like illicit financial flows or corrupt procurement) more costly and strengthening local political/advisory capacity committed to growth

Lant Pritchett - Rethinking evidence and refocusing on growth in development economics (podcast & article)

• Argues development economics overly relies on ‘rigorous’ evidence (like RCTs) and systematic reviews, often ignoring vital local context, leading to misguided policies

• Critiques the field's shift from focusing on broad national development and economic growth to narrower poverty alleviation programs

• Identifies weak state capability as a crucial yet neglected challenge in development research and practice

• Calls for rebalancing development economics to prioritise national development, inclusive growth, and building state capacity, alongside a more balanced and context-aware approach to using evidence

Leverage & Neglected Opportunities

Given the difficulty in reliably promoting national-level growth and the fact that it's a claimed priority for nearly every government and major international institution (World Bank, IMF, etc), one might ask if this is a crowded field for individuals, smaller NGOs, or philanthropies. The answer is likely yes, significant resources and expertise are already dedicated to growth promotion globally.

However, even in a crowded space, there can be potential niches where targeted efforts can still have significant impact. These niches often involve identifying specific bottlenecks, supporting under-resourced areas, or pursuing strategies that larger, more bureaucratic actors might find difficult.

You may find an edge due to the following factors.

• Hits-based giving

  • Willingness to fund uncertain but high-potential ideas that might not fit traditional aid models

• Agility and Size

  • Ability to make smaller, faster grants than large multilaterals

• Complementary Role

  • Supporting civil society, advocacy (particularly on high-income country policies affecting LMICs) or acting as a 'laboratory' to test new approaches

To see how one major philanthropy is thinking about contributing to growth, you could read this summary on why Open Philanthropy have decided to have LMIC growth as one of their focus areas.

Open Philanthropy - Economic Growth in Low- and Middle-Income Countries

• OP believes economic growth is central to improving the well-being of the global poor and has decided to invest significantly in this area, despite their own initial skepticism about philanthropic impact

• They acknowledge the field is crowded but believe they can find valuable niches due to their willingness to fund uncertain but high-reward opportunities, their agility, and their ability to complement traditional development actors

• They are exploring concrete grant areas focused on specific leverage points, such as

  • Funding high-quality economic policy advice to LMIC governments

  • Advocating for policy changes (especially in high-income countries) to promote LMIC exports

  • Supporting efforts to target and curb illicit financial flows

• They prioritise finding valuable niches within the crowded field

• They recognise the risks and uncertainties involved in promoting growth externally but believe the potential upside for poverty reduction justifies the effort

Specific areas where individuals and smaller organisations might find leverage or contribute include the below.

• Economic Policy Advice

  • Supporting independent, high-quality technical advice to governments in LMICs, especially during reform opportunities or where local capacity is limited (through think tanks or direct advisory roles)

• Export Promotion

  • Advocating for specific policy changes, such as the renewal of trade preferences (like the US's AGOA for African countries) or the reduction of non-tariff barriers that hinder LMIC exports

• Targeting Illicit Financial Flows

  • Supporting investigation and advocacy efforts to combat corruption and capital flight, potentially increasing government resources and deterring extractive behaviour

• Improving Data Quality

  • Working on initiatives to improve the reliability of economic statistics, which is useful for effective policy making and evaluation

• Targeted Regulatory Reform

  • Focusing on specific, identified regulations that pose significant bottlenecks to business or investment

• Supporting LMIC Entrepreneurship/Startups

  • Fostering innovation and job creation from the ground up within LMICs

• Focus on Neglected Regions/Approaches

  • Targeting areas or strategies that are overlooked by major players

It's also useful to consider growth as a by-product. Many effective interventions in other development areas, such as improving health or education, may have positive knock-on effects on economic productivity and human capital, indirectly contributing to long-term growth.

Finding leverage in economic growth means identifying specific problems that are tractable for the actors involved and where the potential impact on generating good, inclusive growth is high, even if success isn't guaranteed.

Careers

For individuals motivated to contribute to fostering economic growth and development, particularly in LMICs, there are various pathways available.

Government & Civil Service

Working within national governments, either in ministries of finance, economy, trade or development agencies (like the FCDO in the UK), or directly within LMIC civil services.

• Paths to Impact

  • High potential for scale and impact by shaping national policy, regulation, and public investment programmes

  • Direct involvement in national development strategy and resource allocation

• Example Roles

  • Economist or policy advisor roles in the Treasury, Department for Business and Trade, FCDO in the UK

  • Similar roles in LMIC Ministries of Finance, Planning, Central Banks

  • National trade negotiators

• Pros

  • Direct influence over significant resources and policy levers

  • Opportunity to work on systemic issues

• Cons

  • Can be bureaucratic and slow-moving

  • Susceptible to political shifts and constraints

  • Potentially lower salaries than private sector

  • Security challenges in some contexts

Multilateral Institutions

Organisations such as the World Bank, the IMF and regional development banks employ economists and development professionals.

• Paths to Impact

  • Influence global development discourse and standards; inform lending and aid conditionality

  • Conduct large-scale, multi-country research and analysis

  • Support macroeconomic stability efforts

  • Development Finance

    • Real-world experience in initiatives like Power Africa shows that addressing specific bottlenecks hindering growth (like electricity deficits) requires moving beyond generic fixes towards a transactional approach that mobilises multiple actors

• Example Roles

  • Economist, policy advisor, or programme officer roles at the World Bank, IMF, African Development Bank, Asian Development Bank, WTO

• Pros

  • Global reach and significance

  • Work on complex international issues

  • Access to vast data and expertise

  • Opportunities for research and field work

• Cons

  • Can be highly bureaucratic and slow

  • Potential disconnect from on-the-ground realities

  • Power dynamics with borrowing countries

  • Competitive entry

Research, Academia & Think Tanks

Universities and research institutions generate evidence and analysis on the drivers of growth and the effectiveness of different policies, informing development strategies and public discourse.

• Paths to Impact

  • Provide evidence base for policy design and evaluation

  • Influence expert and public understanding of growth challenges

  • Training of development professionals

• Examples Roles

  • Academic positions in development economics

  • Researcher or policy analyst roles at think tanks focused on development (Centre for Global Development, ODI)

  • Roles at research centres affiliated with universities

• Pros

  • Opportunity to become a leading expert

  • Contribute to shaping long-term approaches

• Cons

  • Impact can be indirect and take time

  • Often requires advanced degrees

  • Highly competitive

  • Funding can be project-based

  • Often highly bureaucratic

Private Sector

This includes roles in traditional firms, investment funds, consulting, and directly starting or working for businesses, particularly in LMICs.

• Paths to Impact

  • Directly drive economic activity, create jobs, mobilise capital and build productive capacity

  • Foster innovation and market solutions

• Examples Roles

  • Consultants advising businesses or governments on emerging markets

  • Roles in private equity or impact investing funds

  • Strategy or operations roles in multinational companies operating in LMICs

  • Founding or working for startups

• Pros

  • Direct contribution to wealth and job creation

  • Potential for innovation and efficiency

  • Clear metrics for success (profit, scale)

  • Higher earning potential

• Cons

  • Profit motive may sometimes conflict with broader development goals

  • Focus can be narrow

  • High risk, especially for startups

Philanthropy & NGOs

Organisations focused on non-profit work, grantmaking, and advocacy in global development.

• Paths to Impact

  • Fund specific, targeted interventions and research

  • Support local civil society and entrepreneurs

  • Advocate for policy changes (including high-income country policies affecting LMICs)

  • Experiment with innovative or potentially high-risk approaches

• Example Roles

  • Programme officer or analyst roles at foundations focused on economic growth

  • Roles in international NGOs focused on improving data quality or reducing illicit financial flows

  • Growth Teams

• Pros

  • Flexibility to fund neglected or risky areas

  • Mission-driven work with strong values alignment

  • Ability to work on specific, complex problems often overlooked by larger players

• Cons

  • Resources are limited compared to governments/multilaterals

  • Challenge of achieving scale

  • Need for careful evaluation and demonstrating impact

  • Subject to donor priorities

Questions

Overall Reflection

• How has your understanding of the relationship between economic growth and human wellbeing changed?

• What surprised you most about the drivers, critiques, or potential leverage points for growth?

• Do you feel more or less optimistic about sustained, inclusive growth globally? Why?

Critiques

• What's the biggest limitation of GDP per capita as a progress measure?

• How significant are environmental constraints on future growth? Can technology fully overcome them?

• Is rising inequality an inevitable consequence of growth, or a policy choice?

• What are the implications of Poor Numbers for policymaking and our understanding of development?

Interventions & Leverage

• Given the difficulty in reliably promoting growth, where should development efforts focus? Specific interventions or broader enabling environments?

• How viable are the specific niches identified by OP (policy advice, IFF, export advocacy)? What are the risks?

• What are the ethical considerations for external funders (like philanthropies) trying to influence growth policy in LMICs?

• Is industrial policy still a viable strategy today?

• How much potential lies in pursuing growth as a by-product of other interventions (health, education)?

Trade-offs

• How should policymakers balance growth objectives with environmental protection and social equity?

• Should LMICs prioritise growth above all else, or focus on wellbeing metrics from the start?

• Is it better to fund efforts to measure growth/wellbeing accurately or efforts to directly promote it?

Careers

• Which career pathways related to economic growth seem most impactful? Most neglected?

• What skills seem most crucial for contributing effectively in this area over the next decade?

Other Resources

• Book Review - How Asia Works?

• Noah Smith - What ‘How Asia Works?’ got wrong

• Probably Good - Economic Growth: An Impact-Focused Overview

• Lant Pritchett - The Case for Economic Growth as the Path to Better Human Wellbeing

• Unified Growth Theory - Suggests that during most of human existence, technological progress was offset by population growth, and living standards were near subsistence across time

• William Easterly - The Elusive Quest for Growth

• Tobi Lawson - Ideas Untrapped - Blog looking at growth, with a focus on Africa

• EconTalk Podcast - Lant Pritchett on Poverty, Growth, and Experiments

• VoxDev - Development Economics Resources

  • Development Impact – World Bank Blogs

  • The International Growth Centre

    • The IGC has tons of resources, including a blog, evidence papers, growth briefs and more

  • Yale Economic Growth Center

  • Ideas For India

    • An economics and policy portal focused on growth and development in India

  • Global Dev - Aiming to connect development research to successful policies

  • British International Investment

  • Brookings: Global Economy and Development at Brookings – Research and Commentary

  • Conversations on Transformation (STEG): Discussions of important new research in structural transformation, growth and economic development

  • CSAE Research Podcasts: A series of conversations between researchers and collaborators about projects taking place at the Centre for the Study of African Economies

  • Ideas Untrapped: Tobi Lawson’s podcast offers a platform for debate on ideas that matter for economic growth

  • Ideas of India: A Mercatur Original Podcast with Shruti Rajagopalan that examines the academic ideas that can propel India forward

  • Trade Talks (Chad Bown): A podcast about the economics of trade and policy. The “Trade Talks Episode Catalog for Educators” divides these 200 episodes by topic and is a super useful resource.

  • BREAD-IGC Virtual PhD courses – recordings and slides available at the following links:

    • Urban Economics

    • Environmental Economics

    • Firms and Development

• VoxLit - overviews of development topics

  • International Trade

  • Foreign Direct Investment

  • Mobile Money

  • Training Entrepreneurs

  • Land Transport Infrastructure

  • Agricultural Technology in Africa

• Dietrich Vollrath - Why Isn’t the Whole World Rich?

• Karthik Tadepalli - Growth Theory Reading List

  • Global development policy can be informed by models that offer helpful diagnostics into the drivers of growth, while growth models can also inform us about how AI progress will affect society

• Should Industrial Policy in Developing Countries Conform to Comparative Advantage or Defy it? A Debate Between Justin Lin and Ha-Joon Chang

• Victor Kumar looking at the future of fertility rates, population and economic growth

The private sector's role is complex. It possesses the resources and feedback loops to generate growth, provide essential goods and services and lift people out of poverty. Yet, its primary driver, the pursuit of profit, doesn't always align with development objectives. Private activity can also lead to significant social and environmental costs.

We will look into the scale and contributions of the private sector, and the mechanisms through which it impacts development, both positively and negatively. A central question will be distinguishing between standard business activity and actions that generate genuinely additional positive development outcomes, i.e. is there a way to work in the private sector that will lead to positive outcomes that wouldn’t have happened anyway.

We will explore the following aspects to help with understanding how to have impact via the private sector.

• Case Studies

• Scale and Contribution

• Risks and Harms of Private Sector Activity

• Counterfactual Impact

• High-Potential Sectors

Case Studies

To illustrate the different roles private actors play let's look at a few case studies.

Wave - Mobile Money in Africa

Wave is a mobile money company, founded in Senegal, making financial services accessible through an app with significantly lower fees than traditional telecom-operated services.

• Ben Kuhn - Working at Wave is an extremely effective way to improve the world

  • “Most people in sub-Saharan Africa don’t have a bank account, because the nearest branch is too far away or they can’t afford the fees. Instead, when they can’t use cash, they use digital wallets, usually built by telecoms, carrying a balance that you can send to other users. To fund a mobile money wallet, you deposit cash at a local business (agent) that uses their spare cash on hand to serve mobile money customers. You can then send that balance to another user who can withdraw it at their own nearby agent”

  • Unfortunately the “winning” system ends up being the one run by the dominant telecom…they aren’t customer-focused, and it shows:

    • Their apps are hard to use

    • Their agents are unreliable

    • Their customer support is unhelpful

    • They charge enormous fees

    • They treat mobile money as just another way to profit from their oligopoly

  • At Wave they:

    • Built a user friendly app

    • Ensure that agents always have enough cash

    • Provide customer support within minutes

    • Charge a lot less then their competitors

  • Benefits

    • Cheaper

      • When Wave launched in Senegal, the average transfer would have cost 3-5x more if done via the largest existing mobile money system

      • Multiplied by millions of monthly active users, that comes out to a savings of over $200 million1 for Wave users

    • Faster

      • Customers get access to their money much faster

      • “Modou’s business was to buy fish from fishermen in Joal and sell them to a wholesaler in Dakar. The fish would travel to Dakar on a truck and the wholesaler would send the payment back via mobile money. Modou wanted to withdraw the money immediately to buy his next batch of fish, but his local agent would often take hours or days to come up with the cash. So he’d have to wait until the next morning, two days after his previous batch. When he tried Wave, Modou found that his local Wave agent always had enough cash to withdraw immediately. As a result, he could withdraw the funds the evening of the first day, and start buying fish after 24 hours instead of 48. In other words, switching to Wave allowed Modou to immediately double his business.”

    • Infrastructure

      • “What prevents companies from succeeding in other areas? Part of the answer is that if you’re not collecting payments yourself, there’s no one else to do it for you. Building a delivery company? Better take cash on delivery. Financed solar panels? You’ll be sending a collection agent to every town on the map. Software as a service? I’m not actually sure how that one would work. All these businesses can’t exist right now in much of Sub-Saharan Africa because they depend on financial infrastructure that doesn’t exist yet. Just like Stripe has found that easier online payments increases the GDP of the internet, we expect accessible financial infrastructure to dramatically increase the GDP of sub-Saharan Africa by making new types of businesses possible”

    • Future

      • Users still have lots of other problems with poor financial infrastructure:

        • People can’t save or invest their money except through an expensive, inconvenient bank account

        • Companies pay their employees’ salaries in cash, which requires expensive middlemen who sometimes skim some off the top

        • People can’t buy things online because they don’t have a credit card.

