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In India, eliminating tuberculosis isn't just a health issue — it's an economic one

Jorge Coarasa's picture

On February 1st, India’s finance minister presented the Union Budget for 2017-2018, and announced the government’s plan to eliminate tuberculosis (TB) by 2025. This is a welcome move. While ridding people of the burden of any disease is a worthy goal by itself, TB elimination provides perhaps one of the strongest cases for public intervention from an economic point of view.

All communicable diseases present what economists call externalities: infectious people can infect other people who in turn infect others and so on. In fact, economist Phillip Musgrove used TB in particular to illustrate this: “no victim of tuberculosis is likely to ignore the disease, so there is no problem of people undervaluing the private benefits of treatment. Rather, the cost of treatment--and the fact that they may feel better even though the disease has not been cured-- may lead people to abandon treatment prematurely, with bad consequences not only for themselves but for others. The rest of society therefore has an interest in treating those with tuberculosis, and assuming at least part of the cost.” Reducing TB incidence could generate benefits of $33 per dollar spent, prompting The Economist to put TB among their list of ‘no-brainers’. According to the Stop TB Partnership, ending TB globally could yield US$ 1.2 trillion overall economic return on investment.

Youth Voices: Effects of The Spaghetti Bowl on South Asia-East Asia Trade Relations

Osama Sajid's picture

As part of the organizing team for the South Asian Economics Student’s Meet (SAESM’13) in Lahore, Pakistan, I already had an overview of what it was like to be part of the SAESM family. The idea behind the first annual conference in 2003 was to provide a platform for the South Asian undergraduate students of economics to interact with each other, exchange ideas, and discuss economic issues in an out of class environment. Participants either write a research paper and present it, or take part in a multiple round competition to contest for the honor of being The Budding Economist of South Asia. In addition, SAESM gives an opportunity to establish cross border friendships and create memories that last a life time. So as soon as the applications for SAESM’14 (Bhutan) opened, I applied to be a part of the Pakistani delegation, and was selected after an academically challenging interview.

I decided to write my research paper on the sub-theme ‘South Asia in Global Perspective’. A lot of hard work, with numerous nights skimming relevant papers, articles and publications led me to narrow down the topic to ‘Impact evaluation of Spaghetti Bowl Effect on South Asia-East Asia trade relations’.

A Bird's Eye View Into the Mahatma Gandhi National Rural Employment Guarantee Act

Rumela Ghosh's picture

World Bank / Curt Carnemark
The 10th South Asian Economics Students Meet (SAESM) was held in Lahore, Pakistan, bringing together 82 top economics undergraduate students from the region. The theme was the Political Economy of South Asia, with a winning paper selected for each of the six sub-themes. In this post, Rumela Ghosh presents her winning paper on the political economy of social security. Posts from the other winning authors will follow over the next few weeks.

Employment is one of the burning problems affecting South Asia. India now has a diminished growth rate below 6% per year. In recent years although the living standards of the 'middle classes' have improved, reform for underprivileged groups has not been so exciting. According to National Service Scheme (NSS) data the average per capita expenditure rose at the exceedingly low rate of 1% per year in India. There has been a sharp decline in real agricultural wages also. A quantitative assessment of the impact of various rural wage employment schemes during the last two five-year plans and the current one shows that the results in terms of employment generated have been steadily decreasing.
My paper looked at schemes to tackle unemployment in India. A Bird's Eye View into Mahatma Gandhi National Rural Employment Guarantee Act firstly examines the Maharashtra Employment Guarantee Scheme (MEGS) introduced in the 1970s. It examines how at different time frames and contexts the elite managed to maintain their support base and reinforced its legitimacy by supporting a poverty alleviation program – the EGS. It also highlights the issue of gender concern and the problem of migrant workers.
Among various EGS, the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) is the flagship program implemented at the national level which achieved measurable success, though with some flaws. It guarantees every rural household up to 100 days of wage employment in a year within 15 days of demand for such employment. My study highlights the significant interstate differences in the supply of employment and tries to explore the reasons why. Supply falls far short of demand, particularly in low-income states, where the organizational capacity to implement the scheme is limited.

The paper examines the conceptual design and delivery of MGNREGA to assess its effectiveness against unemployment and poverty. I discuss existing labor laws applicable to workers in the unorganized sector covering wages, contract and poverty incidence. The paper also seeks to derive the short run and long run implications of a minimum wage law. A detailed empirical analysis of the spatial dimension of implementation, problems of funding, and budgetary incidence of MGNREGA.
A comparative study of MGNREGA scheme as implemented in Tamil Nadu where it is largely fair and corruption free with respect to that in Uttar Pradesh where the implementation has some serious flaws with corrupt practices of local officials paying wage payments to non-existing laborers has been illustrated. It studies the differences in utilization, extent of targeting, magnitude of income transfers and the cost-effectiveness of food subsidies.

