Global book publishers have had their fair share of ups and downs stemming from volatile economic conditions and changing consumer preferences. The pandemic slowed physical print releases as supply chains were disrupted and publishers were forced to operate at a limited capacity. While physical bookstores were closed, online retailers could still deliver books directly to consumers' doorsteps, preventing publishers from facing a significant drop-off. Even so, smaller publishers that couldn't keep up were forced to exit because of low profitability. As the effects of the pandemic waned, book publishers faced higher paper prices, causing an uptick in the prices they charged consumers. Still, rising reading activity carried over and consumers were out and about in physical bookstores. Revenue has pushed up at a CAGR of 0.3% through the end of 2024, reaching $151.9 billion, including a 1.1% uptick in 2024 alone. The transition to digital media will continue to impact the way consumers read. The rise of e-books is forcing publishers to adapt and make their books more accessible digitally. While digital books are more condiment, smaller print runs will cause publishers to pay more for each printing, eating into profit and offsetting the costs they would save by going digital. Even so, many publishers are leveraging technology to make physical books more accessible than ever. Publisher websites can provide links to retailers, release dates and prices for anything a customer wants. This has helped stave off some digital penetration as shopping at brick-and-mortar locations has rebounded since the pandemic. Emerging markets are set to push new publishers into the industry as countries worldwide expand their literacy rates. The push for education alongside local government funding will pave the way for new publishers to release books that cater to these countries, facilitating academic book sales. Overall, global book publishing revenue is set to expand at a CAGR of 2.2% to $169.4 billion through the end of 2029.

Consumer sentiment, disposable income levels and drinking habits impact spending on drinking establishments, including pubs, bars, nightclubs and coffee shops. Europe is known for its well-established drinking culture, which varies from country to country. Beer and wine consumption are very popular on the continent, with many countries also major producers of these beverages. However, alcohol consumption per capita in Europe is on a downward trend, hindering demand for drinking establishments. Meanwhile, coffee shops benefit from resilient demand amid a thriving coffee culture on the continent. Industry revenue is expected to expand at a compound annual rate of 5.8% to €100.6 billion over the five years through 2025, including a 0.1% drop in 2025. The industry is driven by Europe’s deep-rooted culture of socialising, vibrant nightlife and evolving urban lifestyles. Climbing health consciousness, particularly among younger demographics, is shaping the industry’s performance, weakening per capita alcohol consumption levels across most European countries. Consumers are reducing their alcohol intake or completely cutting it off due to the health benefits of staying sober, presenting challenges to venues that rely on alcohol sales. This shift has forced many establishments to diversify their offerings, adding more non-alcoholic options and high-quality snacks. In the aftermath of the pandemic, the hurdle of surging inflation deterred spending on going out and drinking. Many consumers have since turned to beverages offered at supermarkets as off-trade alcohol prices are lower, hindering revenue over the three years through 2025. Intense competition from supermarkets and restaurants has pressured prices, hindering revenue and profit growth. This, paired with higher operational costs, has weighed on profitability. Industry revenue is forecast to swell at a compound annual rate of 3.7% to €120.4 billion over the five years through 2030. An improving European economy will bolster consumer sentiment and disposable incomes, fuelling spending on on-premise drinking. Premiumisation is set to be an emerging trend, with consumers willing to pay more for craft, high-quality beverages, as well as memorable experiences and entertainment. However, subdued levels of alcohol consumption per capita and escalating competition will limit revenue growth. To combat competition and keep up with changing consumer preferences, drinking establishment operators will have to broaden their offerings, dabbling in more varied non-alcoholic beverage options. Those that fail to do so will struggle in the increasingly competitive market.

Consumer sentiment, disposable income levels and drinking habits impact spending on drinking establishments, including pubs, bars, nightclubs and coffee shops. Europe is known for its well-established drinking culture, which varies from country to country. Beer and wine consumption are very popular on the continent, with many countries also major producers of these beverages. However, alcohol consumption per capita in Europe is on a downward trend, hindering demand for drinking establishments. Meanwhile, coffee shops benefit from resilient demand amid a thriving coffee culture on the continent. Industry revenue is expected to expand at a compound annual rate of 5.8% to €100.6 billion over the five years through 2025, including a 0.1% drop in 2025. The industry is driven by Europe’s deep-rooted culture of socialising, vibrant nightlife and evolving urban lifestyles. Climbing health consciousness, particularly among younger demographics, is shaping the industry’s performance, weakening per capita alcohol consumption levels across most European countries. Consumers are reducing their alcohol intake or completely cutting it off due to the health benefits of staying sober, presenting challenges to venues that rely on alcohol sales. This shift has forced many establishments to diversify their offerings, adding more non-alcoholic options and high-quality snacks. In the aftermath of the pandemic, the hurdle of surging inflation deterred spending on going out and drinking. Many consumers have since turned to beverages offered at supermarkets as off-trade alcohol prices are lower, hindering revenue over the three years through 2025. Intense competition from supermarkets and restaurants has pressured prices, hindering revenue and profit growth. This, paired with higher operational costs, has weighed on profitability. Industry revenue is forecast to swell at a compound annual rate of 3.7% to €120.4 billion over the five years through 2030. An improving European economy will bolster consumer sentiment and disposable incomes, fuelling spending on on-premise drinking. Premiumisation is set to be an emerging trend, with consumers willing to pay more for craft, high-quality beverages, as well as memorable experiences and entertainment. However, subdued levels of alcohol consumption per capita and escalating competition will limit revenue growth. To combat competition and keep up with changing consumer preferences, drinking establishment operators will have to broaden their offerings, dabbling in more varied non-alcoholic beverage options. Those that fail to do so will struggle in the increasingly competitive market.