        • It’s expensive or even impossible to get a loan, because it’s hard for underwriters to know anything about your ability to repay

Zipline - Drone Delivery for Global Health

Zipline specialise in drone-based delivery of medical supplies and other goods. They began delivering blood in Rwanda in 2016 and have expanded to Ghana, Nigeria, Côte d'Ivoire, Kenya, United States and Japan. They have served over 4,500 hospitals and health facilities.

• The problem

  • Traditional delivery in rural regions faces numerous challenges - poor roads, heavy rainfall, difficult terrain and limited transportation options

  • This can lead to increased wastage, prolonged stockouts and lower vaccination rates

• Zipline’s approach

  • Centralised storage of medical supplies at distribution centers

  • On-demand ordering system for healthcare facilities

  • Autonomous drones deliver supplies within minutes

  • Temperature-controlled delivery maintains cold chain for vaccines

  • Each distribution center can serve facilities within a ~100km radius

• Results

  • 96% of providers report increased access to vaccinations in their area

  • 51% fewer deaths from postpartum hemorrhaging in hospitals served

  • A 2025 Ghana study showed that Zipline helped averted 688 disease cases and saved 4 children's lives in the study districts in 2021

    • Cost-effectiveness of ~$50 per averted DALY. Approximately 35-50x more cost-effective than standard willingness-to-pay threshold

    • Cost of $0.66 per fully immunised child, outperforming other delivery methods including mobile immunisation teams

Pinky Promise - AI-Powered Healthcare in India

Pinky Promise is building an AI-powered digital healthcare app in India, designed to reliably diagnose and manage women's reproductive health issues, aiming to make care instantly accessible.

• The Problem

  • Accessing timely, reliable and potentially private reproductive healthcare through traditional means in India can be challenging

  • Existing systems may involve significant delays in getting appointments, inconvenient travel, lack of specialist availability or social discomfort discussing sensitive health issues

• Pinky Promise's Approach

  • Users describe their symptoms to the app anytime

  • An AI system asks clarifying questions about symptoms and medical history then analyses creating a suggested diagnosis and prescription

  • A human gynaecologist reviews the output, edits the prescription if required, and sends it to the patient

  • Ongoing doctor-patient connection and support is maintained via chat, facilitated by an AI co-pilot for the doctors

• Results

  • High patient satisfaction, with over 85% reporting feeling cured by their treatment out of 50,000 users

  • A 25% return rate for other issues within 8 months

These examples highlight the potential for private sector solutions to address key development challenges. However we need to zoom out from individual companies and consider the sector's overall scale and contribution to national economies.

Understanding its size, the typical dynamics of firms within LMICs and the fundamental ways incentives differ from public or non-profit actors can help when considering impact in development.

Scale and Contribution

It is impossible to discuss development without acknowledging the sheer scale and fundamental role of the private sector. Private enterprises provide roughly 90% of jobs globally. This positions the private sector as the central engine for employment and, consequently, poverty reduction. Jobs are the principal pathway out of poverty for most people, serving to boost living standards.

Beyond direct employment, the private sector is the primary provider of the vast majority of goods and services essential for daily life and economic progress. From food (produced, processed, distributed and sold largely by private actors) to construction, transport, telecommunications, manufacturing and retail.

The private sector contributes ~80-90% of most countries GDP, although in poorer countries this can be as low as 60%, with more government control of different industries and higher development assistance.

Economically, it acts as the main engine of growth through three main channels.

• Investment

  • Businesses invest in machinery, technology, buildings and infrastructure, expanding the economy's productive capacity

• Innovation

  • Competition incentivises firms to develop new products, services and more efficient methods of production.

• Productivity

  • Theoretically, market forces drive resources towards more efficient firms and encourage improvements within firms, leading to overall economic gains

The private sector in LMICs has different dynamics to those in high-income nations.

• Across LMICs, SMEs (small and medium enterprises with 5-250 employees) represent about 66% of permanent, full-time formal employment in low-income countries specifically, small firms often constitute the largest share of employment

  

• SMEs in LMICs often face significant barriers to growth. Unlike the 'grow or die' dynamic often seen in richer economies, firms in countries like India or Mexico tend to either stay small or grow very little over their lifespan. This suggests systemic constraints, like access to finance, infrastructure or increased regulations, are preventing firms from reaching efficient scale

  

• This stunted growth has consequences. Larger firms, while employing a smaller share in low-income contexts, tend to be more productive, invest more in training and innovation and offer higher wages. There are wage premiums of 10-30% for small companies and 20-50% for large companies compared to micro-enterprises

  

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• Karthik Tadepalli - Want Growth? Kill Small Businesses2

  • A country's economic growth can be understood as the aggregate of the growth of its individual firms. Growth rate is determined by three factors.

    • Growth in the number of firms

    • The average growth rate of each firm

    • The market share of high-growth firms relative to low-growth firms

  • The average Indian firm that survives 20 years only adds 20% more employees compared to when it started, while US firms that survive 10 years typically triple their employment

  • This stagnation explains why firms in LMICs remain overwhelmingly small. Without ‘grow or die’ pressures, countries become stuck with low-value manufacturing as many modern goods require scale to produce efficiently

  • The vast majority of firms in LMICs have fewer than 10 employees, with most being single owner-operators. Self-employment represents 55% of employment, rising to 77% in sub-Saharan Africa

  • Evidence suggests these self-employed people are not ‘micro-entrepreneurs’ looking to grow businesses (as microfinance assumes), but rather workers looking for wage employment. They transition to wage jobs at similar rates as unemployed people and microloans have little impact on business outcomes

    • This suggests policy should focus on formal-sector firm growth rather than microenterprises

  • Firms face two major barriers to reaching customers - physical mobility barriers and information barriers that prevent consumers from learning about better options

    • When these barriers are reduced, market consolidation occurs, less productive firms close and more productive ones grow

    • Without prospects to sell to a large market, firms don't have any incentive to invest in productivity improvements

    • Solutions include better transportation infrastructure and e-commerce logistics chains

  • Even large firms in LMICs use frontier technology at much lower rates than counterparts in rich countries

    • Importing technology helps, but knowledge transfer is needed. Without training, productivity improvements can disappear

  • Firms also have weak management practices. Studies show management training significantly improves productivity and profits, with effects persisting for decades

  • Global market interaction catalyses productivity growth. When firms gain export opportunities, they invest more in technology and quality improvements

  • When firms grow, they create stable formal-sector jobs that provide paths to prosperity. Helping even one firm grow can benefit hundreds of people, far more leverage than targeting individual households

Feedback Mechanisms

Private sector entities operate within distinct feedback systems that fundamentally shape their behaviour and impact. Understanding these mechanisms helps explain why businesses act as they do and how they might contribute to, or hinder, development.

Market-Based Feedback Loops

• Consumer Demand Signal

  • The most immediate feedback comes through purchasing decisions. When consumers buy products or services, they signal approval of price and quality (more so in regularly repeated purchases)

  • This feedback is typically rapid and quantifiable, allowing businesses to quickly identify successful offerings. In LMICs these signals may be distorted by limited choice, information gaps or purchasing constraints

• Competitive Pressures

  • Companies face pressure from competitors, driving innovation and efficiency

  • When new entrants offer better value or established rivals improve their offerings, businesses must adapt or risk losing market share

  • The intensity of this feedback varies significantly across markets, highly competitive sectors generate stronger improvement incentives, while monopolistic or oligopolistic structures weaken these pressures

• Capital Markets and Investor Discipline

  • For formal businesses, particularly larger ones, investment capital provides crucial feedback. Investors reward companies showing growth potential and profitability with continued funding, while withdrawing from underperforming ventures

  • This mechanism can be particularly potent in driving business decisions, though it may prioritise short-term financial metrics over long-term value creation or developmental impact. In many LMICs, limited access to formal capital markets means this feedback may operate primarily through informal lending networks or international investors

• Supply Chain Relationships

  • Businesses receive important feedback from suppliers and business customers. Requirements for quality and timeliness create pressure for operational improvements, especially when integrating into global value chains

  • These relationships often transmit international standards and practices to local businesses, though power imbalances may lead to unfavourable terms for smaller players

Comparison with Other Sectors

• Public Sector

  • Unlike businesses, government entities respond primarily to political processes - elections, public opinion and lobbying

  • These feedback loops typically operate on longer cycles (electoral terms rather than quarterly earnings), allowing greater policy stability but potentially slower adaptation to changing conditions

  • Accountability mechanisms are often less direct than market forces, relying on citizen voices rather than buying competitor products

• Non-Profit Feedback

  • Non-profits face a double accountability challenge, responding to both donors who provide resources and beneficiaries who receive services, with donor preferences generally being optimised for

  • This can create tension when donor preferences diverge from recipient needs

  • Measurement challenges also complicate feedback, as social outcomes are harder to quantify than financial returns, making impact assessment more difficult, less accurate and less timely

Market-Based Approaches vs Other Solutions

Understanding when market-based solutions are likely to be more effective compared to government or non-profit interventions is helpful when considering development strategies.

Conditions Often Favouring Market-Based Solutions

• Clear Revenue Potential

  • When beneficiaries (individuals, businesses or governments) are able and willing to pay a price that can sustain the service or product, market mechanisms drive scale and allocate resources

    • Mobile money services charging transaction fees

    • Affordable private schools or clinics with user fees

• Need for Efficiency and Innovation

  • When the problem demands rapid iteration technological advancement or high operational efficiency, competitive pressures and profit incentives often spur faster innovation and cost reduction than typically found in public bureaucracies or non-profits

    • You may also see operational efficiency in militaries (mostly government run), but militaries face a different type of competitive pressure to ensure that they stay effective, with strong feedback mechanisms (during war times)

• Requirement for Large-Scale Delivery

  • When reaching millions of users is necessary, private capital markets can provide significant funding for rapid expansion assuming a viable business model far exceeding typical non-profit budgets

    • Mass expansion of mobile phone networks

    • Roll-out of successful consumer technologies

• Close Alignment Between Profit and Impact

  • When the core business activity inherently generates the desired social or environmental good creating a sustainable revenue stream directly linked to positive outcomes

    • Companies selling clean cookstoves or solar lanterns that save users money and reduce indoor air pollution

    • Businesses providing essential productive assets (irrigation pumps tools) that directly increase farmer income

Conditions Often Favouring Government or Non-Profit Approaches

• Provision of Public Goods

  • When benefits are non-excludable (difficult to prevent non-payers from benefiting) or non-rivalrous (one person's use doesn't diminish another's) making private provision unprofitable or inefficient

    • Basic scientific research

    • Public health surveillance and information campaigns

    • Environmental protection (clean air, national parks)

• Serving the Ultra-Poor or Acute Crises

  • When target populations have essentially zero ability to pay or require immediate humanitarian relief unlinked to payment

    • Free food distribution during famine

    • Emergency healthcare in disaster zones

    • Basic services targeted specifically at destitute populations

• Very Long Time Horizons or Uncertain Returns

  • When the benefits of an investment are diffuse realised only decades later or highly uncertain making it unattractive for private capital seeking predictable returns

    • Universal basic education systems

    • Preventive public health infrastructure with long-term payoffs

    • Fundamental infrastructure in high-risk fragile states

• Severe Information Asymmetries or Trust Deficits

  • When consumers cannot easily judge the quality or necessity of a service creating potential for exploitation that markets alone may not solve

    • Regulation of complex financial products

    • Oversight of highly specialised medical procedures

    • Ensuring quality in credence goods (expert services)

• Focus on Rights Policy or Systemic Change

  • When the primary goal is not service delivery but establishing legal frameworks protecting rights or advocating for policy reform

Hybrid Models

Occasionally the most effective solutions might blend approaches.

• Public-Private Partnerships

  • Government contracts with private firms to build or operate infrastructure/services leveraging private efficiency with public oversight

• Market Shaping

  • Non-profits or governments use subsidies information campaigns or guarantees to reduce risks or build initial demand making a market viable for private actors long-term (common in vaccines or renewable energy)

• Results-Based Financing

  • Funders (often public or philanthropic) pay private providers for achieving pre-agreed verifiable social outcomes allowing providers flexibility in methods

The private sector is vast and economically central, acting as the primary engine for job creation and growth, driven by powerful feedback loops. However, this carries inherent risks and the potential to generate significant negative consequences.

Risks From Private Sector Activity

While essential for economic activity, the pursuit of profit within competitive markets can lead to significant negative outcomes, particularly when regulation is weak or externalities are ignored.

Negative Externalities

These are costs imposed on third parties or society at large.

• Environmental Damage/Public Health

  • Industrial pollution contaminating air and water

  • Contributions to climate change, particularly from the fossil fuel industry and energy-intensive sectors

  • Depletion of natural resources and deforestation

• Governance Challenges

  • Companies may engage in bribery to secure contracts or permits over other organisations, or lobby to weaken useful regulations

  • Tax evasion can deprive countries of revenue for public services

  • Monopolies or cartels can lead to higher prices, lower quality, reduced innovation and barriers to entry for smaller competitors

• Economic Inefficiency or Misallocation

  • Market pressure can sometimes prioritise short-term profits over long-term investments

  • Companies may possess information that consumers or regulators lack, leading to suboptimal outcomes (selling unsafe products)

  • Significant resources allocated to advertising or creating artificial demand for marginally differentiated products

• Social Costs

  • Public health burdens from the promotion and sale of harmful products

  • Large-scale projects can displace communities without adequate consultation or compensation

• Labour Issues

  • The drive to minimise costs can lead to exploitation and unsafe conditions such as excessive working hours, dangerous workplaces and use of child or forced labor in some supply chains

  • Precarious work lacking job security, benefits and a stable income

It can be pointed out that many of these issues can also occur via governments and to a lesser degree non-profits.

Positive Externalities

Private enterprise can also generate positive externalities, benefits that extend beyond direct business transactions to benefit society more broadly.

• When companies invest in employee training, they develop human capital that remains valuable even when workers change jobs, raising productivity across the economy

• Infrastructure investments by businesses, such as telecommunications networks or transportation hubs, often create shared value by improving connectivity and economic opportunities for communities well beyond their customer base

• Knowledge spillovers occur when innovations, management practices and technologies developed by one firm spread to other companies through employee movement or observation

• Private sector growth can strengthen institutions through demands for more transparent governance, standardised regulations and consistent enforcement

• Foreign firms may introduce higher environmental or employee standards that domestic companies eventually adopt

• Successful private enterprises expand the tax base, generating revenue that funds essential public services

• In sectors like healthcare and education, private provision can reduce strain on public systems while sometimes pioneering improvements that public sectors later adopt

Acknowledging the economic role and the potential harms forces an analytical step. Simply observing positive outcomes like job creation or service provision isn't enough, especially when weighed against potential negatives. This brings us to a key question. Even when the outcomes appear positive, how much of that impact is truly additional? We need to assess whether our actions generate benefits beyond what standard market forces would have produced anyway.

Counterfactual Impact

The pursuit of profit drives private sector activity. This generates economic benefit but understanding actual impact requires looking beyond this inherent activity. We need to assess what positive outcomes would have happened anyway without a specific company or action.

