This is a joint post with Denizhan Duran and Kate McQueston.
The global health legacy of 2012 will be twofold, a year of both increased commitments to health and flat lining budgets. Just look at this past summer: world leaders made a call to end preventable child deaths, the London Summit on Family Planning has resulted in $2.6 billion of commitments, and the International AIDS Conference saw a commitment to the “beginning of the end of AIDS.” While these are all great news, it is still uncertain as to who will pay for these ambitious goals: biggest donors are already scaling down their health aid budgets, and there remains a tremendous resource gap to reach the end of AIDS.
Through our value for money work, we have attempted to reconcile these opposing trends of declining resources and increasing ambition. In a period of declining resource envelopes, donors are facing the challenge to do more with same or less money. We have also worked extensively on measuring aid effectiveness for donors, by quantifying the quality of health aid and writing about the future of the United States’ global health architecture, calling for a more harmonized and focused approach. We have focused extensively on how global health funders could ensure value for money, blogging and writing background papers. All of these feed into our ongoing working group on value for money, which is timely as the Global Fund underwent a serious transformation this year. We are bringing all of this work with us into 2013: as Mark Dybul takes the helm at the Global Fund, we hope our advice will inform the Fund’s transition. We are also hoping that the world’s largest global health donor, the United States, completes the reorganization of its global health architecture in a way that fosters harmonization and effectiveness.
The challenge of sustaining value for money has also affected low- and middle-income countries in 2012, as most of them are set to see increasing healthcare costs. One way to deal with these issues is to establish institutions which set priorities rationally (read: based on equity and cost-effectiveness) for public spending on health. Over the next year we are hoping to see better use of priority-setting processes and systems to decide how health funding is allocated. Many countries, especially those in Latin America, have already made great strides in the systematic incorporation of priority-setting processes into their decisions regarding the coverage of health services. These innovations could be better shared between countries and to countries currently lacking sufficient processes for evaluation. Such processes are also of growing importance in light of the increasing support for universal health coverage, which aims to increase coverage of some health services but often lacks significant health budget increases to accompany these changes (see Bill Savedoff and Victoria Fan's Lancet article here). While UHC is an important goal for countries to work towards, the concept leaves something to be desired as a potential post-2015 development goal (see here). Next year we hope to see more agreement over the definition of UHC, and the use of better priority-setting processes to help countries get there.
Enabling and utilizing data for informing national and donor choices was another major theme this year, and is set to inform donors and countries as they seek to maximize value for money. This year CGD teamed up with the African Population and Health Research Center to convene the Data for Development Working Group, which is working to identify the underlying political economy issues related to the collection, analysis and use of data for policy-making. The recently released Global Burden of Disease Study 2010 from IHME and its partners is another example of efforts to better utilize systematic efforts to understand global health issues, in particular addressing global burdens of mortality and disability. A further example of global data intended for policy use is our Commitment to Vaccination Index, which evaluates the performance of countries of all income levels, finding that populous middle-income countries in particular could benefit from improved vaccination coverage. Thankfully, more people are talking about data - mostly in the context of what has been dubbed as big data. Next year, we are hoping to see better data feeding into policymaking – and hoping to feel less like this guy as we attempt to use data to answer these questions.
Beyond wrapping up our data-driven value for money work, we also have three new exciting topics on the pipeline. We will be writing more about how to adapt insight from behavioral economics into global health. We will be starting new research on intergovernmental transfers in populous low- and middle-income countries, and how they can be used for better health outcomes. We are also amid a call for proposals to update Millions Saved, a set of case studies demonstrating proven successes in global health (friendly reminder the deadline to submit is January 15th).
Stay tuned for more stimulating research in 2013, and happy holidays!