Consumer sentiment, disposable income levels and drinking habits impact spending on drinking establishments, including pubs, bars, nightclubs and coffee shops. Europe is known for its well-established drinking culture, which varies from country to country. Beer and wine consumption are very popular on the continent, with many countries also major producers of these beverages. However, alcohol consumption per capita in Europe is on a downward trend, hindering demand for drinking establishments. Meanwhile, coffee shops benefit from resilient demand amid a thriving coffee culture on the continent. Industry revenue is expected to expand at a compound annual rate of 5.8% to €100.6 billion over the five years through 2025, including a 0.1% drop in 2025. The industry is driven by Europe’s deep-rooted culture of socialising, vibrant nightlife and evolving urban lifestyles. Climbing health consciousness, particularly among younger demographics, is shaping the industry’s performance, weakening per capita alcohol consumption levels across most European countries. Consumers are reducing their alcohol intake or completely cutting it off due to the health benefits of staying sober, presenting challenges to venues that rely on alcohol sales. This shift has forced many establishments to diversify their offerings, adding more non-alcoholic options and high-quality snacks. In the aftermath of the pandemic, the hurdle of surging inflation deterred spending on going out and drinking. Many consumers have since turned to beverages offered at supermarkets as off-trade alcohol prices are lower, hindering revenue over the three years through 2025. Intense competition from supermarkets and restaurants has pressured prices, hindering revenue and profit growth. This, paired with higher operational costs, has weighed on profitability. Industry revenue is forecast to swell at a compound annual rate of 3.7% to €120.4 billion over the five years through 2030. An improving European economy will bolster consumer sentiment and disposable incomes, fuelling spending on on-premise drinking. Premiumisation is set to be an emerging trend, with consumers willing to pay more for craft, high-quality beverages, as well as memorable experiences and entertainment. However, subdued levels of alcohol consumption per capita and escalating competition will limit revenue growth. To combat competition and keep up with changing consumer preferences, drinking establishment operators will have to broaden their offerings, dabbling in more varied non-alcoholic beverage options. Those that fail to do so will struggle in the increasingly competitive market.

Over the past five years, the Global Hotels and Resorts industry has expanded. The current period started with a pandemic-low revenue level. As business and travel activities gradually resumed, industry revenue surpassed the pre-pandemic level in 2023. However, rising inflation following the pandemic and geopolitical tensions depressed the potential revenue growth. Further, stringent fatal aviation accidents and potential tariff war further deteriorate consumer confidence, inducing them to put off travel plans. Overall, industry revenue is expected to grow at an annualized rate of 14.2% to $1.8 trillion over the five years to 2025, including a 2.4% growth in 2025. In the same year, profit is also expected to reach 18.5%. While the prominence of well-known hotel chains looms over the industry, it still experiences low concentration since it has numerous small independent hotels. Due to low concentration, the industry remains highly competitive, and the steady increase in the supply of new hotel rooms has limited the hotels' ability to raise room prices. However, the industry is changing and continues to become more consolidated. This gives larger chains control over industry parts through loyalty programs and discounted pricing structures. Over the next five years, the largest growth will likely be in Asia and the Pacific, which will help emerging economies surpass several developed economies as favored destinations for tourists. However, uncertainty in some markets, specifically those with political and health risks, will hamper consumer sentiment early during the outlook period, placing pressure on hotels. Further, the potential tariff war between the US and other powerhouses such as China and the EU will likely affect travel rates as these countries strengthen their border control. Even so, more hotels and resorts will be built due to travel rates expected to rise overall, which should drive industry revenue growth. Overall, industry revenue is projected to increase at an annualized rate of 2.2% to $2.0 trillion over the five years to 2030.