Additionality

This is a core concept, assessing the difference made compared to the most likely alternative scenario. For the private sector, the baseline is typical market activity driven by profit incentives. Additionality is the positive outcome that occurs because of a specific intervention or firm, which would not have happened, or would have happened slower or less effectively, otherwise. I.e. “What was the added positive impact beyond what the market would have delivered?”.

Sources of Company-Level Additionality

A company generates additional impact when its actions lead to positive outcomes that would not have been produced by standard market forces alone. Markets, particularly in LMICs, are often inefficient. Promising, impactful opportunities may be neglected or poorly executed by existing players.

Sources of additionality include:

• Addressing Market Failures

  • Operating profitably in areas where mainstream markets fail to serve needs (designing products for ultra-low incomes, providing financial services for the unbanked in remote areas ignored by competitors)

• Pioneering Innovation

  • Introducing genuinely new technologies, business models or approaches that unlock previously impossible solutions or dramatically reduce costs for underserved populations

• Exceeding Standards

  • Voluntarily adopting higher environmental, social or labour standards than required, incurring costs others wouldn't, leading to better non-market outcomes

• Operating in Difficult Contexts

  • Investing or maintaining essential services in regions facing instability, conflict or severe logistical challenges where others withdraw

• Leveraging Scale via Capital Access

  • Achieving significant development reach and impact that would be impossible or far slower without the large-scale capital (venture funding, debt) accessible through a for-profit structure

The Individual Counterfactual

Applying counterfactual thinking at the individual level is needed when considering a career for development impact. It’s worth asking yourself “What positive difference results because of my presence in this role, compared to what would have happened if someone else filled it?”

The assumption that someone equally good will immediately take your place is not always true. Several factors influence individual additionality.

• Likelihood of Replacement

  • In highly specialised roles, nascent industries or organisations with unique demands, finding a suitable replacement might be difficult or time-consuming, making one less replaceable

• Performance Differential

  • If an individual possesses skills or motivation that makes them significantly better suited for the role than the likely alternatives, their superior performance contributes additional value

• Changing the Role

  • Perhaps the largest potential for individual additionality comes from using the position differently than a typical replacement would. This might involve bringing unique expertise that shapes strategy towards greater impact such as founders building a company explicitly designed to address market failures, successfully advocating for internal changes or measurably improving team performance

Analysing additionality is challenging as it requires speculating about alternative realities. However, it is essential for moving beyond simply observing correlation between private activity and positive outcomes towards understanding genuine contributions that you could make and impact beyond the market baseline.

High-Potential Sectors

Certain sectors frequently present opportunities for private actors in LMICs to generate additional benefits. This often involves tackling market failures, leveraging technology, overcoming structural barriers or adding significant value locally. Identifying these sectors helps focus attention on where private initiative might be particularly catalytic for economic growth and prosperity.

Infrastructure

• Why it Matters

  • Provides the essential backbone for almost all economic activity improved quality of life and connectivity. Gaps severely limit growth and access to opportunities

• Potential Additionality

  • Reaching unserved or underserved populations with essential services (power, internet, transport)

  • Introducing significantly cheaper cleaner or more reliable alternatives to public systems

  • Development of critical infrastructure like roads, bridges, tunnels, railways, ports, EV charging networks

  • Creating logistics solutions that overcome barriers

  • Developing enabling infrastructure like cold chains or efficient ports

• Examples

  • Solar power (M-KOPA, Greenlight Planet, Niko)

  • Expansion of affordable internet (various MNOs, Starlink)

  • Innovative logistics (Zipline, Kobo360, Cargon)

  • Well-managed Special Economic Zones

Finance

• Why it Matters

  • Access to basic financial tools (payments savings credit insurance) is critical for household resilience economic participation and small business growth

  • Formal systems often exclude the majority in LMICs

• Potential Additionality

  • Designing and delivering affordable accessible financial products specifically for low-income or previously unbanked populations

  • Leveraging mobile technology to drastically reduce transaction costs and improve convenience

  • Creating new mechanisms for credit assessment or risk management for those without formal financial histories

  • Facilitating cheaper international remittances

• Examples

  • Mobile money transfer payment and savings platforms (M-Pesa, Wave)

  • International remittances often using common tools like WhatsApp (Félix Pago, LemFi)

Healthcare

• Why it Matters

  • Health is fundamental to wellbeing and productivity. Weak public systems high costs and logistical challenges often limit access to quality care and essential medicines in LMICs

• Potential Additionality

  • Significantly increasing the affordability and availability of essential generic medicines

  • Using technology to overcome distance and specialist shortages

  • Developing and deploying low-cost diagnostic tools suitable for LMIC contexts

  • Improving the efficiency and reliability of medical supply chains

• Examples

  • Generic drug manufacturing (Cipla Aspen Pharmacare)

  • Telemedicine (Pinky Promise)

Agriculture

• Why it Matters

  • The majority of the poor in LMICs rely on agriculture for their livelihoods.

  • Low productivity post-harvest losses and poor market access are major constraints

• Potential Additionality

  • Providing information to smallholders that improves yields or market timing

  • Introducing productivity-enhancing technologies (irrigation mechanisation)

  • Reducing post-harvest losses through better storage or logistics

  • Creating reliable and fair market linkages for small producers

  • Adding value through processing of agricultural commodities rather than exporting raw materials

• Examples

  • Darli - uses AI for translation and advice, mentoring farmers

Education

• Why it Matters

  • Human capital contributes to long-term growth. Education systems in LMICs often face resource constraints and may not align well with labour market demands

• Potential Additionality

  • Expanding access to quality educational materials especially in underserved areas or local languages

  • Providing vocational training that is linked to specific industry needs and job opportunities

  • Creating platforms that effectively connect skilled individuals in LMICs with global remote work opportunities

• Examples

  • Accessible platforms offering locally relevant curriculum content (Abwaab in MENA)

Manufacturing

• Why it Matters

  • Key for structural transformation creating more stable higher-skilled jobs than agriculture or informal services and diversifying economies

• Potential Additionality

  • Moving beyond simple assembly by integrating genuine skill transfer technology adoption and local sourcing

  • Developing export-oriented industries that meet international quality standards

  • Manufacturing essential goods locally that were previously imported reducing costs and increasing reliability

  • Adopting cleaner production technologies

Digital Services

• Why it Matters

  • Can leverage global connectivity to create large numbers of formal-sector jobs especially for educated youth even in countries with limited physical infrastructure or local markets

• Potential Additionality

  • Providing first-time formal employment opportunities and skill development

  • Generating foreign exchange earnings

  • Catalysing improvements in local digital infrastructure

• Examples

  • Call centres customer support operations

  • Data entry and basic IT support services

  • More advanced digital marketing or software development services

Construction

• Why it Matters

  • A major employer often of lower-skilled labour critical for building essential housing infrastructure and commercial facilities driving urbanisation

• Potential Additionality

  • Developing housing solutions for low-income urban populations

  • Formalising parts of the construction workforce with better training safety protocols and labour conditions

Wholesale & Retail Trade

• Why it Matters

  • Essential for distributing goods connecting producers to consumers and providing widespread employment often in the informal sector

• Potential Additionality

  • Formalising significant parts of the retail sector leading to improved product quality, consumer protection and tax revenue

  • Developing efficient logistics and distribution networks that lower consumer prices

  • Providing reliable market access for small local manufacturers or farmers

  • Implementing modern inventory management and food safety standards

Water & Sanitation Services

• Why it Matters

  • Access to clean water and sanitation is fundamental for public health and economic productivity

• Potential Additionality

  • Expanding service coverage to unserved low-income or rural areas where public utilities lack capacity or incentive

  • Introducing lower-cost service delivery models (prepaid meters, community management)

  • Improving operational efficiency and reducing water losses significantly

Focusing on these sectors does not guarantee impact. The way businesses operate and the specific context are still important. However these areas frequently offer opportunities for private sector actors to make a positive additional difference beyond standard business operations.

Policy and Regulation

The private sector operates within a framework of laws, regulations and societal expectations. This is primarily set and influenced by governments. Effective policy and regulation can guide private sector activity towards positive development outcomes.

Engagement here offers high leverage as it shapes the environment for potentially thousands of firms. This influence and leverage manifest through several key approaches, including:

• Designing and Implementing Effective Regulatory Frameworks

  • Core government function

  • Roles here involve creating, refining and enforcing the laws and regulations

  • Example Roles

    • Economists, lawyers, policy advisors, regulators, inspectors within government ministries, regulatory agencies or within the judiciary ensuring legal enforcement

• Holding Corporations Accountable

  • Often led by civil society

  • Roles here involve monitoring corporate behaviour, investigating and exposing malpractice and campaigning for greater transparency and adherence to standards and laws

  • This provides a non-market feedback loop, applying pressure where regulation is weak, compelling companies to change practices through public or reputational risk

  • Example Roles

    • Researchers, advocates, campaigners, legal officers, monitoring specialists and journalists

• Shaping the Policy Environment

  • This can occur from various positions. It involves advocating for specific policies or reforms that improve the overall business climate for beneficial private activity (like streamlining business registration, strengthening contract enforcement, or combating corruption to help formal SMEs) or engaging constructively to design regulations that are effective but don't inadvertently stifle innovation or push businesses into the informal economy

  • This can involve working within a company to advocate for responsible practices, or within organisations that advise or represent the private sector.

  • Example Roles:

    • Individuals working in corporate affairs or sustainability roles within companies, staff within industry associations or chambers of commerce, consultants advising governments on regulatory quality, policy analysts in think tanks

• Using Public Procurement Strategically

  • Governments are major customers. Roles in public procurement can achieve development goals beyond simply acquiring goods/services by designing purchasing policies and tender processes that require suppliers to meet standards, set targets for purchasing, or use large-scale purchases to stimulate markets for innovative pro-development products

  • Example Roles

    • Public procurement specialists, advisors in international organisations, like development banks, helping governments design strategic procurement policies

Moving Between Sectors

When considering a career with development impact, understanding how to strategically move between different sectors can help increase your long-term contribution.

Moving from private sector to government or non-profit roles is generally easier than the reverse. Starting in the private sector keeps more doors open, whereas beginning elsewhere may limit future options.

Starting in the private sector offers several benefits that can enhance later development work in other sectors.

• Skill Acquisition

  • Structured training in multiple areas is more common in the private sector and better resourced

  • Large companies often have access to frontier tools and data that most non profits will be unable to afford or don’t have the scale to use

• Professional Networks

  • Exposure to many connections spanning industries, countries and sectors

  • The private sector often has a higher focus on the benefits of networking

• Understanding

  • Practical understanding of market mechanisms and specific sectors from the inside helps identify approaches to development challenges

Questions

Overall Reflections

• What was the most surprising idea or statistic from this week?

• How much do you think the private sector shapes daily life for people in LMICs?

• How central do you believe the private sector is to achieving progress, compared to the roles of government, non-profits or academia?

• When is the private sector more likely to have a positive impact?

• Should international development agencies play an active role in supporting or shaping private sector activity?

• How could governments work with businesses to achieve development outcomes?

• When might a government, non-profit or academia approach be better?

• How do we evaluate the cost-effectiveness of private sector interventions relative to traditional global health or poverty alleviation programmes?

Counterfactual Impact

• How could someone have counterfactual impact in a private sector role?

• How would you assess whether a company is creating genuinely additional impact versus just capturing market share that would have been filled by competitors?

• What factors might make someone less replaceable in a role, increasing their potential for counterfactual impact?

• If you joined a company, what strategies might help you increase your impact beyond what would happen if someone else was hired?

• How does the speed of market adoption affect your assessment of impact? (If something would happen eventually, but you make it happen years earlier, how valuable is that?)

Risks & Trade-offs

• Which risks associated with private sector activity seem most difficult to effectively regulate?

• Can you think of a problem where a purely market-based solution might be actively harmful?

• How do we balance social impact with financial sustainability of an organisation?

• What are the advantages and disadvantages of locally-grown businesses versus multinational corporations?

• What are the pros/cons of focusing on policy supporting startups vs small businesses vs large firms?

Careers

• Which sectors do you think offer the most promising opportunities for private enterprise to contribute?

• If you wanted to have positive development impact through a private sector career, what type of role could you pursue?

• If you work in a standard business not explicitly focused on development, what are some ways you might still be able to create positive development impact?

• When would it be better to found a startup or join a larger company?

• Is working directly for an impactful private sector company in an LMIC likely to achieve more good than an ‘earning to give’ career in a high-income country?

• Where do you see the most neglected opportunities for high-impact work within the private sector?

Future Trends

• How do you think AI might affect the private sector in LMICs?

• What non AI trends will be important in the next 5-10 years?

• How should we think about climate change, urbanisation, population change in connection with private sector trends and startup opportunities?

• To what extent do you think ‘leapfrogging’ (skipping outdated technologies/systems) is a realistic pathway for businesses in LMICs?

Other links

• Ben Kuhn - Why and how to start a startup serving emerging markets

• Ask Me Anything with Wave

• GiveWell - Zipline — Desk-Based Scoping of Drones to Increase Vaccination Coverage

• Estimating the Value of Mobile Money

• IFC Jobs Study - Assessing Private Sector Contributions to Job Creation and Poverty Reduction

• 80,000 Hours - What does economics tell us about replaceability?

• Charter Cities Institute - Reading list (including Special Economic Zones)

• Why Entrepreneurship Is Even More Important in Crisis-prone Regions

• Yaw - Manufacturing in Africa - Meet the 14 African countries that each have billions of dollars of manufactured exports that they sell to the world

• Tobi Lawson - Free Markets in Africa

• Direct Work For-Profit Entrepreneurship is Underrated

Consider two neighboring countries with similar resources, histories and geographic conditions that nonetheless follow dramatically different development trajectories. Or why some promising interventions succeed in one context but fail in another. The answer often lies in the quality of institutions and governance.

Institutions determine whether resources are invested productively or captured by a minority, whether innovations spread or stagnate and whether public services reach those who need them most. They are also usually the foundations on which all development programmes run.

Overview

1. Democracy

   • Defining Democracy

   • A Brief History of Democratic Ideas

   • Democracy's Global Spread and Measurement

   • Does Democracy Lead To Development?

2. Institutions

   • What are Institutions?

   • Historical Development of Institutions

   • Why Institutions Matter: Inclusive vs. Extractive

   • Critiques of Institutional Theories

3. Government

   • Core Functions

   • The Growth of State Capacity

4. Corruption

   • Historical Examples

   • Relationship with Development

   • Standard Anti-Corruption Strategies

   • Context-Specific Approaches to Fighting Corruption

5. Global Governance Landscape

   • Key Global Institutions

   • Effectiveness, Criticisms, and Reform Debates

   • Power Centres in Global Governance

6. Institutional Change: Mechanisms and Strategies

7. Careers in Government, Institutions & Democracy

Democracy

Democracy represents a category of political systems where power is distributed among people, influencing decision-making and holding leaders accountable. Understanding its characteristics and relationship with development can be vital.

Defining Democracy

Democracy describes systems where citizens participate in decision-making, either directly or through elected representatives. While often associated with national governments, its principles (like participation, voting and defined rules) apply across many organisations. Key elements typically include:

• Collective participation and voting rights

• Meaningful and contested elections

• Established rules for decision-making

• Constraints on executive power (checks and balances)

• Protection of basic political and civil liberties (freedom of speech, assembly, press)

A Brief History of Democratic Ideas

While widespread democracy is recent, its core concepts evolved over centuries.

