Mead Over

Join us for a discussion with Patrick Guillaumont, President of Fondation pour les études et recherches sur le développement international (Foundation for Studies and Research for International Development), Professor at Université d'Auvergne (CERDI), and Member of the UN Committee for Development Policy. He will be presenting his working paper "Adapting Aid Criteria to Development Goals," which argues on both equity and efficiency grounds for the application of selectivity criteria that are more sensitive to a countries "structural vulnerability." Professor Guillaumont's approach leads to allocating a greater share of aid not only to the "least developed" countries, by this measure, but also to small and vulnerable countries or fragile states which otherwise do not quite fit the definition of least developed.

Please join us for a discussion with Dr. Alan Whiteside, where he will examine the origins of AIDS exceptionalism and how it has helped and hindered our response to the epidemic. Whiteside will ask if exceptionalism is still a useful concept in light of our current knowledge about the epidemic, the global financial crisis and changes in health governance. Nandini Oomman and Mead Over from the Center for Global Development will serve as discussants for what promises to be a fascinating conversation.

HIV and AIDS in South Asia: An Economic Development Risk, a new book edited by Markus Haacker and Mariam Claeson, offers an original perspective on HIV and AIDS as a development issue in a region with a low HIV prevalence and concentrated epidemics. Although the impact of HIV and AIDS on economic growth appears to be very small, three major risks to development are associated with HIV and AIDS in South Asia: the risk of escalating concentrated epidemics, the economic welfare costs, and the fiscal costs of scaling up treatment.

Why do ten million children continue to die each year from preventable causes? There is good clinical evidence, and some examples, illustrating that child deaths could be rapidly reduced through inexpensive measures readily available today. However, despite sometimes good intentions, neither foreign assistance nor local governments have achieved enough. A bias towards public provision of clinical services, the use of ineffective interventions, and the failure to exploit parents' natural love for their child, may explain lack of success. Effective Intervention, in partnership with the London School of Hygiene and Tropical Medicine, is currently implementing two large aid projects in west Africa and India, designed as randomized controlled trials, that aim to rapidly reduce child deaths and test whether modest foreign assistance can truly save large numbers of lives.

Integrating private providers into national disease programs is increasingly seen as critical to extending access-to-care, particularly to poor households which paradoxically are often among those most likely to pay for private services. A number of global programs, notably TB, malaria, and reproductive health, have made considerable progress in engaging private providers in both prevention and treatment activities. Private TB care is supported through public-private mix (PPM-DOTS) initiatives in all high-burden countries. Subsidized private distribution of malaria nets and medicines, of family planning commodities and services, and of clean water and vitamins are all accepted as effective and desirable by both donors and low-income governments and are common around the world. This type of engagement is less common in donor-supported HIV/AIDS programs. This talk will focus on the possible reasons for why this is so, and why a few countries are exceptions and continue support for private ART as a component of their national AIDS programs. Whether this is a good thing or a bad thing for sustainability of programs, for access to care, and for social justice and cost-effectiveness will be discussed.

Abstract: It is widely believed that cost-sharing—charging a subsidized, positive price—for a health product is necessary to avoid wasting resources on those who will not use or do not need the product. We explore this argument in the context of a field experiment in Kenya, in which we randomized the price at which pregnant women could buy long lasting anti-malarial insecticide treated nets (ITNs) at prenatal clinics. We find no evidence that cost-sharing reduces wastage on those that will not use the product: women who received free ITNs are not less likely to use them than those who paid subsidized positive prices. We also find no evidence that cost-sharing induces selection of women who need the net more: those who pay higher prices appear no sicker than the prenatal clients in the control group in terms of measured anemia (an important indicator of malaria). Cost-sharing does, however, considerably dampen demand. We find that uptake drops by 75 percent when the price of ITNs increases from zero to $0.75, the price at which ITNs are currently sold to pregnant women in Kenya. We combine our estimates in a cost-effectiveness analysis of ITN prices on infant mortality that incorporates both private and social returns to ITN usage. Overall, given the large positive externality associated with widespread usage of insecticide-treated nets, our results suggest that free distribution is both more effective and more cost-effective than cost-sharing.

An innovative model for fighting HIV/AIDS in Africa is being piloted in Botswana through a public-private partnership involving the Government of Botswana, the Bill & Melinda Gates Foundation and Merck & Co., Inc. The partnership is intended to help Botswana achieve an "AIDS-Free Generation by 2016" by expanding prevention, supporting treatment, increasing counseling and testing, and empowering communities. How does this model differ from other approaches to fighting HIV/AIDS? Has it succeeded? Can lessons from Botswana be used to develop similar public-private partnerships elsewhere in Africa? How can donors support such partnerships? Please join us for a lively discussion of these and other important issues relevant to Botswana’s national AIDS program.

Thailand and the United States began negotiating a free trade agreement in 2004. Although negotiations are now stalled, the latest version of the FTA would restrict Thailand's ability to produce or import generic AIDS drugs. Limpananont argues that these restrictions could have a significant impact on Thailand's national HIV/AIDS treatment program. We anticipate a lively discussion about the tradeoffs between the potential economic benefits of FTAs and access to medicines.