Global Health Policy

The Lancet just published a letter I wrote questioning an influential study in its pages that concluded that most or all foreign aid for health goes into non-health uses. The letter follows up on concerns I expressed in this space in April 2010. Why the 2.5-year lag? Only this past January did the Seattle-based Institute for Health Metrics and Evaluation (IHME) share the data set and computer code that it used to generate the published findings. And only with those in hand could I check my concerns and describe them to others with credibility. (I'm grateful to the kind people at IHME who gave me the data and code, but don't want to let the institution per se off the hook.)

Confusingly, in May the Public Library of Science published another critique of the same article. I questioned that reanalysis, and it was eventually retracted.

Here, I sketch my argument, comment on the reply from Chunling Lu and Christopher Murray, then call out the Lancet for a certain lack of transparency, as well as for sometimes bringing more reputation than rigor to policy-relevant social science research.

Announced in May 2009 by President Obama, the Global Health Initiative (GHI) promised a new way for the United States to do business in global health. Fragmented U.S. programs would be united under a single banner; vertical structures would be dismantled in favor of an integrated approach; and narrow, disease-focused programs would transition toward a focus on broader health challenges, such as maternal health, child survival, and health systems’ strengthening.

[Update, June 29, 2012. The authors of the study here blogged have retracted it. The issue they refer to in the retraction is one I raise toward the end of this post, where I write, "It appears to me that the estimator does not include fixed effects, but merely clusters standard errors by country."]

Cash on Delivery Aid (COD Aid) is moving from concept to reality as I learned in a recent trip to Europe. In the process we are learning a lot about measuring outcomes and other implementation challenges. While I heard about the ways aid agencies are beginning to try COD Aid or similar initiatives, the internal resistance they face told me a lot about the internal contradictions we’ve lived with in foreign aid for a long time.