• Ancient Athens

  • Direct democracy where some people (~15%) voted directly on laws and policies

  • Despite narrow citizenship (excluding women, slaves and foreigners) they introduced citizen participation as legitimate governance and accountability of officials

• Roman Republic

  • Developed more representative elements with elected officials and checks on power through a system of assemblies, consuls and the Senate

  • Though representation remained limited to patrician classes, it established principles of separation of powers

• Medieval Innovations

  • Swiss Landsgemeinde - direct democratic assemblies for citizen voting

  • English Magna Carta - limited monarchical power

  • Various city-states in Northern Italy and the Hanseatic League - experimented with councils and representation

• Modern Democratic Revolutions

  • The American and French revolutions institutionalised democratic principles through written constitutions, rights declarations and representative institutions

  • Rejected hereditary power and established popular sovereignty as a source of legitimate government

Democracy's Global Spread

The expansion of democratic governance worldwide is largely a phenomenon of the last century, particularly accelerating after WWII and the Cold War. As the visualisation below shows, democratic rights were virtually non-existent 200 years ago, compared to billions living under some form of democracy today.

• Our World in Data - 200 years ago, everyone lacked democratic rights. Now, billions of people have them

  • Throughout the 19th century, democracy remained rare, with only 14 million (less than ~1%) people living in liberal democracies by 1900

  • Democratic progress accelerated in the 20th century, despite setbacks like the rise of fascism in the 1930s

  • By the late 1990s, the majority of the world's population (about 3 billion people) lived in electoral or liberal democracies

  • Recent decades show both democratic advances in formerly authoritarian contexts and democratic retreat in established democracies

Democracy measurements are done by a variety of organisations using different indices, with some focused on voting procedures and others on liberal democracy more generally (including rights protections, press freedoms and judicial independence). Considering the visualisation above, the difference between whether the number of people globally living in democracies is decreasing or staying roughly similar depends on how India is classified. Episodes of Regime Transformation (ERT)-project and Regimes of the World (RoW) both define India as an electoral autocracy whereas Boix-Miller-Rosato still count India as a democracy.

There is inherent subjectivity when trying to determine how democratic a country is, and these classification differences highlight the complexity of measuring democracy across political systems. Even with rigorous methodologies, these assessments ultimately involve expert judgments about the quality and extent of political rights, which can lead to disagreements at the margins. Despite these challenges, the broader pattern of recent democratic decline across multiple indices suggests a genuine global shift rather than merely a methodological artifact.

Our World in Data - How democratic have countries been across the world? And how big are the differences between them?

Does Democracy Lead To Development?

A central question is whether, and how, democracy affects development outcomes. The relationship is complex and debated, particularly regarding economic growth, but is clearer for human development aspects.

Democracy and Human Development

Democracies tend to perform better on human development indicators like education and life expectancy and are notably better at avoiding catastrophes like famines.

• Our World in Data - Does democracy lead to better health?

  • There is a correlation between democratic governance and health outcomes (measured by life expectancy)

  • Several studies suggest this relationship is causal

  • Mechanisms linking democracy to better health

    • Increased government responsiveness to citizens' needs due to electoral accountability

    • Higher public spending on health and other public goods

    • More effective and less favouritism-driven public service delivery

Democracy and Economic Growth

The link between democracy and economic growth is more contested than the link with human development.

• Acemoglu et al - Democracy Does Cause Growth

  • Analysing 175 countries from 1960-2010 found that democratisation increases GDP per capita by approximately 20% over the long run

  • The effect of democracy on growth doesn't seemingly depend on a country's initial level of economic development

  • There's no evidence of negative effects of democracy on growth, even for countries at low levels of economic development

  • Democracy appears to increase economic growth through several channels:

    • Increasing investment

    • Encouraging economic reforms

    • Improving provision of public goods (education, healthcare)

    • Increasing tax revenue

    • Reducing social unrest

• Does democracy cause growth? A meta-analysis (of 2000 regressions)

  • Democracy has a positive and direct effect on economic growth, contrary to previous meta-analyses

  • The growth effect of democracy appears stronger in more recent papers not included in a previous 2008 meta-analysis

• Challenges

  • The East Asian Paradox

    • Rapid growth occurred under authoritarian regimes before democratisation in several countries

  • China's Model

    • Sustained growth without democracy (though with significant economic liberalisation)

  • Institutional Quality Matters

    • The effectiveness of democratic institutions varies greatly and state capacity matters

  • Potential for larger policy gridlock in more democratic countries

Evidence suggests links to better human development outcomes, including health, likely driven by accountability mechanisms. Its relationship with economic growth is more debated but getting stronger more recently, with evidence supporting a positive causal link.

While we've looked at the relationship between democratic systems and development outcomes, it's important to recognise that democracy is just one aspect of a broader institutional landscape. The quality of institutions often determines whether democratic processes translate into meaningful development. For instance, a country might hold regular elections (a democratic procedure) but still struggle with development if property rights remain insecure or if the rule of law is weak. This brings us to the broader concept of institutions.

Institutions

What are Institutions?

Institutions are fundamental frameworks that structure political, economic and social interactions within societies. Understanding institutions is critical because they determine how resources are distributed and underpin long-term development trajectories.

Institutions encompass both:

• Formal rules - often written down and officially sanctioned

  • Examples include a country's constitution, specific laws regulating banking, property titling systems, tax codes or electoral laws defining how votes are cast and counted

• Informal constraints - these are unwritten codes of conduct, norms, traditions and conventions that shape behaviour

  • Examples include norms around corruption (is it tolerated or condemned), social customs related to marriage or inheritance, conventions in business negotiations, or community-level rules for managing shared resources like water or forests

Together, these formal and informal structures create predictability by establishing expectations and defining the rewards and penalties associated with different actions.

They operate across various domains.

• Political institutions

  • Electoral systems, rules governing campaign finance, parliamentary procedures, constitutional limits on executive power

• Economic institutions

  • Property rights systems (how land is owned and transferred), contract enforcement mechanisms, banking regulations, patent laws, rules governing international trade

• Legal institutions

  • The structure of the court system, legal codes (civil law vs common law traditions), procedures for evidence and trial, mechanisms for appointing judges

• Social institutions

  • Examples: Norms surrounding family structures and gender roles, educational systems and curricula, widespread religious practices, cultural attitudes towards trust and cooperation

  • You can see an interesting example of how religious institutions can affect development outcomes in this post by Alice Evans looking at how the afterlife affects economics1

The historical development of institutions shows how they generally evolved to address challenges as they came up.

• Classical antiquity

  • Political instability led Athens to develop democratic institutions

  • Rome's expansion and desire to maintain control led to standardised laws, citizenship frameworks and provincial administration to govern diverse populations

• Medieval period

  • In England, Henry II's desire to centralise royal power led to common law systems replacing inconsistent feudal justice

  • Church and state demand for educated administrators spurred university creation

  • Increasing specialisation and economic complexity necessitated guilds for quality control and merchant protection

• Early modern period

  • Currency instability and trade expansion required stable banking institutions

  • The costs and risks of overseas trade and colonial expansion led to joint-stock companies and maritime insurance, enabling investors to share financial risks

  • Growing state responsibilities required merit-based bureaucracies over patronage

• Modern era

  • Abuses of power drove demands for constitutional constraints and representation

  • Global conflicts compelled creation of international peacekeeping organisations

  • Market failures and economic interdependence necessitated regulatory frameworks

Why Institutions Matter: Inclusive vs Extractive

When development efforts fail despite adequate funding and technical expertise, the root cause often lies in the institutional environment. A vaccine programme may struggle in a country with weak public administration, a promising agricultural innovation might not spread where land rights are insecure and anti-poverty transfers may not reach intended recipients when there is entrenched corruption.

A highly influential framework for understanding the impact of institutions comes from Acemoglu and Robinson's Why Nations Fail. They distinguish between:

• Inclusive Institutions that create virtuous cycles, fostering innovation and sustained, broad-based prosperity

  • Secure private property rights, unbiased legal systems, regulations that encourage competition and new business entry, freedom to choose careers

  • They create broad incentives for investment, innovation and effort

  • Distribute political power broadly, establish constraints on its exercise and uphold the rule of law

  • Inclusive political institutions tend to support and be supported by inclusive economic institutions

• Extractive Institutions that may achieve short-term growth (e.g., by forcibly mobilising resources), but ultimately stifle innovation and effort, leading to stagnation and instability as they actively resist changes threatening elite control

  • Designed by ruling elites to extract wealth and resources from the rest of society

  • Feature insecure property rights (for the masses), biased legal systems, high barriers to entry and often coercion

  • Concentrate power in the hands of a narrow elite, lacking constraints and accountability

• Critiques

  • The China Challenge

    • China has maintained high growth for decades despite politically extractive institutions. Acemoglu and Robinson argue this is unsustainable without political reform, while critics see it as a fundamental challenge to their theory

  • Geography vs. Institutions

    • Jared Diamond and Jeffrey Sachs argue that geographical factors (climate, disease burden, natural resources) play a more fundamental role than acknowledged

  • Reverse Causality

    • Does economic development lead to better institutions rather than vice versa? They use historical natural experiments like the divergence of formerly similar regions to address this

      • Some successful developers (Singapore, South Korea, Taiwan) established inclusive economic institutions before fully inclusive political ones

  • Measurement and Implementation

    • The difficulty of operationalising the inclusive/extractive framework for policy purposes

  • Historical Interpretation

    • Some historians question the interpretation of specific historical cases used to support their theory

Case Study: The Two Nogales

One of the illustrations used by Acemoglu and Robinson is the comparison of Nogales, Arizona (USA) and Nogales, Sonora (Mexico) - two halves of the same city divided by a border. Despite shared geography, climate and cultural heritage, the U.S. side has three times the income of the Mexican side, better public services, lower crime rates and higher health outcomes.

They attribute this divergence not to geography, culture or individual leadership, but to the different institutional trajectories of the United States and Mexico. The U.S. developed more inclusive institutions that broadly distributed political power and economic opportunity, while Mexico's institutions evolved from colonial extractive systems that concentrated power and wealth.

Case Study: South Korea and North Korea

Another illustration comes from the Korean peninsula. Following division in 1945, both nations started with similar cultural backgrounds, natural resources and Japanese colonial legacy. South Korea gradually developed inclusive institutions with economic freedoms, property rights and eventually democratic accountability. North Korea established highly extractive institutions with centralised economic control and concentrated political power.

By 2023, South Korea's GDP per capita exceeded $34,000 while North Korea's remained under $1,800. South Korea became a technological innovator with world-class companies and living standards, while North Korea has experienced recurring famines and economic crises.

• Dietrich Vollrath - Why Isn’t the Whole World Rich?

  • Early economic research attributed growth differences to ‘factors of production’ - physical capital (infrastructure, equipment) and human capital (skills, education). Countries that invested more in these areas tended to grow faster. However, these studies didn't explain why some countries invested in these factors while others didn't, leading researchers to look for deeper causes

  • Economists have grouped these fundamentals into three categories: culture, geography and institutions - with institutions receiving the most research attention

  • Institutions like property rights, constraints on government power, democracy and lack of corruption appear associated with growth, but causality is difficult to establish, and measuring institutions objectively is problematic

  • Researchers have turned to natural experiments to better isolate institutional effects

    • The divergence between North and South Korea after 1953

    • The lasting negative effects of colonial institutions like Peru's Spanish forced labor system

    • The impact of direct British rule in parts of India

    • How pre-colonial political organisation affects current economic outcomes in Africa

  • Recent research focuses less on identifying specific growth-promoting institutions and more on understanding why failed institutions persist. This work suggests that expanding economic and political power to more people helps countries negotiate better economic institutions

  • They claim to have identified which institutions don't work and recognise that wider distribution of economic and political power creates conditions where good institutions are more likely to emerge

Institutions provide the framework within which governments operate. If institutions are the 'rules of the game,' governments are the primary players tasked with implementing, enforcing and sometimes changing these rules.

The effectiveness of government, its ability to deliver services, maintain order and implement policy, depends heavily on the institutional environment. At the same time, governments through their actions can gradually reshape institutions. This dynamic relationship helps explain why government structures can produce radically different outcomes across countries with similar institutional histories.

Government

The ways societies organise themselves politically and economically are crucial for development. At the heart of this are institutions and within institutional framework operates governments, the specific set of organisations and individuals with the authority to make and enforce decisions for a society. Key functions include law-making, enforcement (defence, policing), providing public goods (infrastructure, education, public health), and revenue collection. A capable and responsive government is essential for translating institutional potential into tangible outcomes.

Understanding government involves looking at its core functions, its structure (form), and its ability to act effectively (state capacity).

Core Functions

Beyond the specific mechanisms of democracy or the nature of institutions, governments typically perform several functions vital for development.

• Rule-Making and Enforcement

  • Establishing laws and regulations (within the institutional framework) and ensuring compliance through policing, defence and judicial systems. This creates predictability and order

• Provision of Public Goods

  • Supplying goods and services that markets may under provide, such as infrastructure (roads, power), public health, basic education and national defence

• Revenue Collection

  • Raising the necessary funds to finance public activities and services, often via taxation

• Redistribution

  • Implementing policies (taxes, social transfers) to alter the distribution of income and opportunity, often aiming to reduce inequality or poverty

• Regulation

  • Overseeing economic activities to ensure fair competition, protect consumers and the environment and maintain financial stability

• Economic Management

  • Steering the macroeconomy, managing trade policy and sometimes undertaking strategic industrial policy (though the extent and nature of this role are debated)

For governments to fulfil these essential functions effectively, they require specific operational capabilities, often called state capacity. A government might be democratically elected and operate within nominally inclusive institutions, but without adequate capacity to implement policies, collect revenue or maintain territorial control, it will struggle to deliver development outcomes.

The Growth of State Capacity

Historically, the ability of states to perform these functions effectively, their state capacity, was limited. Over the last 200 years, particularly in high-income countries, state capacity has grown enormously, enabling extensive service provision and regulation.

Taxation

• Our World in Data - Taxation & Public Spending: Explore long-run trends in government revenue and expenditure, indicators of state capacity

  • Until 1920, tax revenues were low across early-industrialised countries (below 10% of national income)

  • Low- and Middle-Income Countries (LMICs) rely more heavily on indirect taxes, particularly trade and consumption taxes vs direct taxation and personal income taxes in richer countries

  • Political institutions impact tax collection - countries with stronger executive constraints collect higher tax revenues

  • There's a strong positive correlation between GDP per capita and tax revenue as a percentage of GDP

  • Taxes and transfers reduce income inequality by about one-third on average in OECD countries

Territorial control

A government's ability to control its territory represents one of the most basic expressions of state capacity. Most contemporary states effectively control virtually all their territory, with government authority recognised throughout their borders. However, significant exceptions exist in West and East Africa, parts of Central and South America, and some fragile states where government control remains contested by insurgent groups, criminal organisations, or where remote areas remain effectively ungoverned.

Historically, even today's strongest states once faced territorial control challenges. The progression towards comprehensive territorial control represents a fundamental aspect of state development.

