Global Health Policy Research Network Update

1. Report on a Global Investment & Action Agenda for Adolescent Girls

2. PEPFAR Reauthorization: Improving Transparency in U.S. Funding for HIV/AIDS

3. Concept Paper: Drug Resistance as a Global Health Policy Priority

4. New Project on Emerging Pharmaceutical Markets

5. Published Data on African Health Professionals Abroad

6. Recent CGD Events

7. Global Health Policy Blog

1. Report on a Global Investment & Action Agenda for Adolescent Girls
The wellbeing of adolescent girls in developing countries shapes global economic and social prosperity--yet girls' needs often are consigned to the margins of development policies and programs. Girls Count: A Global Investment & Action Agenda, co-authored by CGD Vice President Ruth Levine; Cynthia Lloyd (Population Council), Margaret Greene (International Center for Research on Women), and Caren Grown (American University), describes why and how to initiate effective investments that will give adolescent girls in developing countries a full and equal chance for rewarding lives and livelihoods.

Girls Count reviews issues related to girls' nutrition, working conditions, and reproductive health, and includes a special section on adolescent girls and HIV/AIDS. Offering targeted recommendations for national and local governments, donor and technical agencies, civil society, and the private sector, this report argues for country-specific agendas to recognize and foster girls' potential. These and other points are summarized in a recent Voices of America interview with Ruth Levine, and were discussed in more depth at the report launch on January 30.

2. PEPFAR Reauthorization: Improving Transparency in U.S. Funding for HIV/AIDS
In a new CGD note from the HIV/AIDS Monitor, Michael Bernstein and Sarah Jane Staats (Hise) urge Congress to mandate the regular release of PEPFAR funding data as part of the process of reauthorizing the program for 2008-2013. The U.S. Government already collects this funding data but it is not publicly available, and in some cases even PEPFAR staff do not have access. Bernstein and Staats (Hise) argue that releasing the data would improve coordination between PEPFAR and other donors, and allow PEPFAR staff to better assess progress, hold recipients accountable, and increase cost-effectiveness of programs.

To receive more information about the ongoing developments and analysis of the major AIDS donors, please sign up for the HIV/AIDS Monitor E-Update.

3. Concept Paper: Drug Resistance as a Global Health Policy Priority
CGD convened the first meeting of the Drug Resistance Working Group in Washington, DC, on November 8-9, 2007. In advance of this meeting, Rachel Nugent, Jessica Pickett and Emma Back prepared a document describing the sources of drug resistance against AIDS, malaria, tuberculosis and other bacterial infections; the rationale for global policy action; and the types of policies and actions that donors and agencies should consider if drug resistance is to be brought under control. "Drug Resistance as a Global Health Policy Priority" (pdf) has received additional expert input from the Working Group and is now final. In the paper, the authors pose six key questions for further research and deliberation:

• What are the short- and long-term political, social and economic costs of resistance?
• What are the causes and important correlates of resistance, and how do they vary by region and disease?
• What information is available about drug resistance and how is it shared? What new information systems or mechanisms are needed?
• What conditions contribute to cross-country transmission?
• Can existing models of collective action be applied to resistance?
• What should private and public sector actors do now for long-term containment of resistance?

Over the course of the next year, these lines of inquiry will guide the Working Group's analysis of the institutional, social, and economic conditions contributing to drug resistance and inform specific policy recommendations and investments that could be undertaken at a global level to reduce it.

4. New Project on Emerging Pharmaceutical Markets
The Center has recently launched the Global Health Frontiers project to re-visit some unresolved issues about access to affordable global health products and services in light of the new conditions in middle-income countries. The global pharmaceutical industry is in transition: growth in high income markets has slowed, while growth in emerging economies such as Brazil, Thailand, Indonesia, India and China is in the double digits. Although many programs have focused on access to new drugs and vaccines in the least developed countries, rapidly growing countries at higher income levels home to more than 70% of the world's poor have historically been ignored by both companies and donors. While the countries are too wealthy to qualify for much development assistance, entrenched inequality and substandard delivery systems have prevented healthcare and medicines from reaching the entire population. At the same time, economic development has increased the demand for new health products, and the concurrent increase in the burden of non-communicable disease has led to a greater degree of overlap with the products currently available in high-income markets.

Within this context, the Center for Global Development seeks to explore whether the economic driver of the relative wealth of emerging market countries can provide an incentive for pharmaceutical companies to contribute to expanded access to health-related products and services that will benefit the poorest populations at the "bottom of the pyramid." If such potential exists, CGD hopes to identify specific ways in which global health actors, including the donor community, can support engagement of pharmaceutical innovators and suppliers in emerging markets.

5. Published Data on African Health Professionals Abroad
Human Resources for Health published a paper by Michael Clemens and Gunilla Peterson documenting that about 30% of physicians born in sub-Saharan Africa, as well as roughly 15% of registered nurses, work outside Africa. The BBC, Voice of America, Radio France, and others discussed the work. Recent years have seen a rising tide of international attention to the 'brain drain' of African health professionals, discussed with grave concern by the World Health Organization and labeled by the British Medical Association as the "rape" of Africa. News reports on CGD's counts of African health workers abroad tended to take a similarly bleak view of the numbers and move immediately to discussion of how emigration can be stopped. In response to a misreading of the research, Michael urged more nuanced thinking about these issues in a blog post as well as a technical working paper.

6. Recent CGD Events
CGD regularly hosts public events where other researchers and program leaders have the opportunity to share their work with Washington-based development community. Several recent and upcoming events are particularly relevant to ongoing debates in global health:

• Rukmini Banerji of the Pratham India Project discussed the use of impact assessment and community involvement by Pratham in working with the government, citizens and the corporate sector to further universal primary education.
• Brookings Institution Research Fellow Jessica Cohen presented results on free distribution compared to cost sharing from a malaria prevention field experiment in Kenya. Moderator Mead Over shared his reflections on the event in two related blog posts on user fees and social marketing. The conversation continued with a January 25 event in which doctoral candidate Vivian Hoffman discussed how the method of acquisition impacts the intra-household allocation of nets.
• Jacques van der Gaag addressed the potential market for health insurance in Africa through a study analyzing willingness-to-pay in Namibia.
• Julian Schweitzer, Director of the Health, Nutrition and Population program at the World Bank, gave a talk on Health Systems Strengthening and a new aid architecture.
• Dominic Montagu spoke on the role of the private sector in HIV/AIDS treatment programs.

Please see our events page for information about other upcoming events.

7. Global Health Policy Blog
For ongoing news, updates and commentary about our own work and our partners' activities, please visit and contribute comments to our Global Health Policy blog. Recent highlights have included:

• Comparison of drug resistance to global warming on factors like limited resource use.
• Building momentum towards achieving the maternal health MDG.
• Commentary on an LA Times article on global health programs and a discussion of strategies for addressing issues in African health systems.
• How the revision of AIDS prevalence data affects resource allocations.
• Discussion of a new paper written by Jeremy Shiffman during his time at CGD on whether HIV/AIDS funding is displacing aid for other health issues.

Suggestions for topics can be sent to globalhealthpolicy@cgdev.org.