Policymakers recognize that increased investment in agricultural research is key to increasing agricultural productivity. Despite this, many low- and middle-income countries struggle with capacity and funding constraints in their agricultural research systems. Agricultural Science and Technology Indicators (ASTI), facilitated by the International Food Policy Research Institute (IFPRI) within the portfolio of the CGIAR Research Program on Policies, Institutions, and Markets, works with national, regional, and international partners to collect time series data on the funding, human resource capacity, and outputs of agricultural research in low- and middle-income countries. Based on this information, ASTI produces analysis, capacity-building tools, and outreach products to help facilitate policies for effective and efficient agricultural research. “Agricultural research” includes government, higher education, and nonprofit agencies, but excludes the private for-profit sector. Total agricultural research spending includes salaries, operating and program costs, and capital investments for all agencies, excluding the private for-profit sector, involved in agricultural research in a country. Expenditures are adjusted for inflation and expressed in 2011 prices. Purchasing power parities (PPPs) measure the relative purchasing power of currencies across countries by eliminating national differences in pricing levels for a wide range of goods. PPPs are relatively stable over time, whereas exchange rates fluctuate considerably. In addition to looking at absolute levels of agricultural research investment and capacity, another way of comparing commitment to agricultural research is to measure research intensity—that is, total agricultural research spending as a percentage of agricultural output (AgGDP). “Total agricultural researchers” (excluding the private for-profit sector) are reported in full-time equivalents (FTEs) to account for the proportion of time researchers actually spend on research activities. A critical mass of qualified agricultural researchers is crucial for implementing a viable research agenda, for effectively communicating with stakeholders, and for securing external funding. Therefore, it is important to look at the share of PhD-qualified researchers. Gender balance in agricultural research is important, given that women researchers offer different insights and perspectives that can help research agencies more effectively address the unique and pressing challenges of female farmers. Age imbalances among research staff should be minimized to ensure the continuity of future research as researchers retire.

The popularization of financial literacy has become a global trend, with governments across the world expressing commitment to continuously enhancing the financial literacy of their citizens to improve the country’s overall financial well-being. However, there is a lack of research evaluating the actual effects of financial literacy on Chinese households. This study first investigated the micro impact of financial literacy on the household stock profit level using data from the 2019 China Household Finance Survey. As most existing studies use factor analysis to measure financial literacy from a single dimension of financial knowledge, our study additionally used the entropy method to construct a composite evaluation system of financial literacy from four dimensions: financial skills, knowledge, attitudes, and behaviors. The ordinary least squares model was utilized as the primary regression model to estimate the correlation, and the average financial literacy of other households in the same community was selected as an instrumental variable. Further instrumental variable regression analysis was conducted using the two-stage least squares method. Three robustness tests were performed to ensure the reliability of the research findings. The results demonstrate that financial literacy significantly enhances household stock profit levels. The mediation effect analysis indicates that financial literacy affects stock profit levels through financial information attention. Moreover, financial literacy has a more substantial promoting effect on stock profit levels for households with members working for state-owned enterprises and those living in first-tier cities. This study confirms the value of financial literacy; identifies important channels for residents to increase their property income; and provides important guidance for the government, educational organizations, and financial institutions. This also injects more vigor into market participation to improve the persistently sluggish Chinese stock market.

IntroductionOwnership of healthcare providers has been considered as one factor that might influence their health and healthcare related performance. The aim of this article was to provide an overview of what is known about the effects on economic, administrative and health related outcomes of different types of ownership of healthcare providers -namely public, private non-for-profit (PNFP) and private for-profit (PFP)- based on the findings of systematic reviews (SR).Methods and FindingsAn overview of systematic reviews was performed. Different databases were searched in order to select SRs according to an explicit comprehensive criterion. Included SRs were assessed to determine their methodological quality. Of the 5918 references reviewed, fifteen SR were included, but six of them were rated as having major limitations, so they weren't incorporated in the analyses. According to the nine analyzed SR, ownership does seem to have an effect on health and healthcare related outcomes. In the comparison of PFP and PNFP providers, significant differences in terms of mortality of patients and payments to facilities have been found, both being higher in PFP facilities. In terms of quality and economic indicators such as efficiency, there are no concluding results. When comparing PNFP and public providers, as well as for PFP and public providers, no clear differences were found.ConclusionPFP providers seem to have worst results than their PNFP counterparts, but there are still important evidence gaps in the literature that needs to be covered, including the comparison between public and both PFP and PNFP providers. More research is needed in low and middle income countries to understand the impact on and development of healthcare delivery systems.

The popularization of financial literacy has become a global trend, with governments across the world expressing commitment to continuously enhancing the financial literacy of their citizens to improve the country’s overall financial well-being. However, there is a lack of research evaluating the actual effects of financial literacy on Chinese households. This study first investigated the micro impact of financial literacy on the household stock profit level using data from the 2019 China Household Finance Survey. As most existing studies use factor analysis to measure financial literacy from a single dimension of financial knowledge, our study additionally used the entropy method to construct a composite evaluation system of financial literacy from four dimensions: financial skills, knowledge, attitudes, and behaviors. The ordinary least squares model was utilized as the primary regression model to estimate the correlation, and the average financial literacy of other households in the same community was selected as an instrumental variable. Further instrumental variable regression analysis was conducted using the two-stage least squares method. Three robustness tests were performed to ensure the reliability of the research findings. The results demonstrate that financial literacy significantly enhances household stock profit levels. The mediation effect analysis indicates that financial literacy affects stock profit levels through financial information attention. Moreover, financial literacy has a more substantial promoting effect on stock profit levels for households with members working for state-owned enterprises and those living in first-tier cities. This study confirms the value of financial literacy; identifies important channels for residents to increase their property income; and provides important guidance for the government, educational organizations, and financial institutions. This also injects more vigor into market participation to improve the persistently sluggish Chinese stock market.