Bureaucratic quality

The effectiveness of state policies depends heavily on the quality of public administration. High-performing bureaucracies (found primarily but not exclusively in wealthy democracies) feature merit-based recruitment, professional standards and limited corruption. In contrast, low-capacity bureaucracies struggle with endemic corruption, patronage-based hiring and arbitrary implementation of rules.

Beyond bureaucratic quality, states also differ in their information-gathering capabilities. The establishment of population registries, regular census-taking and statistical agencies represents a dimension of administrative capacity that enables evidence-based policy.

• Our World in Data - State Capacity

  • Most countries have strengthened their state capacity over recent decades.

  • Particularly dramatic improvements have occurred in countries starting from lower capacity bases like Uganda and Vietnam

  • Even high-capacity states like Germany have continued to enhance their capabilities

  • This trend spans all major regions and income groups

  • Some states have experienced capacity deterioration, particularly those affected by armed conflict, economic collapse, state capture by predatory elites or external destabilisation

Even with strong formal institutions and substantial state capacity, development efforts can be undermined by corruption, the misuse of public power for private gain.

Corruption essentially creates a gap between formal institutions (what the rules say should happen) and actual practice (what really happens). Understanding corruption as a systemic challenge rather than simply individual moral failings provides insights into why anti-corruption efforts often fail and what approaches might prove more effective.

Corruption

Corruption is a major impediment to development.

• Our World in Data - Corruption - How common is corruption? What impact does it have? And what can be done to reduce it?

  • Historical examples include ‘rotten boroughs’ in 1800s England

    • Rotten boroughs were constituencies in England with small electorates, sometimes fewer than 10 voters. Wealthy patrons could effectively buy these seats by controlling these few voters through bribes or influence. For example, Old Sarum in Wiltshire had only seven voters but sent two members to Parliament, while Manchester with 60,000 inhabitants had no representation

  • There is a strong correlation between lower corruption and higher human development

  • Increased monitoring and audits can reduce corruption (Indonesian study showed 30% reduction in missing funds)

    • Evidence of officials in charge of Indonesian road projects responding to incentives: it found that audits were most effective when officials faced elections soon, and village elites shifted to hiring family members, which was harder to detect

  • Education correlates with lower corruption levels, although some countries can have high education ratings and still have high corruption

  • Cultural norms affect corrupt behaviour

  • There is significantly less corruption where officials face reelection

Standard anti-corruption strategies often focus on transparency, accountability and strengthening enforcement agencies (police, courts, anti-corruption commissions).

Institutional economists like Mushtaq Khan argue these approaches often fail in contexts where corruption is widespread. They misunderstand the problem: it's not just a few ‘bad apples’ but a systemic issue where rule-breaking is pervasive, often necessary to navigate daily life due to low capabilities and pervasive informality. In such contexts, enforcement agencies themselves often become corrupted or tools of political power.

Enforcement relies heavily on horizontal policing (peers checking peers). If the relevant peers for a given activity all benefit from rule-breaking (networked corruption), top-down vertical enforcement is unlikely to work and may provoke conflict (e.g., Niger Delta oil theft).

Effective anti-corruption efforts need to be context-specific and politically feasible. Khan suggests focusing on the below.

• Identifying situations where powerful actors have divergent interests regarding rule-following

• Designing interventions that align the self-interest of some powerful actors with rule-following (e.g., dual-use infrastructure projects that provide immediate local benefits, incentivising monitoring by capable locals)

• Creating exit strategies from networked corruption by providing alternative livelihoods or services

• Focusing on building organisational capabilities incrementally

Many development challenges, like corruption, transcend borders and require coordinated international action. Global institutions have emerged to address these challenges, from financial instability to health emergencies. These international organisations operate within their own complex institutional environments, facing challenges of representation, accountability and effectiveness that parallel those at the national level, but with the added complexity of sovereign states as their members.

Global Governance Landscape

Global governance institutions have profoundly shaped our world since the mid-20th century. Operating beyond national borders, these organisations create frameworks for addressing transnational challenges ranging from poverty reduction to pandemic response.

Key Global Institutions

United Nations (UN)

The UN emerged in 1945 from the ashes of World War II, replacing the (seemingly failed) League of Nations. Its mandate spans maintaining international peace, protecting human rights, delivering humanitarian aid and promoting sustainable development. The organisation's structure reflects power dynamics of the post-war era: a General Assembly representing all member states, a Security Council with five permanent veto-wielding members and a network of specialised bodies including the Economic and Social Council and International Court of Justice.

Through agencies like UNDP and UNICEF, the UN establishes global norms and coordinates development initiatives worldwide. Despite its universal membership, the UN struggles with Security Council reform deadlock, funding shortfalls and the gap between its ambitious resolutions and actual implementation capacity.

World Bank Group

The World Bank Group comprises five institutions, with the International Bank for Reconstruction and Development and International Development Association forming its core lending operations. Founded in 1944 primarily to finance European reconstruction, the Bank's mission has expanded dramatically over decades.

• 1960s: Infrastructure Focus

  • Large-scale projects dominated this era, reflecting modernisation theory emphasis on physical capital as the key development constraint. Dams, highways and power plants received priority funding, often with minimal input from affected communities

• 1970s: Poverty Reduction Shift

  • The Bank began addressing basic human needs amid oil shocks and widespread nationalisations. Rural development programmes and investments in health and education gained prominence under Robert McNamara's presidency

• 1980s: Structural Adjustment Programmes

  • Responding to developing country debt crises, the Bank mandated market-oriented reforms including privatisation, liberalisation and fiscal austerity. These programmes proved socially disruptive in many contexts and were criticised for imposing standardised solutions regardless of local conditions

• 1990s: Governance and Institutions

  • Conditionality expanded to include democratic reforms and good governance requirements. Environmental impacts received greater scrutiny, while the Bank played a major role in post-Soviet transitions across Eastern Europe and Central Asia

• 2000s: Debt Relief Era

  • The Heavily Indebted Poor Countries Initiative and Multilateral Debt Relief Initiative marked this period. China emerged as an alternative development partner and lender, coinciding with the Millennium Development Goals framework

• 2010s: Inclusive Growth Focus

  • Inequality reduction and shared prosperity became central concerns. The Bank increased attention to fragile states and conflict regions while aligning with the Sustainable Development Goals

• 2020s: Climate and Pandemic Response

  • Climate finance, adaptation strategies and health system strengthening have taken centre stage in recent years, alongside digital transformation initiatives

International Monetary Fund (IMF)

Created alongside the World Bank at Bretton Woods in 1944, the IMF initially focused on stabilising exchange rates and addressing balance of payments issues. Its role evolved substantially after the collapse of fixed exchange rates, shifting towards global financial system surveillance.

Today the IMF functions as a crisis lender providing emergency financing to troubled economies, conducts regular economic monitoring through Article IV consultations and delivers technical assistance on monetary and fiscal policy. Reform discussions continue regarding its governance structure, where advanced economies maintain disproportionate voting power, and its conditionality requirements, which critics argue often impose excessive austerity on vulnerable populations.

World Health Organization (WHO)

Established in 1948 as the UN's specialised health agency, the WHO coordinates global health efforts through four main functions: disease surveillance, emergency response coordination, standard-setting for medicines and convening international health initiatives. Its achievements include smallpox eradication, dramatic reductions in child mortality and expanded immunisation coverage worldwide. The organisation faces significant challenges including unstable funding heavily dependent on voluntary contributions, political interference from powerful member states and limitations in its authority during health emergencies as demonstrated during recent outbreaks.

The above multilaterals represent only part of global governance architecture. A wider ecosystem encompasses regional bodies like ASEAN and the African Union, specialised agencies such as the IAEA and issue-specific partnerships including GAVI Alliance. Together they form an intricate network with overlapping mandates that often creates coordination problems.

Effectiveness, Criticisms, and Reform Debates

International institutions face recurring challenges that have sparked calls for reform.

• Representation Issues

  • Decision-making power remains concentrated among wealthy nations, particularly in the IMF and World Bank where voting rights distribution largely favours advanced economies. Countries most affected by institutional policies often have minimal input into their design

• Policy Shortcomings

  • Washington Consensus reforms promoted by international financial institutions often failed to account for sequencing challenges, social impacts or country-specific contexts. One example is the imposition of rapid privatisation in post-Soviet economies without adequate regulatory frameworks. Coordination failures between institutions frequently result in contradictory policy advice

• Accountability Gaps

  • Measuring the actual impact of international institutional interventions proves consistently difficult. Feedback mechanisms that would enable learning from failures remain underdeveloped in most organisations. Many programmes generate unintended consequences that aren't adequately addressed

Reform proposals span a spectrum from modest to transformative approaches. Some advocate incremental changes like adjusted voting weights and transparency improvements. More ambitious structural reforms include new decision-making bodies and revised lending criteria. The most radical proposals call for fundamentally reimagining global governance architecture for contemporary challenges.

Case Study: Reforming the UN Humanitarian System

The challenge of reforming global institutions is clear in efforts directed at the UN humanitarian system. While essential for global crisis response through agencies like WFP and UNHCR, the system itself faces acknowledged structural issues: overlapping mandates, inbuilt inefficiencies and agency competition, often hindering coordinated action and making reforms difficult to implement due to member state dynamics and systemic inertia.

Recognising this, the UK, as a major donor between 2011-2018, attempted to leverage its funding to push for greater effectiveness. Successes included championing the shift to cash transfers and providing predictable multi-year funding, which demonstrably helped agencies like WFP build new capacities and plan more efficiently in contexts like South Sudan.

However, the UK's ambitious attempts to tackle deeper systemic issues proved complex. Its drive for accountability led to increasingly demanding reporting requirements, which, while aiming for oversight, placed more burdens on UN agencies already navigating complex operations, running counter to internationally agreed goals of harmonising such demands.

An experimental 'Payment by Results' scheme, linking 30% of core funding to collective reform progress across six UN bodies, was aimed directly at breaking down agency silos. Yet, its design and the UK's failure to secure buy-in from other key donors limited its traction against the UN's resistance to change, with some UN staff misinterpreting it as a drive towards cost savings rather than programme effectiveness, which led to misaligned incentives.

While evaluating the effectiveness and reform challenges of established international institutions provides valuable insights, global governance extends far beyond formal government structures and multilateral organisations. Understanding this broader landscape is essential because development outcomes are increasingly shaped by a diverse range of actors, many operating outside traditional governance frameworks.

From technology companies determining information access to financial institutions influencing capital flows, these entities often exercise governance functions without corresponding accountability mechanisms. By looking at this wider landscape, we can better identify leverage points for change.

Power Centres in Global Governance

The Effective Institutions Project has attempted to map the wider landscape by identifying the most influential organisations shaping global outcomes. Their analysis covers an ecosystem where governmental, corporate, multilateral and civil society actors interact and compete.

Examining these different categories is useful as it illuminates the diverse channels through which governance occurs, not just through treaties and international organisations, but through standard-setting, resource allocation, idea generation and technological control.

It highlights the growing importance of non-state actors in shaping development outcomes and provides context for institutional competition and forum-shopping as actors seek favourable venues for advancing their interests.

Government Leaders

• United States

  • Executive Office of the President: Controls world's largest military and reserve currency

  • National Security Council: Coordinates foreign policy and security apparatus

  • Congress (Representatives and Senate): Holds budgetary authority and treaty ratification powers

• China

  • Communist Party Politburo: Central decision-making body in rising superpower

  • State Council: Implements domestic and international policy

• European Union

  • European Commission: Regulatory superpower with global standard-setting influence

  • European Council: Coordinates member state positions on foreign policy

• Russian Government: Nuclear capabilities and energy resources leverage

• Other Key Governments: India, Brazil, UK, Germany, France, Japan, Saudi Arabia, Türkiye

National governments remain the primary building blocks of global governance, retaining formal sovereignty and the authority to enter binding agreements. However, their influence varies dramatically based on economic weight, military capability and technological advancement.

Corporate Influence

• Technology Giants

  • Amazon - E-commerce infrastructure and cloud computing dominance

  • Alphabet (Google/DeepMind) - Controls information access and AI development

  • Meta (Facebook/WhatsApp/Instagram) - Global communications platforms

  • OpenAI - Advancing frontier AI capabilities

  • Chinese Tech companies - (Baidu, Huawei, Tencent)

• Financial Powers

  • BlackRock - World's largest asset manager ($11+ trillion under management)

  • JPMorgan, Goldman Sachs

  • City of London/Wall Street - Financial services hubs

• Resource Controllers

  • Aramco - World's largest oil producer

  • Trafigura - Commodities trading networks

  • Rio Tinto - Mining conglomerate

  • Cargill - Agricultural commodity giant

These corporate entities increasingly function as governance actors themselves by setting standards, controlling essential infrastructure and shaping regulatory environments. Their economic resources often exceed those of smaller nation-states, raising questions about democratic accountability in global governance.

Multilateral Frameworks

• UN, WHO, World Bank Group

• African Union - Continental integration efforts

• OECD - Policy coordination among advanced economies

• NATO - Military alliance

• Regional Development Banks - Asian Development Bank, African Development Bank, etc.

Knowledge and Norm Shapers

• Media - BBC, The New York Times, Al Jazeera, etc with agenda-setting influence

• Foundations - Gates, Wellcome, Novo Nordisk (combined assets >$180 billion, which is just under one year of ODA from governments)

• Academia - Harvard, Oxford, Tsinghua, etc

• Think Tanks - Brookings Institution, Chatham House, International Crisis Group

• NGOs - Amnesty International, Greenpeace, Oxfam

• Religious Institutions - Vatican, Al-Azhar university, various faith networks

These actors wield soft power through their ability to shape narratives, generate knowledge and influence values. While lacking formal authority, they can mobilise public opinion, provide expertise and establish normative frameworks that guide the behaviour of more powerful actors.

Understanding the landscape of global governance, from multilateral organisations to corporate influence, raises a fundamental question: how do institutions change?

Institutional Change: Mechanisms and Strategies

Institutional change is among the most challenging aspects of development. Both history and contemporary experience show that institutions are typically resistant to change, as they often reflect existing power structures and entrenched interests. Yet meaningful institutional transformation does occur, sometimes gradually and sometimes rapidly.

Critical Junctures and Windows of Opportunity

Significant institutional changes often occur during periods of crisis or transition when established arrangements are weakened or delegitimised.

• Political transitions

  • Democratic revolutions, regime changes, and independence movements can create openings for institutional redesign. South Africa's transition from apartheid allowed for the creation of new political institutions embodied in its 1996 constitution

• Economic crises

  • Severe economic disruptions can discredit existing institutional arrangements and create space for reform. The Latin American debt crisis of the 1980s led to widespread institutional restructuring across the region, including privatisation, trade liberalisation, and fiscal reforms

• Natural disasters or pandemics

  • Major shocks can expose institutional weaknesses and generate political will for change. Following the devastating 2004 tsunami, Indonesia implemented significant decentralisation reforms that redistributed power and resources to local governments

However, these windows don't automatically lead to better institutions, the direction of change depends on multiple factors going well.

Incremental Change and Institutional Layering

Not all institutional change is dramatic. Often, transformation occurs through incremental processes.