I designed a game-theoretic model to design a near-perfect scheme with suggestions to eliminate the loop holes. Various falsified implementation strategies by contractors like fictitious names in muster rolls, commission to the contractor for partially/not working laborers has undermined the objectives of MGNREGA. This illegal money laundering from a subsidized scheme like MGNREGA digs a deep hole in India's economic pocket when the economy is reeling under inflation and rupee value depreciation pains. The model attempts a systematic game theory based solution approach for restricting these scheme implementation faults. A graphical presentation shows that, with such a policy laborers in the long run will have an incentive to deliver under MGNREGA only.

Inclusion is No Illusion

Zahid Hussain's picture

The World Bank’s recent report Bangladesh: Towards Accelerated, Inclusive and Sustainable Growth—Opportunities and Challenges examines inclusiveness along three dimensions—poverty, inequality, and the distribution of economic opportunities. The findings are summarized in this post.

Economic growth in the last two decades in Bangladesh has been pro-poor. Poverty declined significantly from 58.8 percent in 1991/92 to 31.5 percent in 2010. Bangladesh succeeded in “bending the arc of poverty reduction” in the decade ending 2010, a period in which the number of poor declined by around 15 million, compared with a decline of about 2.3 million in the preceding decade. There has also been regional convergence in poverty patterns during 2005-10. Poverty reduction in the lagging Western divisions (Rajshahi, Khulna, and Barisal) was larger than in the Eastern divisions. A number of other indicators of welfare also show notable improvements between 2000 and 2010 for the general population and the poor alike.

Income distribution stabilized after deteriorating in the 1990s. While comparisons based on consumption data have been used to argue that inequality in Bangladesh is low by international standards, when income rather than HIES consumption data are used, inequality appears to be much higher. The degree of income inequality was reasonably low and stable compared to countries such as Malaysia, Thailand and Philippines during the 1970s and 1980s. But there was a sharp increase between 1991-92 and 1995-96. Gini consumption concentration ratios based on HIES 2000, 2005, and 2010 data were almost unchanged while Gini income concentration ratios increased by 3.5 percent during 2000-05 followed by 1.9 percent decrease during 2005-10. The good news is it has been a race to the top in the past decade with consumption growing for the poor and non-poor alike. However, income inequality in Bangladesh is relatively high. Among Bangladesh’s peer group of countries only Sri Lanka has a higher income Gini and Cambodia is close.

Bangladesh: The Next China?

Zahid Hussain's picture

This is the sixth and last in a series of posts about the recent report, Bangladesh: Towards Accelerated, Inclusive and Sustainable Growth. The previous post looked at what sort of policies it will take to achieve the goal of middle income status by 2021.

Bangladesh, one of Asia’s youngest countries, is poised to exploit the long-awaited “demographic dividend” with a higher share of working-age population. Labor is Bangladesh’s strongest source of comparative advantage, and Bangladesh’s abundant and growing labor force is currently underutilized. Absorbing the growing labor force and utilizing better the existing stock of underemployed people requires expansion of labor-intensive activities. And that means expanding exports, as domestic consumption offers limited opportunities for specializing in labor-intensive production.

What are the potentials for expanding exports? Bangladesh’s competitors are becoming expensive places in which to do business. In the next three to four years, China’s exports of labor-intensive manufactured goods are projected to decline. It will no longer have one-third of the world market in garments, textiles, shoes, furniture, toys, electrical goods, car parts, plastic, and kitchen wares. Capturing just 1% of China’s manufacturing export markets would almost double Bangladesh’s manufactured exports.

What will it take for Bangladesh to become a Middle Income Country?

Zahid Hussain's picture

This is the fifth in a series of six posts about the recent report, Bangladesh: Towards Accelerated, Inclusive and Sustainable Growth. The previous post looked at the numbers behind Bangladesh’s goal of middle income status by 2021. The next and last post will look at the way forward.

For Bangladesh, achieving its goal of middle income status by 2021 will require more than business-as-usual: the average annual GDP growth rate will have to rise from the current 6 percent to 7.5-8 percent, while sustaining remittance growth at 8 plus percent. Faster growth in turn will depend on four main factors: (i) increased investment, (ii) faster human capital accumulation, (iii) enhanced productivity growth, and (iv) increased outward orientation.

Increase investment by at least 5 percentage points of GDP. Investment is constrained by infrastructure, business environment, land, and skills. Analysis based on Investment Climate Assessment surveys highlights the role of infrastructure in triggering a virtuous cycle of growth: better infrastructure will improve productivity which in turn will make exports more competitive and attract FDI, thus leading to further increase in productivity. Expanded provision of infrastructure has to come with easing difficulties in doing business, increasing access to serviced land, and meeting skill shortages.

Build on achievements in human capital formation. Bangladesh has done well in increasing the stock of human capital, topping the list of Asian countries along with Vietnam by improving average years of schooling by 1.3 during 2000-10. Our analysis indicates that achieving the needed GDP growth rate will require further increases from the current 5.8 to 7.3 average years of schooling. In addition, relatively low returns to schooling point to the importance of improving quality of education. These will require addressing external and internal inefficiency as well as weaknesses in education management and finance.