Abstract

The World Bank is interested in gauging the views of clients and partners who are either involved in development in Lao PDR or who observe activities related to social and economic development. The World Bank Country Assessment Survey is meant to give the World Bank's team that works in Lao PDR, greater insight into how the Bank's work is perceived. This is one tool the World Bank uses to assess the views of its critical stakeholders. With this understanding, the World Bank hopes to develop more effective strategies, outreach and programs that support development in Lao PDR.

The survey was designed to achieve the following objectives: - Assist the World Bank in gaining a better understanding of how stakeholders in Lao PDR perceive the Bank; - Obtain systematic feedback from stakeholders in Lao PDR regarding: · Their views regarding the general environment in Lao PDR; · Their overall attitudes toward the World Bank in Lao PDR; · Overall impressions of the World Bank's effectiveness and results, knowledge and research, and communication and information sharing in Lao PDR; and · Perceptions of the World Bank's future role in Lao PDR. - Use data to help inform the Lao PDR country team's strategy.

Geographic coverage

National

Analysis unit

Stakeholder

Universe

Stakeholders of the World Bank in Lao PDR

Kind of data

Sample survey data [ssd]

Sampling procedure

In April and May, 1,017 stakeholders of the World Bank in Lao PDR were invited to provide their opinions on the Bank's assistance to the country by participating in a country survey. Participants in the survey were drawn from among the office of the President or Government's Office; Ministry Cabinet offices; the National Assembly; employees of a ministry, ministerial department, or implementation agency; consultants/contractors working on World Bank supported projects/programs; project management units (PMUs) overseeing implementation of a project; local government officials or staff; bilateral agencies; multilateral agencies; private sector organizations; private foundations; the financial sector/private banks; international NGOs; mass-based organizations; the media; independent government institutions; local non-profit associations; academia, research institutes or think tanks; and the judiciary branch.

Mode of data collection

Mail Questionnaire [mail]

Research instrument

The Questionnaire consists of 9 Sections:

A. General Issues facing Lao PDR: Respondents were asked to indicate whether Lao PDR is headed in the right direction, what they thought were the top three most important development priorities, and which areas would contribute most to reducing poverty and generating economic growth in Lao PDR.

B. Overall Attitudes toward the World Bank: Respondents were asked to rate their familiarity with the World Bank, the Bank’s effectiveness in Lao PDR, Bank staff preparedness, the extent to which the Bank meets Lao PDR’s need for knowledge services and financial instruments, the extent to which the Bank should seek to influence the global development agenda, their agreement with various statements regarding the Bank’s work, and the extent to which the Bank is an effective development partner. Respondents were also asked to indicate the sectoral areas on which it would be most productive for the Bank to focus its resources, the Bank’s greatest values and greatest weaknesses in its work, the most and least effective instruments in helping to reduce poverty in Lao PDR, with which groups the Bank should work more, and to what reasons respondents attributed failed or slow reform efforts.

C. World Bank Effectiveness and Results: Respondents were asked to rate the extent to which the Bank’s work helps achieve sustainable development results in Lao PDR and the Bank’s level of effectiveness across thirty-two development areas, such as economic growth.

D. The World Bank’s Knowledge: Respondents were asked to indicate how frequently they consult Bank knowledge/research, the areas on which the Bank should focus its research efforts, and to rate the effectiveness and quality of the Bank’s knowledge/research, including how significant of a contribution it makes to development results, its technical quality, the Bank’s effectiveness at providing linkage to non-Bank expertise, and the extent to which specific Bank products contribute to helping solve Lao PDR’s development challenges.

E. Working with the World Bank: Respondents were asked to rate their level of agreement with a series of statements regarding working with the Bank, such as the World Bank’s “Safeguard Policy” requirements being reasonable, and the Bank disbursing funds promptly.

F. Specific Project/Program Related Issues: Respondents were asked to rate their agreement with various statements regarding the World Bank’s involvement in Nam Theun 2 and the Lao PDR Poverty Reduction Support Operation Series (PRSO).

G. The Future Role of the World Bank in Lao PDR: Respondents were asked to rate how significant a role the Bank should play in Lao PDR’s development in the near future and to indicate what the Bank should do to make itself of greater value in Lao PDR.

H. Communication and Information Sharing: Respondents were asked to indicate where they get information about economic and social development issues, how they prefer to receive information from the Bank, their access to the Internet, and their usage and evaluation of the Bank’s website. Respondents were asked about their awareness of the Bank’s Access to Information policy, past information requests from the Bank, and their level of agreement that they use more data from the World Bank as a result of the Bank’s Open Data policy. Respondents were also asked their level of agreement that they know how to find information from the Bank and that the Bank is responsive to information requests.

