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Global Health Policy

CGD experts discuss such issues as health financing, drug resistance, clinical trials, vaccine development, HIV/AIDS, and health-related foreign assistance.

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Global Health Policy

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India Has a New Approach to Improving State Performance in Health

A new pay-for-performance approach to spur the 35 states of India to perform better in the health sector was recently announced. For the first time, central government funding to individual states under the country's 'flagship' health program, the National Rural Health Mission (NRHM), will depend on the state's performance. According to a Times of India news article, states that fail to perform on certain areas – primarily a more equitable distribution of doctors and nurses – will have their NRHM budget reduced, while states demonstrating performance on other areas, such as providing free generic drugs at public facilities, can earn additional outlays.

Will the Agenda for Child Survival Survive?

Saving kids: Who doesn’t want to do that? Though relatively uncontroversial (say, compared to saving drug addicts and sex workers), the agenda for child survival is not new. In fact, it’s a (relatively) old agenda in global health, arguably dating back to the time of UNICEF's third Executive Director James Grant (1980-1995) who pushed to recognize the “global silent emergency” and to reduce preventable child deaths.

A Nearly Extinct Species: Demographers at the World Bank

At the end of the month, the last senior demographer at the World Bank will leave on retirement, cementing the erosion of the Bank’s technical cutting edge in demography and stirring the question:  How will the World Bank understand key development challenges without demographic expertise in-house?  And without this knowledge, how will the Bank advise its client countries effectively?

“Stunning Progress” or “Implausible and Invalid”: The Afghanistan Mortality Survey 2010?

Afghanistan accounted for 15 percent of all U.S. economic assistance allocated in FY2012, amounting to 2 billion dollars. USAID has contributed at least 15 billion in aid to Afghanistan since 2001, with cumulative investments in the health sector at nearly 1 billion. But the impact of these investments has been difficult to judge because of lack of reliable data and accurate measurement, leaving many wondering: What have these funds achieved? In particular, has this economic assistance improved the health of Afghans?

What Indicators Reveal about Interest in Global Health: The World Health Statistics Report

A few days ago the World Health Statistics 2012 Report released its annual compendium of statistics. No doubt, it was a lot of work to compile—to verify every number in every cell, for each country and indicator. The WHO should be commended for providing this invaluable global public good. A sincere request: the Report would be more user-friendly and useful if the Report came with spreadsheets in downloadable tables (much like the World Malaria Report), and if the Report’s tables were consistent with their main database, the Global Health Observatory (GHO). For example, the coverage measures of oral rehydration therapy (ORT) which were included in the Report are absent from the GHO, as far as we can tell. (On an unrelated note, we did notice that the GHO recently added hand-washing as an indicator, perhaps in response to a recent blog—kudos to WHO!)

West Africa: The Demographic Dividend Is Not a Given

Nowadays, the international development community is abuzz about the strong economic performance of sub-Saharan Africa.  This year alone, the International Monetary Fund (IMF) estimates growth in the region at 5.4 percent, and only ‘developing Asia’ should do better.  Often this kind of economic boon is accompanied by falling fertility rates that usher in a ‘demographic dividend’ – or a window of opportunity when dependency ratios decline and the labor force increases relatively.  But rapid population growth in the West African sub-region in particular may slow down economic development and

Results-Based Aid in Liberia: USAID Forward (and one step back)

In a recent working paper, Jacob Hughes, Walter Gwenigale and I describe Liberia’s unique experience in pooling donor funds for health in a post-conflict setting, with good results. We also describe a new and complementary agreement between Liberia and USAID, called the Fixed Amount Reimbursement Agreement (FARA). It’s been heartening to see USAID take this step towards implementing results-based aid in Liberia, but the process has also highlighted the problems that such aid faces in the ‘real world’.

How Does HIV/AIDS Funding Affect a Country’s Health System?

Recently, the American Journal of Tropical Medicine & Hygiene published a paper by Shepard et al. evaluating the impact of HIV/AIDS funding on Rwanda’s health system. The headline of the press release was catchy and assertive: “Six-year Study in Rwanda Finds Influx of HIV/AIDS Funding Does Not Undermine Health Care Services for Other Diseases. Study Addresses Long-standing Debate about Funding Imbalances for Global Diseases.”

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