• Layering

  • Adding new elements to existing institutions without dismantling them. China's economic reforms beginning in 1978 show this approach, market mechanisms were gradually introduced alongside, rather than replacing, state planning. Especially when compared to the dramatic upheaval caused by the cultural revolution of the previous decade

• Conversion

  • Repurposing existing institutions for new goals. Many colonial-era bureaucracies were maintained after independence but redirected towards national development priorities

• Drift

  • When institutions remain formally unchanged but their impact evolves due to changing environments. Environmental protection agencies established in the 1970s now address climate change, though their core structures remain similar

These gradual changes can accumulate over time, resulting in profound institutional transformation without obvious breaking points. This can be for better or worse as can be seen with various government departments, NGOs or foundations shifting away from their original goals.

Internal Reformers

Working within systems to change them requires specific approaches.

• Coalition building

  • Successful reformers identify and mobilise supportive stakeholders across different groups. In Georgia's anti-corruption reforms (2004-2012), reformers built coalitions across political parties, civil society and business sectors

• Strategic sequencing

  • Prioritising easier quick win reforms first can build momentum for deeper changes. Rwanda's post-genocide government initially focused on security and basic service delivery before undertaking more ambitious institutional reforms

• Pocket of effectiveness approach

  • Creating well-functioning units within otherwise dysfunctional systems

• Reform through demonstration

  • Proving that better institutional arrangements work in controlled settings before expanding. Vietnam's economic reforms began with limited experiments in agricultural production before broader implementation

External Catalysts

Outside actors have several potential leverage points.

• Technical assistance and knowledge transfer

  • International organisations and bilateral donors provide expertise and training to strengthen institutional capacity. The OECD's anti-bribery convention implementation has supported legal and enforcement reforms across member countries

• Financial incentives and conditionality

  • Linking financial support to specific institutional changes. While controversial, conditionality has contributed to institutional reforms in areas like public financial management and banking regulation

• Creating and supporting transnational advocacy networks

  • External actors can amplify domestic reform voices. International support for anti-corruption NGOs helped advance institutional reforms in countries like Indonesia and Ukraine

• Normative pressure and socialisation

  • International standards and peer review mechanisms can motivate reforms. The Financial Action Task Force's evaluations have spurred anti-money laundering institutional improvements globally

Civil Society and Bottom-Up Pressure

Non-state actors drive institutional change through the following.

• Monitoring and advocacy - Tracking government performance and advocating for reforms

• Strategic litigation - Using courts to force institutional change

• Information campaigns - Educating citizens about institutional shortcomings can generate reform pressure

• Collective action and social movements - Mass mobilisation can force institutional responses

Challenges and Limitations

• Isomorphic Mimicry and Facade Reforms

  • A persistent challenge is that institutional changes often remain superficial, countries adopt the forms of effective institutions without their functions. Development organisations frequently contribute to this problem by emphasising formal structures over actual capacity and performance

• Power and Political Economy

  • Institutional reforms that threaten entrenched interests typically face fierce resistance. Understanding the political economy, who wins, who loses, and who has the power to block change, is essential for effective reform strategies

  • Acemoglu and Robinson emphasise that sustainable institutional change requires shifts in the underlying distribution of power. Otherwise, elites will eventually reassert control, undermining formal institutional changes

• Path Dependence and Cultural Constraints

  • Institutions develop within specific historical and cultural contexts that constrain change possibilities. What works in one context may fail in another due to different historical legacies, cultural norms or complementary institutions

How can individuals contribute to improving governance and institutional quality? Various career pathways offer opportunities to influence these systems, each with distinct leverage points, challenges and considerations.

Careers in Government, Institutions & Democracy

Working to improve governance and institutions is challenging but offers potentially high-leverage pathways for impact, as these systems often underpin other development outcomes.

1. Government, Politics & Civil Service

• Working within or directly engaging with state structures offers channels to shape/implement policy, manage public resources, deliver services or gain political power. Success hinges on navigating political realities, bureaucratic processes, and public opinion

• Organisations: National ministries (finance, planning, justice, sector-specific), local government authorities, public service commissions, anti-corruption bureaus, electoral management bodies, political parties, campaign organisations, elected offices

• Considerations:

  • Pros: Potential for large-scale impact, direct involvement in implementation/decision-making, deep contextual understanding

  • Cons: Bureaucracy, political interference limiting technically sound solutions, potential for corruption exposure/pressure, job insecurity in political roles, potentially lower pay than private sector for civil service. Measuring individual contribution can be hard

  • Link - Civil Service Careers in LMICs - Probably Good

2. Multilateral & Intergovernmental Organisations

• These bodies influence global norms, provide technical assistance/funding for governance reforms, convene international actors, and sometimes adjudicate international law. Work often involves cross-country analysis, diplomacy, and specialised legal/technical expertise

• Organisations: World Bank, IMF, UN agencies (UNDP, UNODC), regional development banks (AfDB, ADB), OECD, specialised bodies (International IDEA), international courts (ICC, ICJ), treaty secretariats

• Considerations:

  • Pros: Global reach, influence on policy agendas, access to diverse contexts, often good career stability/benefits

  • Cons: Bureaucratic constraints, potential disconnect from local realities, navigating complex member state politics, slow decision-making. Advanced degrees often required

3. Research, Academia & Think Tanks

• Generating evidence, developing theories, analysing trends and providing policy recommendations on governance, institutions, democracy and related issues

• Organisations: Universities (political science, economics, public policy, law, anthropology depts), independent research institutes (CGD, ODI, Brookings, Chatham House), regional policy think tanks

• Considerations:

  • Pros: Intellectual freedom (relatively), potential to shape understanding and long-term agendas, contributing to evidence base

  • Cons: Challenge of ensuring research uptake, reliance on grant funding, highly competitive academic tracks, impact often indirect and long-term

4. Non-Governmental Organisations (NGOs) & Civil Society

• Advocating for specific reforms, monitoring government performance, empowering citizens, implementing grassroots governance projects, building community capacity and organising collective action

• Organisations: Transparency International, Human Rights Watch, Carter Center, national chapters of global NGOs, community organising groups, grassroots movements

• Considerations:

  • Pros: Often closer to communities, potential for agility and direct impact on accountability, strong value alignment for staff

  • Cons: Funding instability, reliance on donor priorities, measuring advocacy/organising success can be difficult, potential political risks/pushback

5. Private Sector, Consulting & Corporate Influence

• Providing advisory services to governments/IOs, developing relevant technologies, managing political/institutional risks for businesses, and shaping governance norms/practices from within large corporations

• Organisations: Major consulting firms (public sector practices), specialist governance consultancies, technology companies (civic tech, gov tech, major platforms setting content/data policies), political risk advisory firms, large corporations (govt. affairs, ethics/compliance, sustainability depts)

• Considerations:

  • Pros: Often well-resourced, focus on tangible results/efficiency, potential to influence powerful private actors internally, exposure to diverse challenges

  • Cons: Risk of applying generic solutions without deep context, aligning profit motives with public good, ethical dilemmas working with certain regimes or on potentially harmful policies/internal practices

6. Media & Journalism

• Investigating and reporting on government actions, corruption, institutional failures, and political processes to inform the public and hold power accountable

• Organisations: News outlets (international, national, local), investigative journalism units/non-profits, freelance journalists

• Considerations:

  • Pros: Crucial role in transparency and democratic accountability, potential for high public impact through exposés

  • Cons: Financial precarity in the industry, potential political pressure/threats, challenge of maintaining objectivity, impact depends on public/official reaction

7. Philanthropy & Grantmaking

• Strategically allocating resources from foundations or donor funds to support initiatives aimed at improving governance, democracy, institutional capacity or accountability

• Organisations: Private foundations (e.g., Gates, Ford, Open Society Foundations, Wellcome Trust), community foundations, donor advised fund sponsors

• Considerations:

  • Pros: Significant influence on agendas and resource allocation, ability to fund innovation and long-term work, often good working conditions

  • Cons: Limited number of roles, potential for echo chambers/funder bias, responsibility of making impactful allocation decisions, distance from direct implementation

8. Innovation & Entrepreneurship (GovTech/CivicTech/Social Enterprise)

• Creating and scaling new technologies, platforms or organisational models (non-profit or for-profit) specifically designed to address governance challenges like service delivery, citizen engagement, transparency or efficiency

• Organisations: Start-ups, social enterprises focused on governance, innovation hubs/labs (within larger orgs or standalone), accelerators/incubators supporting civic ventures

• Considerations:

  • Pros: High potential for disruptive impact and scalable solutions, direct creation/implementation

  • Cons: High failure rate for start-ups, funding challenges (esp. for non-profit models), navigating complex government procurement/adoption processes, ensuring genuine impact vs. superficial tech solutions

Questions

• Overall Reflection:

  • How central do you believe institutions and governance are to long-term development, compared to factors like aid or technology?

  • Which institutional failure (e.g., low state capacity, corruption, extractive politics) seems like the biggest bottleneck to progress?

  • Has your view on the role of democracy in development shifted?

  • Where do you see the biggest real-world tension between democratic processes (which can be slow or messy) and the desire for decisive action or rapid development? Are there examples where non-democratic systems seem to achieve 'better' development outcomes in some areas, and what are the trade-offs?

• Interventions & Change:

  • How effective do you think international institutions like the IMF/World Bank have been? What is their most constructive role moving forward?

  • Given the difficulty of institutional reform, where should efforts be focused? Building state capacity? Fighting corruption? Promoting democracy?

  • What are the ethical considerations and risks for external actors trying to influence governance in LMICs?

  • What roles in government are likely to be the most impactful?

  • Is it possible to make changes to institutions (from inside or outside)?

  • How much potential is there in non-state approaches like charter cities or strengthening social movements to drive institutional change?

  • Many aspects of good governance are hard to measure directly, unlike health metrics like mortality rates. How important are these intangible factors and how should we factor them into our understanding of development progress or the success of governance reforms?

• Future Impact

  • Thinking about the different careers, which ones seem best positioned to influence long-term, systemic institutional change?

  • What skills or perspectives seem most valuable for someone wanting to contribute effectively to these areas over the next 5 to 10 years?

  • Where do you see the most potential for innovation in improving governance? Is it through technology (GovTech/CivicTech), new models of citizen participation, reforms within international institutions or something else?

  • Which aspect of this week's topics resonate most with you as an area where you'd potentially want to contribute?

• Feedback

  • What key aspects were missing from this overview?

  • What questions did this topic raise that weren't listed?

Further Reading

• Why Nations Fail Summary by Ben Kuhn

• Open Philanthropy - Global Public Health Policy

• CFR

  • What Is the IMF?

  • What Does the World Health Organization Do?

• Yaw

  • The International Monetary Fund's & World Bank's Many "Attempts" to Fix Poverty in Sub-Saharan Africa

  • Book Review - The Problem of Democracy: America, the Middle East and the Rise & Fall of An Idea by Shadi Hamid

In recent decades, global development has seen a shift towards using evidence to inform action. This application has led to the increasing use of methodologies like randomised control trials (RCTs). This shift has generated successes, such as cost-effective interventions to combat infectious diseases, but questions remain about how much evidence can be generalised and how to implement solutions at scale.

Topics

• The Evidence Revolution

  • Science

  • Medicine

  • Randomised Control Trials

    • Critiques of RCTs (and Impact Evaluation)

    • Evolution of the Field

    • Practical Implementation Challenges

• Global Health

  • The Current Global Health Landscape

  • Key Global Health Areas

  • Global Health Spending

• Career Pathways in Global Health

The Evidence Revolution

Science

The pursuit of evidence as a cornerstone of understanding and progress has deep historical roots. The scientific revolution of the 16th and 17th centuries marked a fundamental shift away from reliance on tradition and authority towards systematic observation, experimentation and the formulation of testable hypotheses. It hinged on the earlier invention of the printing press by Johannes Gutenberg in the 15th century. This allowed scholarly works to be more widely read and enabled people to build upon previous knowledge, rather than starting from scratch. This acceleration in knowledge dissemination paved the way for evidence-based thinking.

Key moments:

• 1543 - Copernicus's heliocentric model challenged the long-held geocentric view. This was a shift in perspective, placing the Sun, rather than the Earth, at the center of the solar system and questioning humanity's central place in the universe

• 1610 - Galileo used the newly invented telescope to make astronomical observations, discovering the moons of Jupiter, which provided evidence supporting Copernicus and further undermining the accepted understanding of the cosmos. This demonstrated that celestial bodies could orbit something other than the Earth, weakening the view that everything revolved around our planet

• Francis Bacon emphasised inductive reasoning and careful observation. His ideas about systematic experimentation and collaborative research helped lead to the establishment of the Royal Society of London (after his death), which formalised scientific investigation by providing a platform for sharing findings, replicating experiments and engaging in peer review

• 1687 - Newton formulated the laws of motion and universal gravitation, providing a mathematical framework for explaining a wide range of physical phenomena. They offered a unified explanation for both terrestrial and celestial motion, establishing the foundation for classical physics and enabling future technological advancements

These intellectual transformations laid the groundwork for evidence-based approaches in other domains, including a gradual evolution within academia. While the scientific revolution was driven by individual scientists, scientific societies and wealthy patrons largely outside the traditional university system1, the growing prestige and practical successes eventually spurred universities to incorporate scientific disciplines. Over time, universities increasingly adopted peer review and empirical methodologies as key parts of academic inquiry.

Medicine

Building upon the foundations laid by the Scientific Revolution, the medical field underwent its own transformative period. It saw a shift from relying on traditional remedies and anecdotal observations towards a scientific understanding of disease and treatment. As diseases were increasingly understood through a biological lens with the advent of germ theory, the need for evaluation of medical interventions became increasingly apparent.

• Development of Vaccines: Edward Jenner's work with cowpox vaccination in 1796 demonstrated the possibility of preventing infectious diseases by stimulating the immune system with a weaker version of the disease

• Germ Theory of Disease: The work of Louis Pasteur and Robert Koch established that many diseases are caused by specific microorganisms. This breakthrough revolutionised sanitation practices and laid the foundation for vaccines and antibiotics

• Antiseptic treatments: In 1865 Joseph Lister's application of carbolic acid to sterilise surgical instruments and wounds dramatically reduced infections from operations

• Public Health Interventions: The implementation of clean water systems, improved sanitation, and other public health measures significantly reduced mortality from infectious diseases

  • John Snow is credited as a founder of modern epidemiology for studying the Broad Street cholera outbreak and his hypothesis that germ-contaminated water was the cause, rather than something in the air called ‘miasma’

  • The Metropolis Water Act of 1852 introduced the regulation of the water supply companies in London, including minimum standards of water quality for the first time

The advances in understanding the causes of disease, coupled with a growing emphasis on systematic evaluation of treatments, transformed the practice of medicine.

• In the late 19th and early 20th centuries, statistical methods began to be applied to medical data, allowing researchers to identify correlations and trends

• In the mid-20th century, cohort studies and case-control studies became more widely used, enabling researchers to investigate the relationship between risk factors and disease outcomes

• By the 1980s, the importance of synthesising evidence from multiple studies was increasingly recognised, leading to the development and widespread adoption of meta-analyses and systematic reviews as key components of evidence-based practice

Increasingly, cost-effectiveness analysis (CEA) was adopted to evaluate the relative value of different interventions, informing resource allocation decisions by comparing costs to health outcomes achieved. CEA often uses standardised metrics like Quality-Adjusted Life Years2, Disability-Adjusted Life Years3, and Well-being Adjusted Life Years4 to quantify the health and well-being benefits of interventions, allowing for comparisons across different diseases and programs.

