Middle income countries

This study discusses fertility trends and variation in countries that completed the transition from high to around-replacement fertility in the 1950s to 1980s, especially in Europe, East Asia and North America, and
summarizes the key relevant findings for those countries with a more recent experience of fertility decline towards replacement level. A central finding
is that there is no obvious theoretical or empirical threshold around which period fertility tends to stabilize. Period fertility rates usually continue falling once the threshold of replacement fertility is crossed, often to very low levels.
While cohort fertility rates frequently stabilize or change gradually, period fertility typically remains unstable. This instability also includes marked upturns and reversals in Total Fertility Rates (TFRs), as experienced in many
countries in Europe in the early 2000s. The long-lasting trend towards delayed parenthood is central for understanding diverse, low and unstable post-transitional fertility patterns. In many countries in Europe this shift to a late childbearing pattern has negatively affected the TFR for more than four decades. Many emerging post-transitional countries and regions are
likely to experience a similar shift over the next two to three decades, with a depression of their TFRs to very low levels.

Question
What evidence, lessons and best practice have emerged from previous humanitarian responses in middle income countries (MICS) that may be of particular relevance to ongoing responses across MENA?

Summary
The literature uncovered by this rapid review indicates that there is very little evidence available about the way in which humanitarian response is carried out in middle income countries in comparison to low income contexts (or an amalgamation of the two). Where there have been evaluations of humanitarian response in middle income countries, they have not really focused on transferable lessons or best practice for similar situations.

Evidence, best practice and lessons emerging from the available literature for humanitarian response in middle income countries include:
◾Middle income countries generally have national capacity to lead the humanitarian response, and international humanitarian efforts should collaborate with these national systems and be carried out in partnership with the national government and civil society organisations. However, progress still needs to be made as international actors sometimes struggle to partner effectively with national organisations and have ended up setting up parallel systems.
◾Responding to humanitarian crisis in middle income countries has a higher financial cost as they are more expensive locations than many low income contexts.
◾The current humanitarian financing system does not provide enough support for middle income countries and the funds available to them are ill-suited to crisis response. As a result there are calls to make financing for refugees in middle income countries eligible for grants and concessional loans by reclassifying the eligibility criteria of the World Bank’s International Development Association (IDA) to follow the people in need and not the income levels per capita of the countries, for instance.
◾In middle income countries, the needs of those affected by crisis often intersect with the needs of other vulnerable communities. As a result, humanitarian response in middle income countries should work together with development efforts. This will involve responding to the needs of refugees/affected populations and host communities and supporting existing services.
◾Cash-based assistance may be more appropriate than in-kind assistance, especially in highly monetised economies. In some crises in middle income countries, cash transfer distributions have been linked to existing social protection systems.
◾The private sector could be supported to be more involved in humanitarian response in order to take advantage of private capital for humanitarian response and potentially help make humanitarian response quicker, bigger and more effective.
◾Previous experience suggests avoiding camp based solutions and proactively reaching out to urban refugees.
◾Planning and assessment should be flexible and quick to ensure activities remain relevant.

Interactions between access to finance, product innovation, and labor supply are studied in a two-period overlapping generations model with an endogenous skill distribution and financial market imperfections. In the model lack of access to finance (induced by high monitoring costs) has an adverse effect on innovation activity not only directly but also indirectly, because too few individuals may choose to invest in skills. If monitoring costs fall with the number of successful projects, multiple steady states may emerge, one of which defined as a middle-income trap, characterized by low wages in the design sector, a low share of the labor force engaged in innovation activity, and low growth. A sufficiently ambitious policy aimed at alleviating constraints on access to finance by innovators may allow a country to move away from such a trap by promoting the production of ideas and improving incentives to invest in skills.

This paper studies the existence of middle-income growth traps in a two-period overlapping generations model of economic growth with two types of labor and endogenous occupational choices. It also distinguishes between " basic " and " advanced " infrastructure, with the latter promoting design activities, and accounts for a knowledge network externality associated with product diversification. Multiple steady-state equili-bria may emerge, one of them taking the form of a low-growth trap characterized by low productivity growth and a misallocation of talent—defined as a relatively low share of high-ability workers in design activities. Improved access to advanced infrastructure may help to escape from that trap. The implications of other public policies, including the protection of property rights and labor market reforms, are also discussed.