I. Background Information: Respondents were asked to indicate their current position, specialization, whether they professionally collaborate with the World Bank, their exposure to the Bank in Lao PDR, and their geographic location.

Response rate

A total of 532 stakeholders participated in the country survey (52%).

Irrespective of the promising opportunity to improve profit efficiency by at least 73%, microfinance institutions operating in Sub-Saharan Africa are efficient only for 27%, far below the average value. The conclusion is drawn after analyzing the profit efficiency of the microfinance institutions using the stochastic frontier approach applied to data obtained from 128 microfinance institutions operating in 34 Sub-Saharan African countries. The study results suggest the presence of uniform profit efficiency experience across time among microfinance institutions. Microfinance institutions operating in low-income countries and credit union form microfinance are economically more efficient than their counterparts. Furthermore, the profit efficiency of microfinance institutions is significantly affected by total assets, cost per loan, loan per staff, legal status, and the county’s income group of microfinance. Notably, the profit efficiency of microfinance institutions is adversely affected by the presence of female borrowers and female loan officers suggesting that gender diversity plays a role in the efficiency of microfinance institutions. Finally, we recommend that the managing body of microfinance work more on improving labor efficiency, earning asset utilization, loan collection efficiency, women’s involvement and the hottest technology implementation.

In 2018, Germany was the European country with the highest number of skiing participants, with 14.6 million Germans taking part in the sport. When considering the total population, the share of people who ski in European countries was the highest in Liechtenstein and Austria as of 2019, with 36 percent of the population in either country, which comes to a much higher number in Austria due to population size.

The UK: A tradition of snowsport

Established in 1903 and with over 28,000 members on the books, The Ski Club is the largest and oldest snowsports membership organisation in the UK. The turnover of the organization has grown in the past several years, reaching nearly six million British pounds in 2018. In the same year, it registered gross profit of approximately 1.1 million British pounds.

Off piste Freshtracks holidays were most popular among skiers.

In 2018, a total of 1,365 skiers chose off piste Freshtrack holidays from Ski Club Great Britain. Weekend ski holidays were chosen by 267 skiers members of the organization. Out of all the different skiing activities, snowboarding is also done by 21 percent of skiers in the United Kingdom (UK).

Personal and household goods rental and leasing revenue is forecast to contract at a compound annual rate of 3.7% over the five years through 2024 to €23.9 billion, including an estimated drop of 0.3% in 2024. As technology and appliances become more affordable, consumers and businesses increasingly prefer owning rather than renting. The trend against rentals is robust in countries like Poland and Italy, which have the lowest EU prices on home appliances and electronics. However, the rental market remains viable for short-term needs such as those of international students, accounting for a significant portion of rentals in countries like Germany, France and the Netherlands. In response to changing consumer tastes, rental companies now offer rent-to-own schemes that allow consumers to purchase rented equipment at a reduced price. While the profitability of the rental industry has suffered due to lower electronics prices and increased sourcing from low-cost countries, rental companies have sustained their profit through multiple rentals over the lifespan of their equipment. Revenue is forecast to expand at a compound annual rate of 5.7% over the five years through 2029 to €31.6 billion, while the average profit margin is expected to shrink. Major electronic retailers are cutting prices to boost competitiveness, threatening income. Technological advancements reducing the life cycle of electronics, coupled with a solid economic climate in Germany, promise higher disposable incomes and increased consumption. Higher sales of electronic goods will make electronic appliances more accessible to a broader consumer base and impact the growth of the rental sector.

Consumer sentiment, disposable income levels and drinking habits impact spending on drinking establishments, including pubs, bars, nightclubs and coffee shops. Europe is known for its well-established drinking culture, which varies from country to country. Beer and wine consumption are very popular on the continent, with many countries also major producers of these beverages. However, alcohol consumption per capita in Europe is on a downward trend, hindering demand for drinking establishments. Meanwhile, coffee shops benefit from resilient demand amid a thriving coffee culture on the continent. Industry revenue is expected to expand at a compound annual rate of 5.8% to €100.6 billion over the five years through 2025, including a 0.1% drop in 2025. The industry is driven by Europe’s deep-rooted culture of socialising, vibrant nightlife and evolving urban lifestyles. Climbing health consciousness, particularly among younger demographics, is shaping the industry’s performance, weakening per capita alcohol consumption levels across most European countries. Consumers are reducing their alcohol intake or completely cutting it off due to the health benefits of staying sober, presenting challenges to venues that rely on alcohol sales. This shift has forced many establishments to diversify their offerings, adding more non-alcoholic options and high-quality snacks. In the aftermath of the pandemic, the hurdle of surging inflation deterred spending on going out and drinking. Many consumers have since turned to beverages offered at supermarkets as off-trade alcohol prices are lower, hindering revenue over the three years through 2025. Intense competition from supermarkets and restaurants has pressured prices, hindering revenue and profit growth. This, paired with higher operational costs, has weighed on profitability. Industry revenue is forecast to swell at a compound annual rate of 3.7% to €120.4 billion over the five years through 2030. An improving European economy will bolster consumer sentiment and disposable incomes, fuelling spending on on-premise drinking. Premiumisation is set to be an emerging trend, with consumers willing to pay more for craft, high-quality beverages, as well as memorable experiences and entertainment. However, subdued levels of alcohol consumption per capita and escalating competition will limit revenue growth. To combat competition and keep up with changing consumer preferences, drinking establishment operators will have to broaden their offerings, dabbling in more varied non-alcoholic beverage options. Those that fail to do so will struggle in the increasingly competitive market.

