Gender Dynamics and Upgrading in Global Value Chains: The Case of Medical Devices

Global value chain (GVC) integration and upgrading have become key goals of trade and investment policy in developing countries. This study seeks to contribute to the gap in the gender and trade debate by analyzing the gender implications of, and impacts on trade and competitiveness in, a single high value manufacturing sector, medical devices. The medical devices industry offers an interesting example of a high-tech and high-value manufacturing sector. It is characterized by strong and growing global demand as populations age and healthcare expenditure expands. This study utilizes a gendered GVC framework to analyze the dynamics of female participation in two emerging countries in the industry: Costa Rica and the Dominican Republic. Three key questions are addressed: (1) what is female intensity in the industry and how does it compare to the manufacturing sector as a whole; (2) does female intensity change over time as the sector grows and more technologically sophisticated products are manufactured in a particular location, and (3) do changes in wages as a result of upgrading affect female intensity in different roles within the industry. The study is structured as follows: first, a brief overview of the existing literature on gender and GVC-trade, focusing on the benefits of a gendered GVC approach, followed by a discussion of the methodology used is presented. Second, an overview of the medical device GVC is provided to highlight key global industry characteristics, particularly with respect to the nature of work in the industry. The report examines the experiences of the two countries cases, focusing on each nation’s upgrading trajectory and gender dynamics within the industry.

Pakistan in the Medical Device GVC

Duke GVCC’s study into Pakistan’s medical devices industry was sponsored by the World Bank.

Central America in Manufacturing Global Value Chains (GVCs)

This research uses the global value chain (GVC) framework to analyze Central America’s participation in global manufacturing value chains, to understand the region’s competitiveness drivers and to evaluate potential risks to continued participation if US trade policies were to change. Central America’s entry into manufacturing GVCs has been through the insertion in various chains including apparel, wire harnesses (automotive) and medical devices. These sectors span low-, medium-, and high-tech manufacturing. They are important contributors to the region’s export basket, and the US is central to their trade. To understand how the region operates in these manufacturing sectors, this report analyzes the participation of select countries in each of the three value chains: apparel (El Salvador, Guatemala, Honduras, and Nicaragua), wire harnesses (Honduras and Nicaragua) and medical devices (Costa Rica and Dominican Republic).

Chlorhexidine for Umbilical Cord Care: A Value Chain Analysis in Bangladesh

The GVC framework can shed light on issues that are literally a matter of life and death. Case in point is a recent study led by the Duke Global Health Institute (DGHI) and GVC Center that identified value chain improvement opportunities for a life-saving commodity: chlorhexidine (CHX) for umbilical cord care. A Duke team of students, staff and faculty dedicated two semesters of research to investigate this topic. This included site visits to Dhaka, Bangladesh in March and May 2015, just before the CHX launch in the country.

Infections cause 13% of the 3 million newborn deaths each year globally. Clinical trials conducted in Bangladesh and other countries have shown that an estimated 23% of neonatal deaths can be averted using 7.1% chlorhexidine digluconate. The UN Commission on Lifesaving Commodities for Women and Children has advocated for country by country introductions of CHX where newborn deaths are high due to infection. CHX is inexpensive (less than $1 per dose) and is manufactured by local as well as multinational generic manufacturers in gel and liquid formulations.

GVC mapping depicts the labor, policies, capabilities, inputs, technologies, standards, regulations and markets relevant to a particular product, commodity or service. Using value chain analysis, Jeffrey Moe (DGHI) and Danny Hamrick authored the study. The report described the full range of CHX activities in the country, including development, production, distribution and adoption and use by mothers and their caregivers.

Duke students contributed to the report by reviewing clinical studies and launches of CHX in other countries and interviewing key actors involved in CHX’s introduction in Bangladesh. Analysis of the map revealed seven “leverage points” — an opportunity to consider “upgrading” to capture efficiencies, reduce costs and increase access and quality. The seven leverage points highlighted in the report are:

1. Research and development

2. Packaging

3. Regional supply and market expansion

4. Safe delivery kits

5. Distribution

6. Global coordination

7. Monitoring and performance metrics

Moe and Hamrick suggested that the “report provides another application of value chain analysis to studies of global health by highlighting the various roles actors play, the governance structures that guide activities and the crucial leverage points.”

The student work and their visit to Bangladesh was funded by the Bass Connections program at Duke University. USAID’s Health Education Solutions Network also provided support.


Costa Rica in the Medical Devices Global Value Chain: Opportunities for Upgrading: Chapter 2

This report begins with an overview of the medical devices value chain, discussion of key segments,  governance structure, upgrading and workforce development. Understanding the manner in which the industry operates at a global level is essential to be able to determine how Costa Rica may be able to grow in the future. The next section examines the upgrading experience of Baja California and Ireland in the GVC for lessons to inform Costa Rican policy development and to identify potential upgrading trajectories for the country. Section four provides an analysis of Costa Rica’s current contributions to the global medical devices sectors and the country’s position in the GVC, highlighting significant trends in the evolution of the industry in the country. Finally, challenges that could undermine attempts to upgrade and grow are discussed.

Gereffi gave a presentation at the Life Sciences Forum in San Jose, Costa Rica (March 18-20, 2013) based on results of this 2013 report on Costa Rica in the Medical Devices Global Value Chain: Opportunities for Upgrading. More than 400 leading company representatives from the medical industry and international experts gathered from the United States, Puerto Rico, Italy and Latin America at the event to discuss topics of interest for the life sciences sector.

A World FZO Bulletin article “Global value chains and upgrading: Export promotion in FTZs” highlights Costa Rica’s medical devices sector based on the GVC Center’s 2013 report for Costa Rica. The issue was distributed to all participants at the World FZO conference held in Dubai, May 9-11, 2016.

The Globalization of Innovation: Can India and China Cure the Global Pharmaceutical Market?

Multinational pharmaceutical corporations are searching for means to broaden their capacity for drug development while decreasing costs. Pharmaceutical firms in India and China are increasingly forging partnerships with these corporations to gain revenue and to develop their own expertise. These relationships largely appear to be symbiotic. As a result of the movement of research to their countries, Indian and Chinese scientists are rapidly developing the ability to innovate and create their own intellectual property. Several firms in India and China are performing advanced R&D and are moving into the highest-value segments of the pharmaceutical global value chain. This research was funded in part by the Ewing Marion Kauffman Foundation.