Large Middle Income Countries (MICs) have been positioning themselves as providers of South-South cooperation (SSC) at regional and global levels. In that context, the United Nations (UN) system has been exploring new modalities in order to expand and redesign its support to MIC governments’ SSC efforts. This paper investigates two case studies in order to identify key elements of UN SSC support in large MICs and makes two contributions. First, it analyses empirical evidence on how the UN system has been supporting MIC’s SSC at the country level, namely in China and Mexico. Second, based on these insights it revisits claims on the added value of UN SSC support in order to point to potentials and challenges of the UN’s engagement with SSC.

The “middle-income trap” has become a broad designation trying to capture the many cases of developing countries that succeeded in evolving from low- to middle-levels of per capita income, but then appeared to stall, losing momentum along the route toward the higher income levels of advanced economies. Such a trap may well characterize the experience of most of Latin America since the 1980s, and in recent years middle-income countries elsewhere have expressed fears of following a similar path. Underlying these views is a more general feeling that moving up on the income ladder gets harder the higher one climbs. This note outlines two different ways in which the concept has been approached since its first use 12 years ago by Gill and Kharas (2007).

Background: As middle-income countries become more affluent, economically sophisticated and productive, health expenditure patterns are likely to change. Other socio-demographic and political changes that accompany rapid economic growth are also likely to influence health spending and financial protection. Methods: This study investigates the relationship between growth on per-capita healthcare expenditure and gross domestic product (GDP) in a group of 27 large middle-income economies and compares findings with those of 24 high-income economies from the Organization for Economic Cooperation and Development (OECD) group. This comparison uses national accounts data from 1995-2014. We hypothesize that the aggregated income elasticity of health expenditure in middle-income countries would be less than one (meaning healthcare is a normal good). An initial exploratory analysis tests between fixed-effects and random-effects model specifications. A fixed-effects model with time-fixed effects is implemented to assess the relationship between the two measures. Unit root, Hausman and serial correlation tests are conducted to determine model fit. Additional explanatory variables are introduced in different model specifications to test the robustness of our regression results. We include the out-of-pocket (OOP) share of health spending in each model to study the potential role of financial protection in our sample of high-and middle-income countries. The first-difference of study variables is implemented to address non-stationarity and cointegration properties. Results: The elasticity of per-capita health expenditure and GDP growth is positive and statistically significant among sampled middle-income countries (51 per unit-growth in GDP) and high-income countries (50 per unit-growth in GDP). In contrast with previous research that has found that income elasticity of health spending in middle-income countries is larger than in high-income countries, our findings show that elasticity estimates can change if different criteria are used to assemble a more homogenous group of middle-income countries. Financial protection differences between middle-and high-income countries, however, are not associated with their respective income elasticity of health spending. ` Conclusion: The study findings show that in spite of the rapid economic growth experienced by the sampled middle-income countries, the aggregated income elasticity of health expenditure in them is less than one, and equals that of high-income countries. Citation: Vargas Bustamante A, Shimoga SV. Comparing the income elasticity of health spending in middle-income and high-income countries: the role of financial protection.

The main purpose of this paper is to empirically investigate the impacts of remittance inflows, financial inclusion, and economic development and whether inward remittances may help to construct an inclusive financial system. Using both endogeneity-robust generalized method of moments and a structural equation model, our results show that remittances and financial inclusions are engines of growth in countries of different income groups. This implies that the policies to attract extra inward remittances and improve financial inclusion status are of great importance and could pull middle-income countries out of middle-income traps. To this end, our empirical study helps to shed light on the development dilemma of remittance inflows and financial inclusion and to explain both direct and indirect mechanisms through which these effects may happen.

Bu çalışmada enerji tüketimi ve ekonomik büyüme arasındaki ilişki düşük ve orta gelir grubu ülkeler için 1971-2013 dönemi verileri kullanılarak incelenmiştir. Bu amaçla değişkenler arasındaki ilişki Kónya panel nedensellik testi kullanılarak incelenmiştir. Ampirik sonuçlara göre düşük ve orta gelir grubuna dâhil ülkelerde çoğunlukla tarafsızlık hipotezinin geçerli olduğu görülmektedir. Geribildirim hipotezinin ise yalnızca Kenya için geçerli olduğu çalışmadan elde edilen bir başka sonuçtur. Sonuç olarak ekonomik büyüme ile enerji tüketimi arasındaki nedensellik
ilişkisinin yönü için zaman ve ülke boyutuna göre farklılaşmalar olduğunu söylemek mümkündür.