The data needed to perform rigorous CEAs often relies on well-designed studies, and one of the key tools that was developed and used in multiple fields to generate this evidence is the randomised controlled trial (RCT).

Randomised Control Trials

A randomised controlled trial (RCT) is an experiment designed to control for factors outside of direct experimental control. In an RCT, participants are randomly allocated to different treatment groups. This random allocation helps to ensure that the groups are statistically comparable, even for characteristics that researchers haven't identified or cannot directly manage. When well-designed, properly conducted and involving a sufficient number of participants, an RCT can provide a robust comparison of the treatments being studied, mitigating the influence of confounding factors.

• The history of RCTs: scurvy, poets and beer (4 minutes)

  • 1747 - Naval surgeon James Lind compared different treatments for scurvy among six pairs of sailors and he was trying to make sure that the men in the different treatments were as similar as possible5

  • 1884 - Psychology researcher Charles Pierce randomised the order in which subjects received different weights to test their perception of small differences

  • 1920s - The Rothamsted Agricultural Research Station conducted randomised field experiments in agriculture, laying groundwork for statistical analysis in research

  • 1927 Shaffer and other researchers randomly assigned individuals to groups in psychology experiments

  • 1950s - Large-scale RCTs assessed the effectiveness of the polio vaccine, contributing to its widespread adoption

  • 1960s - Heather Ross conducted a field experiment that examined the impacts of negative income tax, representing early use of RCTs in economics

  • 1974 - One of the first development economics experiments investigated teaching mathematics over the radio in primary schools

In 2004 the Center for Global Development convened the Evaluation Gap Working Group. The group was asked to investigate why rigorous impact evaluations of social development programs, whether financed directly by governments or supported by international aid were relatively rare.

3ie - Trends in impact evaluation: Did we ever learn? (3 minutes)

Abhijit V. Banerjee and Esther Duflo's 'Poor Economics' book released in 2011 advocated for an increasingly evidence-based approach to tackling global poverty, challenging grand theories and market-based solutions. The book proposed understanding the decisions and circumstances of the poor through rigorous RCTs and argued that small, well-targeted interventions could lead to significant progress.

Following the growing recognition of a desire for rigorous evidence in global development, a range of influential organisations emerged or shifted their priorities. The Abdul Latif Jameel Poverty Action Lab (J-PAL) spearheaded the movement by focusing on generating research through hundreds of RCTs globally, partnering with implementing organisations to conduct real-world experiments and influencing billions in development spending through its findings.

Funders like USAID and the Gates Foundation, traditionally focused on large-scale interventions, began allocating significant resources to RCTs and other rigorous evaluations.

• Rachel Glennerster - When do innovation and evidence change lives? (5 minutes)

This shift was driven by a desire for greater accountability and a feeling that traditional development approaches had yielded limited or uncertain results.

However, the increased emphasis on RCTs also sparked debates about the limitations of this methodology.

Critiques of RCTs (and impact evaluation generally)

The use of RCTs and broader impact evaluation tools in global development are not without detractors. A range of concerns have been raised, including questions about generalisability, scaling effectiveness, ethical considerations and whether micro-level interventions can address macro development challenges.

Stephanie Wykstra - It’s difficult to test whether poverty relief actually works. Do randomised controlled trials provide a scientific measure? (8 minutes)

Limited Generalisability

• RCT results may not easily translate to different contexts, undermining their broad applicability for policy decisions. For example, from the above article, successful teacher hiring programs in Kenya failed to replicate when implemented with government teachers

• David Roodman - The Smartest RCT Critic

  • Suggests that while RCTs excel at establishing internal validity within a study, the subsequent process of applying those findings externally still requires assumptions about population similarities, mirroring the challenges RCTs aim to overcome internally

• Eva Vivalt - What do 600 papers on 20 types of interventions tell us about how much impact evaluations generalise?

  • Impact evaluations of the same intervention can produce widely different results across contexts, with the typical difference between studies being about 50% of the average effect

The Micro vs. Macro Debate

• While RCTs might demonstrate the effectiveness of interventions like distributing bed nets, they don't address underlying issues such as trade policy, leading to questions about whether RCTs, often focusing on micro-level interventions, address root drivers of poverty compared to broader policy changes

Research Vulnerabilities

• Publication bias and selective reporting can skew the results of even well-designed RCTs

• For example, from the above article by Wykstra, when the US National Heart, Lung and Blood Institute required pre-registration of studies, this dramatically reduced positive results being reported. While this issue affects non-RCTs as well, it demonstrates how scientific processes can undermine methodological rigour

Practical Implementation Challenges

Scaling Challenges

Scaling successful interventions beyond controlled trials introduces more challenges:

• Complexity

  • Scaling interventions beyond pilot programs introduces bigger logistic, management and coordination challenges

• Costs

  • Implementation costs often don't scale linearly, with diseconomies of scale emerging in complex environments. Initial cost-effectiveness calculations from small trials can underestimate large-scale implementation expenses

• Staff motivation and quality

  • Interventions initially implemented by small teams of highly motivated researchers often struggle when scaled through government systems or larger bureaucracies. The attention to detail and problem-solving capabilities present in pilot phases may not translate to larger workforces operating under different incentive structures and varying levels of commitment

• Political economy factors

  • Local power structures can significantly impact implementation. Successful pilots may falter when confronted with bureaucratic resistance, competing priorities or corruption

Research initiatives like the Yale Research Initiative on Innovation and Scale (Y-RISE) are investigating these challenges to understand how to preserve impact while navigating the transition from controlled studies to real-world implementation.

Resource Constraints

RCTs are typically expensive and time-consuming to implement properly, which can limit their feasibility in resource-constrained settings. The high costs of data collection, analysis and monitoring can divert resources from program implementation, raising questions about opportunity costs in development spending.

Methodological Limitations

Hawthorne Effect

Subjects behaving differently simply because they know they're being studied can artificially inflate intervention effects. For example, households that receive regular monitoring visits as part of an RCT may change their behaviour in ways that wouldn't occur in a scaled program without such intensive observation.

Time Horizons

RCTs typically measure short-term effects, but scaled interventions may produce different outcomes over longer timeframes, creating challenges for predicting long-term impact. Many important development outcomes unfold over years or decades, beyond the typical timeframe of an RCT.

This is especially relevant in countries that are changing economically, demographically, culturally in a short amount of time.

Evolution of the Field

While RCTs in development economics face legitimate criticisms, practitioners have evolved their methods to address these critiques.

Tim Ogden - RCTs in Development Economics, Their Critics and Their Evolution

The fundamental disagreements about RCTs stem from different theories of change regarding:

• The value of small vs. big interventions

• Technocratic expertise vs. local knowledge

• The role of individuals vs. institutions in development

Using the ‘Hype Cycle’ framework, Ogden argues that RCTs have matured past inflated expectations and are now in a more productive ‘slope of enlightenment’ phase, with practitioners implementing more sophisticated designs, addressing causal mechanisms, and building institutions to support evidence-based policymaking.

Conclusion

While RCTs have made valuable contributions to development economics and policy, understanding their limitations is critical for appropriate application. The critiques outlined above highlight potential value in methodological pluralism. Rather than relying exclusively on RCTs, the field is moving toward a more nuanced understanding of when they are most useful and how they can be complemented by other research approaches.

Building on this broader understanding of evaluation methodologies, it's useful to examine the progress and ongoing challenges in specific areas of global development. One of the most fundamental of these is global health, where significant strides have been made in improving life expectancy and reducing mortality, but substantial issues persist.

Global Health

Global health is a field focused on improving health for all people worldwide, often with particular focus on improving health outcomes for the world's poorest and most vulnerable populations. There can be challenges that transcend national boundaries and require collective international action but it also covers countries improving their own health systems. This field has been significantly shaped by the evidence revolution, with better measurement and evaluation methods transforming how we understand and address health challenges globally.

Over recent centuries, we've witnessed remarkable progress in health outcomes, with significant increases in life expectancy and reductions in child and maternal mortality. While lower-income countries have made considerable strides, substantial gaps remain, particularly in sub-Saharan Africa, where many still lack access to basic healthcare services.

The Current Global Health Landscape

Understanding the global distribution of disease and mortality offers useful context for seeing how everything fits together.

• Our World in Data - An overview of our research on global health (10 minutes)

Several key trends:

• Declining mortality rates: Child mortality rates have decreased significantly worldwide but remain much higher in low-income countries

  

• Shifting disease burden: Non-communicable diseases like heart disease and diabetes now account for approximately 74% of global deaths

• Persistent issues: Health challenges disproportionately affect certain regions and populations, with the poorest billion people bearing a much higher burden of preventable disease

Global Mortality Trends

The leading causes of death worldwide have evolved significantly between 1990 and 2021. While communicable diseases remain prominent in low-income settings, non-communicable diseases now dominate global mortality statistics. More recently, the COVID-19 pandemic has further altered this landscape.

Health Outcome Disparities

Despite progress, the burden of disease is not evenly distributed:

• Communicable diseases continue to disproportionately affect the poorest populations

• Life expectancy in low-income countries remains significantly lower than in high-income countries

• Within countries, the poorest and most vulnerable often face the greatest health challenges

Key Global Health Areas

Global health efforts are typically organised into areas addressing specific categories of disease and their influencing factors. The following represent major domains in contemporary global health practice:

• Non-communicable Diseases

  • NCDs, including cardiovascular disease, diabetes, cancer and chronic respiratory conditions, now account for the majority of global deaths (around 74% in 2019)

  • Their prevalence is rapidly increasing in lower-middle income countries (LMICs) where healthcare systems are often less equipped to manage chronic conditions

• Infectious Diseases/Communicable Disease

  • Major persistent epidemics (HIV/AIDS, malaria, tuberculosis)

  • Emerging threats (Ebola, COVID-19, "Disease X"6)

  • Antimicrobial resistance

  • Neglected tropical diseases affecting billions worldwide cumulatively

• Water, Sanitation, and Hygiene (WASH)

  • Approximately 2 billion people globally lack access to safely managed drinking water, while 3.6 billion lack adequate sanitation. These deficiencies contribute to diarrhoeal diseases that:

    • Cause ~830,000 deaths annually

    • Remain the second leading cause of death in children under five years

• Maternal, Newborn, and Child Health (MNCH)

  • This area addresses pregnancy-related health needs, childhood illnesses and nutrition affecting ~130 million births annually worldwide. Despite improvements, each year:

    • Approximately 295,000 women die during pregnancy and childbirth

    • Around 5 million children die under the age of 5

• Nutrition and Food Security

  • Global nutrition challenges present in multiple forms:

    • Approximately 828 million people faced hunger in 2021

    • An estimated 149 million children under five suffer from stunting and 45 million from wasting

    • Over 2 billion adults are overweight or obese, highlighting the "double burden" of malnutrition globally

• Mental Health and Substance Use

  • Mental health represents a growing global health priority:

    • In 2019, an estimated 970 million people worldwide were living with a mental disorder, with depression and anxiety as the top two diagnosed conditions

    • Mental health conditions account for approximately 14% of the global burden of disease

    • Suicide claims nearly 800,000 lives annually

    • Significant challenges persist in accurate diagnosis, with large variation between countries

• Health Systems

  • Health systems comprise the infrastructure, workforce, financing, innovation and governance that underpin health interventions. Systems worldwide vary greatly in their structures. Most health systems include:

    • Primary healthcare and public health measures: The foundation of most effective health systems

    • Varying governance structures: Some systems are decentralised with multiple stakeholders, while others are centrally coordinated

    • Multiple actors: Including government entities, private providers, charitable foundations, religious institutions and professional medical associations

    The strength and design of health systems significantly impact a country's ability to deliver effective interventions and respond to health challenges

• Environmental Health

  • Environmental factors significantly impact global health:

    • Air pollution is associated with approximately 7 million premature deaths annually

    • Over 90% of the world's population breathes air that exceeds WHO guideline limits

    • Chemical exposures, unsafe water, and climate change impacts contribute significantly to global disease burden

    • Lead pollution contributes to 1% of the global disease burden

• Injury Prevention and Trauma Care

  • Injuries represent a substantial but often overlooked health challenge:

    • 4.4 million lives were lost due to injury in 2019 (8% of all deaths)

    • Road traffic accidents (1.3 million deaths), violence, falls and burns result in millions of fatalities and injuries annually

    • Injuries are the leading cause of death for people aged 5-29 years worldwide

    • 93% of fatal road traffic injuries occur in LMICs

• Sexual and Reproductive Health

  • This domain encompasses family planning, STI prevention/treatment and sexual health services:

    • Approximately 218 million women have an unmet need for modern contraception

    • Over 38 million people live with HIV globally

    • An estimated 357 million new cases of four curable STIs occur annually

There are many more areas, sub-fields and cross-cutting topics related to global health, but the above are some of the main fields. They highlight the wide range of challenges and possible interventions. Beyond identifying these areas, many practitioners and researchers also examine the effectiveness of different approaches. Understanding what works, and to what degree, can inform decisions about prioritising actions and allocating resources.

Why focus on effectiveness in global health?

Why might practitioners and researchers pay attention to the effectiveness of different interventions? In a world with limited resources for addressing numerous health challenges, understanding which approaches deliver the best outcomes can be valuable. This consideration becomes particularly relevant in resource-constrained settings where healthcare budgets must stretch to cover many competing priorities.

Toby Ord - The Moral Imperative toward Cost-Effectiveness in Global Health (10 minutes)

• The difference between the most and least effective health interventions can be massive, for example, within HIV/AIDS interventions, the least effective intervention produces less than 0.1% of the value of the most effective

• Historical examples like smallpox eradication (costing approximately $15 per life saved while also saving billions in healthcare costs) demonstrate the dramatic variance in intervention outcomes

Limitations and Complexities of Effectiveness Analysis

While examining effectiveness can be informative, it has limitations. The PEPFAR case study (President's Emergency Plan for AIDS Relief) provides an instructive example.

Justin Sandefur - PEPFAR and the Costs of Cost-Benefit Analysis (5 minutes)

• Initially, some economic analyses suggested prevention would be more cost-effective than treatment for HIV/AIDS

• However, PEPFAR ultimately saved millions of lives as drug prices fell dramatically from $100,000 to $300 per patient annually

• The economists' initial assessments missed two key factors: the potential for rapid price reductions through generic production and the possibility that new funding could expand the total resources available rather than simply redirecting existing budgets

Global Health Spending

Understanding how health systems are financed is fundamental to addressing global health challenges. The allocation of financial resources for health, directly impacts who can access healthcare, which services are available and the health outcomes of populations.

Knowledge of global health financing context can help us make more informed decisions when choosing careers, directing donations or advocating for policy changes.

Total global spending on health reached $9.8 trillion in 2022 (about 10% of global GDP), more than doubling from $4.5 trillion in 2000. Health spending is made up of government expenditure, out-of-pocket payments (people paying for their own care), and sources such as voluntary health insurance, employer-provided health programs and activities by NGOs.