Abstract

This study examines various dimensions of primary health care delivery in Uganda, using a baseline survey of public and private dispensaries, the most common lower level health facilities in the country.

The survey was designed and implemented by the World Bank in collaboration with the Makerere Institute for Social Research and the Ugandan Ministries of Health and of Finance, Planning and Economic Development. It was carried out in October - December 2000 and covered 155 local health facilities and seven district administrations in ten districts. In addition, 1617 patients exiting health facilities were interviewed. Three types of dispensaries (both with and without maternity units) were included: those run by the government, by private for-profit providers, and by private nonprofit providers, mainly religious.

This research is a Quantitative Service Delivery Survey (QSDS). It collected microlevel data on service provision and analyzed health service delivery from a public expenditure perspective with a view to informing expenditure and budget decision-making, as well as sector policy.

Objectives of the study included: 1) Measuring and explaining the variation in cost-efficiency across health units in Uganda, with a focus on the flow and use of resources at the facility level; 2) Diagnosing problems with facility performance, including the extent of drug leakage, as well as staff performance and availability;
3) Providing information on pricing and user fee policies and assessing the types of service actually provided; 4) Shedding light on the quality of service across the three categories of service provider - government, for-profit, and nonprofit; 5) Examining the patterns of remuneration, pay structure, and oversight and monitoring and their effects on health unit performance; 6) Assessing the private-public partnership, particularly the program of financial aid to nonprofits.

Geographic coverage

The study districts were Mpigi, Mukono, and Masaka in the central region; Mbale, Iganga, and Soroti in the east; Arua and Apac in the north; and Mbarara and Bushenyi in the west.

Analysis unit

• local dispensary with or without maternity unit

Universe

The survey covered government, for-profit and nonprofit private dispensaries with or without maternity units in ten Ugandan districts.

Kind of data

Sample survey data [ssd]

Sampling procedure

The survey covered government, for-profit and nonprofit private dispensaries with or without maternity units in ten Ugandan districts.

The sample design was governed by three principles. First, to ensure a degree of homogeneity across sampled facilities, attention was restricted to dispensaries, with and without maternity units (that is, to the health center III level). Second, subject to security constraints, the sample was intended to capture regional differences. Finally, the sample had to include facilities in the main ownership categories: government, private for-profit, and private nonprofit (religious organizations and NGOs). The sample of government and nonprofit facilities was based on the Ministry of Health facility register for 1999. Since no nationwide census of for-profit facilities was available, these facilities were chosen by asking sampled government facilities to identify the closest private dispensary.

Of the 155 health facilities surveyed, 81 were government facilities, 30 were private for-profit facilities, and 44 were nonprofit facilities. An exit poll of clients covered 1,617 individuals.

The final sample consisted of 155 primary health care facilities drawn from ten districts in the central, eastern, northern, and western regions of the country. It included government, private for-profit, and private nonprofit facilities. The nonprofit sector includes facilities owned and operated by religious organizations and NGOs. Approximately one third of the surveyed facilities were dispensaries without maternity units; the rest provided maternity care. The facilities varied considerably in size, from units run by a single individual to facilities with as many as 19 staff members.

Ministry of Health facility register for 1999 was used to design the sampling frame. Ten districts were randomly selected. From the selected districts, a sample of government and private nonprofit facilities and a reserve list of replacement facilities were randomly drawn. Because of the unreliability of the register for private for-profit facilities, it was decided that for-profit facilities would be identified on the basis of information from the government facilities sampled. The administrative records for facilities in the original sample were first reviewed at the district headquarters, where some facilities that did not meet selection criteria and data collection requirements were dropped from the sample. These were replaced by facilities from the reserve list. Overall, 30 facilities were replaced.

The sample was designed in such a way that the proportion of facilities drawn from different regions and ownership categories broadly mirrors that of the universe of facilities. Because no nationwide census of for-profit health facilities is available, it is difficult to assess the extent to which the sample is representative of this category. A census of health care facilities in selected districts, carried out in the context of the Delivery of Improved Services for Health (DISH) project supported by the U.S. Agency for International Development (USAID), suggests that about 63 percent of all facilities operate on a for-profit basis, while government and nonprofit providers run 26 and 11 percent of facilities, respectively. This would suggest an undersampling of private providers in the survey. It is not clear, however, whether the DISH districts are representative of other districts in Uganda in terms of the market for health care.