Este trabajo presenta los resultados de un estudio comparativo de los entornos de producción, circulación y uso de la investigación social en Bolivia, Paraguay y Peru. El estudio estuvo basado en tres estudios de caso -uno por cada país- elaborados a partir de la revisión documental y de fuentes secundarias, así como de entrevistas en profundidad con actores clave (tomadores de decisiones, investigadores, Líderes de instituciones de educación superior y centros de investigación) realizadas a partir de un protocolo temático común. El análisis comparado de los tres estudios de caso muestra rasgos comunes importantes, como es la débil o nula presencia del Estado a través de políticas y/o financiamiento para la investigación social. Los tres países están marcados también por un enfoque instrumentista hacia la producción de conocimiento social, aunque se trata de un instrumentalismo tecnocrático en los casos de Peru y Paraguay, mientras que en Bolivia se trata de un instrumentalismo de carácter político/populista. Estos factores tienen un fuerte impacto en la baja producción de investigación en estos países cuando se les compara con otros países de la región, así como también en los tipos y en la calidad de la investigación que se produce, y en la circulación de la investigación en circuitos académicos. Aunque hay diferencias importantes entre los tres países, por ejemplo en cuanto al grado de desarrollo institucional y profesionalización de la investigación, el resultado final es que la investigación en estos países sigue siendo percibida como una tarea solitaria, que adolece de la falta de comunidades de investigación y masa crítica.

Multilateral Development Banks (MDBs) have two financing windows, with different terms, dedicated to low- and middle-income countries. Countries are presumed to cross those windows as their income per capita rises, with middle-income countries (MICs) eventually “graduating” to a non-client status once they reach some criteria. However, due to what may be called “middle-income traps”, such progression toward graduation has been limited to a small number of countries.

Despite scarce empirical research in most countries, evidence has shown that young children are unsupervised or under the supervision of another young child while their adult caregivers attend work or engage in other activities outside the home. Lack of quality supervision has been linked to unintentional childhood injuries and other negative outcomes. Nationally representative, population-based data from rounds four and five of the Multiple Indicator Cluster Surveys (MICS) and four to eight of the Demographic and Health Surveys (DHS) from 61 low-and middle-income countries were used to estimate prevalence and socioeconomic factors associated with leaving children under five years old home alone or under the care of another child younger than 10 years of age. Socioeconomic factors included age and sex of the child, rurality, wealth, maternal education, and household composition. Large variations in the prevalence rates (0.1–35.3% for children home alone and 0.2–50.6% for children supervised by another child) and associated factors have been recorded within and across regions and countries. Understanding why and under what conditions children are home alone or under the supervision of another child is crucial to the development of suitable policies and interventions to protect young children, promote healthy growth, and support caregivers.

Background Despite the significant benefits of palliative care (PC) services for cancer patients, multiple challenges hinder the provision of PC services for these patients. Low- and middle-income countries (LMICs) are witnessing a sharp growth in the burden of non-communicable diseases. There is a significant gap between demand and supply of PC in LMICs in current health services. This review aims to synthesise evidence from previous reviews and deliver a more comprehensive mapping of the existing literature about personal, system, policy, and organisational challenges and possible facilitators on the provision of PC services for cancer patients in LMICs. Methods A systematic review of reviews was performed following PRISMA guidelines. PubMed, EMBASE, SCOPUS, PsycINFO, Web of Sciences, CINAHL, and Cochrane Library databases were searched to identify review papers published between 2000 and 2018 that considered challenges and possible facilitators to PC provision. A modified socioec...