• High-income countries account for 79% of health spending (US alone is 43%)

• Domestic public spending accounts for 62%, while private spending represents 37.6% ($3.7 trillion)

• External aid constitutes 0.3% ($27.8 billion) of global health expenditure, although this can be a larger proportion of spending in the poorest countries

• Our World in Data - Healthcare Spending (10 minutes)

  • A comprehensive overview of global healthcare financing trends

Relationship Between Spending and Health Outcomes

Healthcare spending per capita shows a positive correlation with life expectancy, though with diminishing returns as spending increases. This relationship is particularly evident when comparing countries across income groups:

• Low-income countries typically see significant gains in life expectancy with relatively modest increases in healthcare spending ($43 per capita)

• Middle-income countries experience continued improvements but at a decreasing rate per additional dollar spent ($132-$540 per capita)

• High-income countries show minimal marginal improvements despite substantially higher spending ($3,731 per capita)

This pattern suggests that initial investments in healthcare systems yield the greatest returns, particularly for basic interventions like vaccinations, maternal care and infectious disease control.

National Income and Health Investment

National income remains the strongest predictor of healthcare spending. This relationship is causal rather than merely correlational, as countries become wealthier, they allocate more resources to health through both public and private channels.

Sources of Healthcare Funding

Domestic vs External Funding

Healthcare systems are primarily funded through domestic sources (government and private sector (out of pocket spending)). However, the dependency on external donor funding varies significantly by economic development. This creates particular vulnerability for low-income countries, whose health systems may experience disruption when donor priorities shift.

Development Assistance

Since the establishment of the Millennium Development Goals in 2000, development assistance for health has increased significantly, especially for targeted areas like child mortality, maternal health, malaria and tuberculosis

Between 2000 and 2019, the share of health spending channelled through government schemes (mainly health budgets) and compulsory health insurance (mainly social health insurance) increased steadily except in low-income countries where it remained mostly unchanged.

• In the poorest countries (GDP per capita below $500), donor funding constitutes ~45% of health expenditure

• As countries develop economically, this external reliance steadily declines: to 34% for those with GDP per capita up to $1000

• Below 25% for nations up to $3000

• Once countries exceed $3000 GDP per capita, external health funding typically represents less than 5% of total health expenditure

  

Health Financing Mechanisms

Healthcare financing comes through several key sources including public, private, out-of-pocket spending (OOPS) and external aid.

• Public Financing

  • Government financing through general taxation or specific health taxes is the main funding for most healthcare systems. Countries with higher tax-to-GDP ratios generally achieve better health coverage with lower out-of-pocket expenses

• Health Insurance

  • Health insurance mechanisms spread financial risk across populations, but differ in how they're funded, who's covered and who manages them.

    • Government expenditure (tax-funded systems): Funded through general taxation, covers all citizens regardless of contribution, and is directly managed by government. Examples include the UK's NHS and Canada's Medicare

    • Social Health Insurance (SHI): Typically mandatory, funded through dedicated payroll contributions (not general taxes), managed by quasi-public agencies or funds and traditionally linked to employment status. Examples include Germany's sickness funds and Japan's system. The number of countries with SHI schemes has risen significantly, particularly among middle-income countries

    • Private Health Insurance (PHI): Private health insurance exists in most countries but varies greatly in its role and market share.

      • Supplementary: Covers services beyond public provision (France, Canada, Australia)

      • Duplicate: Offers faster access or provider choice alongside public systems (UK, Spain, Australia)

      • Primary: Serves as main coverage for certain populations, sometimes being mandatory for all citizens (US, Switzerland, Netherlands)

• Out-of-Pocket Expenditure

  • Direct payment at the point of service remains a significant financing mechanism in many low and middle-income countries. High out-of-pocket spending is associated with:

    • Catastrophic health expenditure (defined as spending >10% of household income on health)

    • Delayed or foregone care

  • The WHO estimates that approximately 930 million people globally spend at least 10% of their household budget on healthcare.

  • While the number of countries with out-of-pocket spending (OOPS) as the main health financing mechanism has declined since 2000, it remained the main financing scheme in 30 low and LMICs as of 2022. In 20 of these countries, OOPS accounted for more than half of total health spending.

Innovative Financing

As traditional funding sources face constraints, new financing mechanisms are increasingly being suggested.

• Sin taxes on tobacco, alcohol and sugar-sweetened beverages, which both generate revenue and reduce consumption of harmful products

• Impact bonds that link investor returns to measurable health outcomes

• Blended finance mechanisms combining public, philanthropic and private capital

• Debt swaps for health, where external debt is forgiven in exchange for domestic health investments

The Future of Healthcare Financing

• Ageing populations globally will drive increased healthcare costs for non-communicable diseases and changing dependency ratios affecting social insurance mechanisms

• New health technologies present potential cost savings through telemedicine and digital health but also increased pressure to finance more expensive newer treatments and diagnostics

• New technologies in general could lead to faster economic growth, safer workplaces, cleaner energy, safer roads, etc leading to lower health demands

• Changing climates could impact temperature related deaths, crop success and migration, impacting health systems

• Changes in foreign aid could impact what does and doesn’t get funded in lower income countries and lead to shifting prioritisation by governments

Careers in Global Health: Making an Evidence-Based Impact

For those interested in improving global health outcomes, several career pathways offer opportunities to make a meaningful impact. However, not all paths will be equally impactful (even with a specific field or a specific organisation there is wide variation in the amount of change you can make). To make the biggest difference, it's crucial to think strategically about where your skills and interests can best be leveraged to address these problems.

Multilateral & Intergovernmental Organisations

These organisations set global health norms, coordinate international responses and provide technical guidance. They usually offer more stable careers with wide-reaching influence, though bureaucratic constraints can limit agility.

Organisations:

• World Health Organisation (WHO)

• United Nations agencies (UNICEF, UNFPA, UNAIDS)

• Global funds (Global Fund to Fight AIDS, TB and Malaria, GAVI)

• World Bank and regional development banks

Key Roles:

• Policy advisor/Technical specialist: Shapes global health policies and provides subject-matter expertise

• Epidemiologist/Biostatistician: Analyses disease patterns and study designs to inform response strategies

• Health economist: Evaluates cost-effectiveness of interventions and advises on resource allocation

• Programme coordinator/manager: Manages implementation of health initiatives across multiple countries

Government & Civil Service

Government institutions direct health system governance and service delivery within countries. The promise of influencing health systems at a national or international level is a major draw. Success here relies on navigating significant political constraints. It often requires exceptional advocacy and communication skills to navigate the landscape, as well as building strong networks to effectively advocate for evidence-based policies. Their is job insecurity inherent in politically sensitive roles, with a high chance of being out of power for several years at a time, vs having less power but more constant access as a civil servant/policy advocate.

Organisations:

• Ministry/Department of Health

• Public health institutes

• Local/municipal health departments

• Foreign affairs departments

• Aid departments (for richer countries)

Key Roles:

• Civil Service - Probably Good on Civil Service Careers in LMICs

• Political roles: Directly shapes health legislation and budget allocation, though success relies on navigating significant political constraints

• Policy advisor, programme director

Clinical & public health practice

The frontline workforce delivering healthcare services and public health interventions. While clinical roles are abundant globally, there's significant maldistribution, with shortages in rural and low-income settings, particularly for specialists. A higher change of seeing direct patient impact and more meaningful work but potentially limited systemic impact. To address this, you could focus on areas with the greatest unmet need and roles that allow you to mentor other healthcare professionals, or eventually move into health policy, amplifying your impact.

• Global health clinician: physician, nurse, allied health professional

• Community health coordinator, health education lead

• Specialists in: disease control, nutrition, child health, mental health, etc

Non-Governmental Organisations

NGOs implement programmes and advocate for change. They offer a range of entry points but often face funding instability and variable career progression paths as well a wide variation in impact even if they are successful in their aims.

Organisations:

• International NGOs (MSF, Partners in Health, PATH)

• Disease-specific organisations

• Community/Regional-based organisations, advocacy groups

Key Roles:

• Programme manager/Field coordinator: Oversees implementation of health interventions, balancing evidence-based approaches with adaptation to local contexts

• Technical advisor, monitoring & evaluation specialist, fundraising, communications

Research & Academic Institutions

These institutions generate and synthesise evidence to inform policy and practice. Academic careers are often highly competitive for entry and advancement but provide opportunities for specialised expertise development.

The strength lies in potential through rigorous research and data analysis. However it relies on others translating research into action. To mitigate this, prioritise focusing on research areas with high potential for scalable impact (e.g., cost-effectiveness of interventions, implementation science, evidence synthesis). Actively seek opportunities to collaborate with policymakers to ensure findings are translated into real-world policies.

Organisations:

• Universities

• Teaching hospitals

• Research institutes

• Public health schools

• Policy think tanks, evidence synthesis organisations

Philanthropy & Funding Organisations

These entities set priorities through resource allocation decisions. Though smaller in number, these roles have outsized influence on the field's direction, usually with good working conditions but limited entry points.

Organisations:

• Private foundations (Gates Foundation, Wellcome Trust)

• Corporate foundations

• Donor advised funds

• Venture philanthropy organisations

Key Roles:

• Grantmaker/Program officer: Evaluates proposals and makes funding decisions that shape global health priorities

• Impact investment analyst, Strategic advisor

• Operations roles

Private Sector

The private sector develops products, technologies and services that address health needs. There's increasing engagement in global health with diverse entry points and often stronger resources than public/non-profit sectors.

Organisations:

• Pharmaceutical & medical technology companies

• Digital health companies, health consulting firms, analytics

• Impact investors

• Sanitation and clean water technology providers

Innovation & Entrepreneurship

This cross-cutting category spans multiple sectors, driving new technologies and approaches to overcome global health challenges. It's an area with high potential for disruptive solutions, though with higher failure rates balanced by potentially outsized impact.

Organisations:

• Start-ups

• Innovation labs

• Incubators and accelerators

• Social enterprises

Key Roles:

• Entrepreneur (Social/Charity): Develops innovative business models or non-profit organisations addressing health gaps.

• Innovation lab director/Incubator manager: Creates environments where novel health solutions can be developed and tested.

The global health field offers numerous pathways to create meaningful impact. The most effective route will depend on your combination of skills, interests and values. Consider where you can leverage your strengths to address critical gaps, and be strategic about building expertise in high-leverage areas.

Resources for Global Health Careers

• Probably Good - Global Health & Development: An Impact-Focused Overview

  • A good summary including career, donation resources and a job board

    • Career profiles on development economics, nonprofit entrepreneurship and Civil Service in LMICs

    • Personal advising service

• 80,000 Hours - Global Health

  • Summary including updated job board just for GH&D

• MIT MicroMaster programs in data, economics, and design of policy

• JPALs online courses on impact evaluation

• The Global Health Network Training Centre - offers extensive catalogue of resources from courses to toolkits, covering a wide range of health research topics

• University of Aberdeen - Randomised Controlled Trials online short course at Masters level, teaching how to design and implement RCTs from start to finish

• Cochrane - global independent network providing evidence through systematic reviews

• VoxDev - features research on global poverty, development economics, and evidence-based interventions

• CSIS Global Health Policy Center

• EA Forum Global Health & Development section - discusses effective altruism approaches to development

• High Impact Medicine - Impactful medical careers

• Innovation for Poverty Action

• Center for Global Development

• 3ie - International Initiative for Impact Evaluation

• GiveWell

• World Health Organization - UN specialised agency that sets international health standards, provides technical assistance to countries and collects global health data

• Coalition for Epidemic Preparedness Innovations - Foundation that finances independent research projects to develop vaccines against emerging infectious diseases, focused on WHO's blueprint priority diseases

• Ambitious Impact - Provides people with training, research and funding to tackle the world's biggest problems through a variety of programs - charity entrepreneurship, founding for good, research, foundation

• GAVI - The vaccine alliance

• The Global Fund - Invests more than $5 billion a year to defeat HIV, TB and malaria

• Global Innovation Fund

• Foundations

  • Gates ~$8-9 billion per year, now aiming to spend down by 2045, which would suggest yearly spending of ~$10 billion

  • Novo Nordisk ~ $160+ billion in total funds

  • Wellcome Trust ~$1.6 billion per year

  • Open Philanthropy

  • Mulago

  • Rockefeller

  • Bloomberg

  • Mastercard

  • Azim Premji

  • Skoll

  • Chan Zuckerberg Initiative

Questions for Week 2

Feel free to come up with your own questions or take 1 or 2 from each section when reflecting on the material from this week.

1. Overall Reflection

   1. What surprised you most about the evolution of evidence-based approaches in global health and development?

   2. Which examples from the module challenge your previous assumptions about how we should evaluate and implement interventions?

   3. What do you see as the most significant contributions of the "evidence revolution" to global health?

   4. What important perspectives or approaches to evidence generation do you think are missing from current practice (or from this post)?

   5. How have your views on evidence, and global health changed since you first heard about these concepts? (which could be years ago, at least 20 in my case)

   6. Have you ever strongly believed in an approach that later evidence proved ineffective? How did that change your thinking?

2. Evidence Quality and Methods

   1. Which forms of evidence do you find most compelling, and why?

   2. How do we balance the desire for evidence with the need for action?

   3. What role, if any, should local knowledge play alongside formal evaluation methods?

   4. What blindspots may exist in current evidence-based approaches?

   5. To what extent can subjective experiences be integrated into evidence-based frameworks?

   6. Would you rather have perfect evidence about a moderately effective intervention or limited evidence about a potentially revolutionary one?

   7. Is it worse to implement an intervention without evidence or to withhold a promising intervention while waiting for more evidence?

   8. How should we weigh evidence-based interventions that benefit current generations versus future ones?

      1. How might different discount rates alter priorities in global health decisions?

3. Prioritisation and Resource Allocation

   1. How can we account for interventions whose benefits are difficult to quantify?

   2. How should we weigh measurable impacts against potential long-term, systemic changes?

   3. If you were allocating a limited health budget, what evidence would you find most persuasive?

   4. What role should governments, NGOs and the private sector play in scaling proven interventions?

   5. How do power dynamics influence what gets researched and implemented in global development?

   6. What areas in global development are currently underfunded relative to their potential impact?

   7. How do geopolitical interests shape global health priorities and evidence generation?

   8. When is it justified to implement interventions without robust evidence?

4. Future Impact

   1. Which areas of global health do you think will be most neglected in 5/10 years time?

   2. How might new technologies change our ability to measure impact?

   3. What boundaries should guide AI applications in global health, and how do they trade off against providing benefits?

   4. How should we evaluate interventions with positive health outcomes but negative environmental impacts?

5. Careers

   1. What skills or knowledge areas seem most valuable for someone wanting to contribute effectively to global health over the next 10/20 years?

   2. Which of the careers described above appeal to you most, if any, and why?

   3. What skills and/or experience should you personally develop if you wanted to contribute to this area?

6. Feedback

   1. What would you say is missing from this week's content?

   2. What questions are missing from this list?

   3. What further readings, videos or resources would you add?

Further Reading

• Why Hasn’t the World Eradicated Polio?

• VoxDev - The future of evidence-based policymaking and international development

• Global Health Economics Hub - a community of international health researchers working to support health economics research capability and its use within policy in lower-income settings

• 80,000 Hours Podcast - Eva Vivalt’s research suggests social science findings don’t generalize. So evidence-based development – what is it good for?

• Angus Deaton & Nancy Cartwright - Understanding and misunderstanding randomized controlled trials

• Lant Pritchett & Justin Sandefur - Context Matters for Size: Why External Validity Claims and Development Practice Don't Mix

• Mary Ann Bates & Rachel Glennerster - The Generalizability Puzzle - Rigorous impact evaluations tell us a lot about the world, not just the particular contexts in which they are conducted.