The Numbers Behind Bangladesh’s Goal of Middle Income Status by 2021

Zahid Hussain's picture

This is the fourth in a series of six posts about the recent report, Bangladesh: Towards Accelerated, Inclusive and Sustainable Growth. The last post, Be Happy Yet Do Worry: Explaining Resilience in Bangladesh's Economy, explained how the economy has withstood recent shocks. The next post will look at what sort of policies it will take to achieve the goal of middle income status by 2021.

Bangladesh’s economic growth has followed a path both theory and international experience would expect. Starting from a low income level, growth initially tends to accelerate through capital accumulation in a market economy. This is what happened in Bangladesh during the four decades since independence in 1971. A recent article in The Economist rightly said, “Bangladesh has become a model of what can be done”. Progress achieved so far provides a credible basis for aspiring to be a middle income nation by 2021, as observed in the World Bank’s recent report “Bangladesh: Towards Accelerated, Inclusive and Sustainable Growth—Opportunities and Challenges”.

Would it take more than just maintaining recent growth rates to achieve middle-income country (MIC) status? It is important to be clear about how middle-income status is defined. It is based on nominal Gross National Income (GNI) measured in Atlas dollars, not real Gross Domestic Product (GDP). Economies are divided according to 2012 GNI per capita, calculated using the World Bank Atlas method. The income thresholds are: low income—$1,025 or less; lower middle income—$1,026 to $4035; upper middle income—$4036 to $12,475; and high income—$12,476 or more.

At current prices, Bangladesh’s per capita GNI would have to exceed US$1,025 to reach the lower end of “low middle income” status. Nominal Atlas GNI per capita, currently $851, will need to grow at a sustained 2.1% and nominal Atlas total GDP will need to grow at 3.5% per annum from now onwards for Bangladesh to reach the middle-income threshold by 2021, when Bangladesh will celebrate its 50th year of independence.

Be Happy Yet Do Worry: Explaining Resilience in Bangladesh's Economy

Zahid Hussain's picture

This is the third in a series of six posts about the recent report, Bangladesh: Towards Accelerated, Inclusive and Sustainable Growth. The last post, The Paradox That Bangladesh Isn’t, explained the sources of GDP growth over the past two decades. Next week's post will look at how the country can achieve its goal of middle income status by 2021.

The World Bank’s report “Bangladesh: Towards Accelerated, Inclusive and Sustainable Growth—Opportunities and Challenges” observes that growth in Bangladesh has been resilient at above 6 percent in recent years, despite several external shocks that slowed exports, remittance and investment growth. Since 2006, Bangladesh has faced political uncertainty (2006-2007); two major floods, the disastrous cyclone Sidr, and Avian Flu (last half of 2007); food and energy price crises (first half of 2008); global financial meltdown and recession (2008-2009); political transition followed by mutiny (first half of 2009); and rapid deterioration of the power and gas supply situation (first half of 2010). Currently, it is braving the impact of Euro area crisis and internal uncertainties surrounding the expected political transition in early 2014. These exogenous shocks resulted in a decline in the efficiency of investment, but the private investment rate itself managed to grow at a rate faster than the growth of GDP while the public investment rate declined. The economy has demonstrated resilience time and again.

The Paradox That Bangladesh Isn’t

Zahid Hussain's picture

This is the second in a series of six posts about the recent report, “Bangladesh: Towards Accelerated, Inclusive and Sustainable Growth”. The first post was Better Jobs Can Outweigh a Secure Life. Next week’s post will look at how Bangladesh’s economy has remained resilient despite global and local shocks over the past few years.

Bangladesh lacks natural resources and good governance. It is beset by natural calamities. Corruption and self-destructive political non-cooperation are common. Yet Bangladesh’s GNI per capita more than tripled in the past two-and-a-half decades, from an average of US$251 in the 1980s to US$851 by 2012. This growth was accompanied by impressive progress in human development. Growth in GNI came almost entirely from growth in GDP in the 1980s and 1990s, but this changed in the last decade due to a surge in remittances from Bangladeshi workers abroad. GDP growth has accelerated by a percentage point and per capita GDP growth has accelerated by 1.7 percentage points in each of the last four decades. A recently published World Bank report, “Bangladesh: Towards Accelerated, Inclusive and Sustainable Growth—Opportunities and Challenges” explains how Bangladesh managed to beat the odds.

Where did GDP growth come from? 

Join us to Discuss Bangladesh's Economic Prospects!

Naomi Ahmad's picture

We've launched a two-day online discussion on Bangladesh's Economic Growth at the World Bank Bangladesh Facebook page. Through the online discussion, we hope to initiate dialogue with you on Bangladesh's economy, the possibilities and the binding constraints for its continued growth.

Our economists will answer your questions and moderate the discussion. We encourage you to share your thoughts or ask questions on these pertinent issues and are looking forward to hosting more discussions on different themes.

Join us, leave comments, and invite your friends!

What? Bangladesh's Economic Growth: How can Bangladesh can embark on its journey towards higher growth?

When? August 25 and 26, 2011

Where? World Bank Bangladesh on Facebook

Let us know what you think!