For the exit poll, 10 interviews per facility were carried out in approximately 85 percent of the facilities. In the remaining facilities the target of 10 interviews was not met, as a result of low activity levels.

Sampling deviation

In the first stage in the sampling process, eight districts (out of 45) had to be dropped from the sample frame due to security concerns. These districts were Bundibugyo, Gulu, Kabarole, Kasese, Kibaale, Kitgum, Kotido, and Moroto.

Mode of data collection

Face-to-face [f2f]

Research instrument

The following survey instruments are available:

• District Health Team Questionnaire;
• District Facility Data Sheets;
• Uganda Health Facility Survey Questionnaire;
• Facility Data Sheets;
• Facility Patient Exit Poll Questionnaire.

The survey collected data at three levels: district administration, health facility, and client. In this way it was possible to capture central elements of the relationships between the provider organization, the frontline facility, and the user. In addition, comparison of data from different levels (triangulation) permitted cross-validation of information.

At the district level, a District Health Team Questionnaire was administered to the district director of health services (DDHS), who was interviewed on the role of the DDHS office in health service delivery. Specifically, the questionnaire collected data on health infrastructure, staff training, support and supervision arrangements, and sources of financing.

The District Facility Data Sheet was used at the district level to collect more detailed information on the sampled health units for fiscal 1999-2000, including data on staffing and the related salary structures, vaccine supplies and immunization activity, and basic and supplementary supplies of drugs to the facilities. In addition, patient data, including monthly returns from facilities on total numbers of outpatients, inpatients, immunizations, and deliveries, were reviewed for the period April-June 2000.

At the facility level, the Uganda Health Facility Survey Questionnaire collected a broad range of information related to the facility and its activities. The questionnaire, which was administered to the in-charge, covered characteristics of the facility (location, type, level, ownership, catchment area, organization, and services); inputs (staff, drugs, vaccines, medical and nonmedical consumables, and capital inputs); outputs (facility utilization and referrals); financing (user charges, cost of services by category, expenditures, and financial and in-kind support); and institutional support (supervision, reporting, performance assessment, and procurement). Each health facility questionnaire was supplemented by a Facility Data Sheet (FDS). The FDS was designed to obtain data from the health unit records on staffing and the related salary structure; daily patient records for fiscal 1999-2000; the type of patients using the facility; vaccinations offered; and drug supply and use at the facility.

Finally, at the facility level, an exit poll was used to interview about 10 patients per facility on the cost of treatment, drugs received, perceived quality of services, and reasons for using that unit instead of alternative sources of health care.

Cleaning operations

Detailed information about data editing procedures is available in "Data Cleaning Guide for PETS/QSDS Surveys" in external resources.

STATA cleaning do-files and the data quality reports on the datasets can also be found in external resources.

Pharmaceutical spending per capita in Canada stood at 1,035 U.S. dollars in 2023 (current prices). In comparison, the United States reported per capita spending of 1,564 U.S. dollars (in 2022). As for medical goods and services in general, the U.S. is among the countries with highest health costs worldwide. The higher costs in the United States are particularly obvious when compared to other high-income, developed countries. Higher drug prices in the U.S.Higher spending on pharmaceuticals is less impacted by higher drug usage by Americans and more by significantly higher drug prices in the United States. While in other countries, drug prices are regulated more or less by governments, the U.S. leaves drug pricing to market competition. As an outcome, the U.S. market is the most profitable for pharmaceutical companies. For example, the price for blockbuster drug Humira was six times higher in the United States than in Germany (2022). Rx drug usage in the U.S.Almost half of all Americans have taken at least one prescription medicine within the preceding month. Generally, women take more prescribed drugs than men, although the difference decreased significantly over the past two decades. In the United States, among the therapeutic areas where spending is the highest are antidiabetics, oncologics, autoimmune, and respiratory diseases. On the other hand, antihypertensives and mental health drugs are the leading classes based on number of prescriptions filled.

Personal and household goods rental and leasing revenue is forecast to contract at a compound annual rate of 3.7% over the five years through 2024 to €23.9 billion, including an estimated drop of 0.3% in 2024. As technology and appliances become more affordable, consumers and businesses increasingly prefer owning rather than renting. The trend against rentals is robust in countries like Poland and Italy, which have the lowest EU prices on home appliances and electronics. However, the rental market remains viable for short-term needs such as those of international students, accounting for a significant portion of rentals in countries like Germany, France and the Netherlands. In response to changing consumer tastes, rental companies now offer rent-to-own schemes that allow consumers to purchase rented equipment at a reduced price. While the profitability of the rental industry has suffered due to lower electronics prices and increased sourcing from low-cost countries, rental companies have sustained their profit through multiple rentals over the lifespan of their equipment. Revenue is forecast to expand at a compound annual rate of 5.7% over the five years through 2029 to €31.6 billion, while the average profit margin is expected to shrink. Major electronic retailers are cutting prices to boost competitiveness, threatening income. Technological advancements reducing the life cycle of electronics, coupled with a solid economic climate in Germany, promise higher disposable incomes and increased consumption. Higher sales of electronic goods will make electronic appliances more accessible to a broader consumer base and impact the growth of the rental sector.