In settings with low seatbelt use prevalence, self-reported seatbelt use estimates often lack validity, and routine observational studies are scarce. In this paper, we aim to describe the prevalence of seatbelt use and associated factors in drivers and front-seat passengers across eight sites in four countries (Egypt, Mexico, Russia, Turkey) using observational studies as well as to produce estimates of country-level and site-level variance. As part of the Bloomberg Philanthropies Global Road Safety Program, data on driver and passenger seatbelt use across four middle-income countries was collected between October 2010 and May 2011 (n=122,931 vehicles). Logistic regression and Intraclass Correlation Coefficient analyses for sites- and country-level clustering were performed. We found high variability of seatbelt wearing rates ranging from 4 to 72% in drivers and 3-50% in front-seat passengers. Overall, average seatbelt wearing rates were low (under 60% in most sites). At the individual level, older and female drivers were more likely to wear seatbelts, as well as drivers of vehicles transiting at times of increased vehicle flow. We also found that 26-32% and 37-41% of the variance in seatbelt use among drivers and front-seat passengers respectively was explained by differences across sites and countries. Our results demonstrate that there is room for improvement on seatbelt use in middle-income countries and that standardized cross-country studies on road safety risk factors are feasible, providing valuable information for prevention and monitoring activities.

Despite scarce empirical research in most countries, evidence has shown that young children are unsupervised or under the supervision of another young child while their adult caregivers attend work or engage in other activities outside the home. Lack of quality supervision has been linked to unintentional childhood injuries and other negative outcomes. Nationally representative, population-based data from rounds four and five of the Multiple Indicator Cluster Surveys (MICS) and four to eight of the Demographic and Health Surveys (DHS) from 61 low- and middle-income countries were used to estimate prevalence and socio-economic factors associated with leaving children under five years old home alone or under the care of another child younger than 10 years of age. Socio-economic factors included age and sex of the child, rurality, wealth, maternal education, and household composition. Large variations in the prevalence rates (0.1–35.3% for children home alone and 0.2–50.6% for children...

The rise in mental health issues is a global phenomenon. The World Health Organisation (WHO) has published data that shows the global burden of mental disorders continues to grow and claim that the health systems throughout the world are struggling to respond adequately to the needs of people with mental health disorders.1 Approximately 85% of the world population resides in 153 low-income and middle-income countries (LMICs). Further, more than 80% of people who have mental disorders are located in LMICs.2 However, it is estimated that 90-95% of mental health resources, including human resources for psychological therapies are being delivered in countries that only account for 5% of the population.3 This is a global inequity and it is unjust. This article serves as a desperate call to researchers to urgently engage in evidence-based psychological therapies interventions in LMICs. This is not as an attempt to reallocate existing provision of mental health resources, but to reduce the treatment gap by advocating opportunities for all.

There is a wide agreement among poverty research community that conventional estimates of poverty (i.e., money-metric measures) do not take into account out of pocket payments of health care.
Significant household health spending would overestimate total household expenditure, which results in an underestimation of poverty measured in terms of household expenditure. The present working paper uses Luxembourg Income Study Center data to explore the impact of household health payments on poverty and child poverty estimates in
five middle-income countries (India, Mexico, South Africa, Russian Federation and Peru). It also extends this analysis to cover education expenditure as well and how it might exert similar effects on these poverty estimates.
Key words: poverty, child poverty, expenditure poverty, out of pocket health expenditure, out of pocket education expenditure, middle-income countries.

This Country Program Evaluation (CPE) with Chile covers the 2011-2013 period and is the third occasion on which the Office of Evaluation and Oversight (OVE) has evaluated the Bank's program with the country. The previous evaluations covered the periods 1995- 2005 (document RE-320) and 2006-2010 (document RE-380-1). The current country strategy (document GN-2642-1) was approved in December 2011 and is for a period (2011-2014) that does not coincide with the country¿s political cycle. The administration of President Piñera was in office from March 2010 to March 2014. IDB Management expects to submit a new country strategy to the Board of Executive Directors in August 2014. The evaluation is structured into four chapters, plus annexes. Chapter I analyzes the general context in the country. Chapter II provides a general analysis of the Bank's program in 2011-2013, with particular reference to the relevance of the country strategy, and an analysis of the program actually implemented. Chapter III provides a sector-based analysis of the implementation, effectiveness, and sustainability of the operations and of the progress achieved towards the Bank's proposed strategic objectives. Chapter IV presents conclusions and recommendations.