This is a joint post with Heather Lanthorn, a doctoral candidate at Harvard School of Public Health.
In mid-July, amidst the busy global-health month of July, in between the Family Planning summit and the AIDS conference, the near-final draft of the independent evaluation of the Affordable Medicines Facility - Malaria (AMFm) was released.
We all know poverty is undesirable. Not only because of its effects on quality of life, but poverty also has intergenerational impacts and leads to negative health outcomes. In general, the poor's demographic characteristics can vary quite significantly from the wealthy—including shorter life expectancies, higher rates of infant and child mortality, reduced educational and human capital attainment levels, and a higher burden of disease. Higher incomes, on the contrary, have been associated with positive improvements in health, increased female labor force participation, and better educational outcomes for children.
Despite major fertility declines that have taken place in recent decades almost all over the world, population growth is far from over. As Ken Weiss points out in a recent five-part series in the Los Angeles Times, the adverse effects of population growth are well documented and wide ranging. But population reduction through fertility declines may also have unintended consequences if proper policies aren’t in place early on.
At the IAS conference, protestors turned out to oppose one reform under consideration at the Global Fund for AIDS, Tuberculosis, and Malaria: allocating funding ex ante instead of having countries propose the amount they would like to receive. Mohga Kamal-Yanni of Oxfam writes:
Two messages reigned supreme at last month’s International AIDS Conference (IAC) in Washington DC: 1) that there should be universal coverage of HIV/AIDS treatment and 2) that international funding for HIV/AIDS has been flat-lining recently and may even shrink. The most optimistic scenario to reach universal coverage will cost $22 billion dollars annually, which means raising an additional $6 billion per year. Clearly, the goal to provide treatment to the 34 million people currently living with AIDS, and the approximately 2.5 million newly infected each year, conflicts with the reality of shrinking aid budgets.
In 2009, Michelle Adato and a co-author pointed out that cash transfers could add value to the HIV response, by reaching the poorest households relatively quickly. Now, a new generation of cash transfer programs in sub-Saharan Africa is reducing new infections and HIV-related risky behavior—and documenting the gains—while also providing consumption, nutrition, education, and mental health benefits to the orphans and vulnerable children who are the primary targets of some programs.
Economists are not global health’s most popular human resource. They usually show up to dampen enthusiasm by nattering on about budget constraints, trade-offs and incentives. In the HIV/AIDS field in particular, health economists and their work have been viewed with profound skepticism. At a recent debate, talking about choices and budget constraints was labeled “dangerous” to fundraising by one participant.
Christmas came early this year for the wonkiest of PEPFAR-watchers. Our gift: the preliminary report on the pilot of PEPFAR’s Expenditure Analysis Initiative, an important and exciting move by PEPFAR towards evidence-based decision making and greater transparency.
This month, both Health Affairs and the Journal of Acquired Immune Deficiency Syndrome (JAIDS) released special thematic issues on the US President’s Emergency Plan for AIDS Relief (PEPFAR) in which the articles – mainly commentaries but some analyses – provide an exceptionally positive readout on PEPFAR’s past performance and future direction. In principle, this is great – any insights into PEPFAR are always welcome, and it’s clearly valuable to discuss and disseminate lessons learned from the program. If these articles were posted on the PEPFAR website, or released as official PEPFAR reports, we wouldn’t bat an eye. But within scientific, peer-reviewed journals, the articles read more like PEPFAR PR rather than commentary and analysis from independent, third-party observers and stakeholders. A quick skim of the titles in the table of contents illustrates this point (see word cloud of selected title excerpts), and a closer look at the contributors sheds some light on why this may be the case: most authors of the articles are somehow affiliated with PEPFAR or with organizations that have received money from the program.
One of the many interesting sessions at the International AIDS Conference was on how PEPFAR and the Global Fund could collaborate more strategically to maximize impact. The motivation for this kind of collaboration isn’t news to anyone in global health: at a time of budget austerity and flat lining aid contributions, a great way to maximize impact is to harmonize, coordinate and pool donor resources.