Personal and household goods rental and leasing revenue is forecast to contract at a compound annual rate of 3.7% over the five years through 2024 to €23.9 billion, including an estimated drop of 0.3% in 2024. As technology and appliances become more affordable, consumers and businesses increasingly prefer owning rather than renting. The trend against rentals is robust in countries like Poland and Italy, which have the lowest EU prices on home appliances and electronics. However, the rental market remains viable for short-term needs such as those of international students, accounting for a significant portion of rentals in countries like Germany, France and the Netherlands. In response to changing consumer tastes, rental companies now offer rent-to-own schemes that allow consumers to purchase rented equipment at a reduced price. While the profitability of the rental industry has suffered due to lower electronics prices and increased sourcing from low-cost countries, rental companies have sustained their profit through multiple rentals over the lifespan of their equipment. Revenue is forecast to expand at a compound annual rate of 5.7% over the five years through 2029 to €31.6 billion, while the average profit margin is expected to shrink. Major electronic retailers are cutting prices to boost competitiveness, threatening income. Technological advancements reducing the life cycle of electronics, coupled with a solid economic climate in Germany, promise higher disposable incomes and increased consumption. Higher sales of electronic goods will make electronic appliances more accessible to a broader consumer base and impact the growth of the rental sector.

Global sugar manufacturers have endured fluctuations in global sugar prices over the five years to 2024. Nonetheless, global sugar manufacturers' revenue is anticipated to strengthen at a CAGR of 5.6% to $83.2 billion over the five years to 2024, including a drop of 8.5% in 2024. Brazil is very influential in the industry's health. The country produces and exports the most sugar of any nation and is also the second-largest producer of ethanol, which is often produced from sugarcane. As energy prices have strengthened over the past five years, Brazil has expansively diverted more of its sugar stock toward ethanol production. Brazil's changing production and export levels have impacted the world supply of sugar, which, in turn, has disturbed world sugar prices. For example, prior to the current period, in 2011, when Brazil cut its production of sugar by 2.0 million tons, the world price of sugar shot up 25.6%; the following year, as Brazil boosted production by more than 2.0 million tons, the world price of sugar dropped 18.5%. These fluctuations in production, coupled with other countries following Brazil's lead and diverting their sugar stock toward ethanol production or other more valuable crops, have led revenue for the entire industry to endure intense volatility during the current five-year period. Profit, measured as earnings before interest and taxes, inched upward to 6.1% of revenue in 2024. These factors are expected to continue driving volatility in the world price of sugar and global sugar manufacturers' revenue over the five years to 2029. Despite ongoing fluctuations, the world price of sugar will moderately drop as global demand for sugar and sugar-heavy products dips, along with lower energy prices, which will likely prompt demand for alternative fuel sources, like ethanol. Also, as demand from developing nations continues to swell and as trade barriers are expansively removed, global production and international trade of sugar will strengthen. As a result of these factors, global sugar manufacturers' revenue will drop at a CAGR of an estimated 1.2% over the next five years to $78.5 billion in 2029.

Global casinos and online gambling businesses are still reeling from the aftereffects of the pandemic, with some rebounding swifter than others, depending on their country of operation and specialization. Sinking tourism rates, especially in 2020, left many casinos in dire straits, even if they could remain open in some capacity. Many have since reopened, welcoming eager tourists, but some, like those in Macau, continued experiencing operational delays related to the pandemic. As a result, though revenue began rebounding as early as 2021, revenue has grown at a CAGR of 0.5% over the past five years, reaching an estimated $305.8 billion in 2024, when revenue is expected to rise 4.7%. Companies focused on online gambling, or casino brands that invested heavily in the segment, were shielded from some of the volatility brought on by the pandemic. Regulations about online gambling remain in flux, but many countries eased restrictions, resulting in consumers gambling remotely, circumventing issues with travel. Online gambling's popularity also attracts consumers who typically would forgo visiting traditional casinos and opening new markets for certain businesses. The lower cost of running online gambling operations, relative to casinos, has enabled some to expand profit, but most are still recovering from lows experienced in 2020. Over the five years to 2029, global tourist arrivals will continue rising, following pandemic-era lows, benefitting casinos. As the global unemployment rate declines, more consumers will feel comfortable spending greater sums on vacations, opting for overseas travel and resort-style stays, often splurging on ancillary services, like entertainment options. Online gambling will grow in popularity, as consumers become increasingly trusting of such platforms, further aiding growth. Revenue is forecast to rise at a CAGR of 2.9% to $352.0 billion over the next five years.