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Independent research for global prosperity

June 2007

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Global Health Policy Research Network Update



June 2007


In this issue:




Report of the Global Health Forecasting Working Group Now Available
CGD convened the Global Health Forecasting Working Group in 2006 to study the challenges surrounding demand forecasting. The group concluded that better forecasting requires wider sharing of the risks involved in producing drugs among those who influence market dynamics, and aligning incentives through three mutually reinforcing actions:


  • Improve the capacity to develop credible forecasts by taking forecasting seriously.
  • Mobilize and share information about product demand in a coordinated way through the establishment of an infomediary.
  • Adopt a set of contractual arrangements.

These recommendations are presented in the Working Group’s final report, A Risky Business: Saving Money and Improving Global Health through Better Demand Forecasts (as well as an accompanying policy brief). The Working Group report was launched on May 29 before a standing-room only crowd at an auxiliary event of the Global Health Council’s 34th Annual International Conference. Several news organizations have picked up the findings, including the Financial Times and Voice of America (to air at 10:30 EDT on Friday, June 8), demonstrating there is much interest in the demand forecasting challenge. Please contact Jessica Pickett (jpickett@cgdev.org) for a complimentary copy of the Working Group report; additional copies will soon be available for purchase.



Following the Money: Toward Better Tracking of Global Health Resources
The Global Health Resource Tracking Working Group has identified the lack of timely, accurate information about spending on health services and public health programs as serious constraints on good policymaking and effective use of limited resources in developing countries. Some advances have been made in improving the quality of data on national spending and external financial flows from public and private donors. But there is a clear need to further improve data systems. More information about what resources are expected - from whom, and for what purpose - and better tracking of how those funds have been spent will allow policy leaders, advocates and analysts to more effectively raise additional resources and allocate them toward the populations and types of services that are vital to the achievement of the Millennium Development Goals. The Working Group’s final report, Following the Money: Toward Better Tracking of Global Health Resources, calls for: coherent and long-term support to improve government budgetary and financial systems in the developing world; standard approaches to documenting and analyzing health sector expenditures; and more timely, predictable and forward looking data on external assistance to the health sector.



Update on IMF Programs and Health Expenditures
Background research for the Working Group on IMF Programs and Health Expenditures, which will issue a report this summer, has been released as an interim CGD Working Paper, "What Have IMF Programs with Low-Income Countries Assumed About Aid Flows?," which finds that IMF projections of net aid to countries in Sub-Saharan Africa are generally more pessimistic than the path implied by commitments at the Gleneagles Summit of a doubling of aid to Africa. Working Group chair David Goldsbrough provided to the UNDP Poverty Centre a summary of IMF fiscal program design features that may have unduly constrained the spending of aid, "The IMF and Constraints on Spending Aid."



Generating Political Priority: Lessons from Maternal Health
In a new policy brief, Visiting Fellow Jeremy Shiffman discusses nine factors that influenced the degree to which national leaders in five countries made one public health issue - maternal mortality - a political priority. Pregnancy-related complications are the leading cause of mortality globally among adult women of reproductive age, with more than half a million deaths annually. But in some countries maternal health has become a priority and maternal deaths have fallen, while in other countries this has not yet occurred. In comparing of the conditions of maternal mortality in these countries, Shiffman offers recommendations for public health priority-setting in developing countries. His bottom line: attaining public health goals is as much a political as it is a medical or technical challenge; success requires not only appropriate technical interventions but also effective political strategies.



New Working Papers on Performance-Based Incentives
CGD has recently released a series of four new working papers from the Working Group on Performance-Based Incentives. They provide a preview of the working group book, to be published by early 2008, which will feature these and three other case studies of performance-based incentives in practice.



Co-author Rena Eichler drew on these findings at a recent workshop on performance-based incentives in Kigali, Rwanda, that convened teams of African implementers and researchers to develop performance-based incentive schemes within their own health systems.



Invitation to Join the International Initiative for Impact Evaluation
The International Initiative for Impact Evaluation (3IE) has been founded to promote more and better impact evaluations of social and economic development programs. A strong array of development organizations are founding members, including: the Mexican Ministries of Health and Education, Ugandan Ministry of Finance, UK Department for International Development, Netherlands Ministry of Foreign Affairs, Canadian International Development Agency, African Development Bank, Bill & Melinda Gates Foundation and William and Flora Hewlett Foundation. If your organization wishes to learn about membership in 3IE, please email rlevine@cgdev.org.



Working Paper on Diarrheal Disease
A recent paper by CGD Non-Resident Fellow Michael Kremer and Alix Zwane, "Cost-Effective Prevention of Diarrheal Diseases: A Critical Review," takes on an underreported disease that is responsible for 20 percent of child deaths worldwide. The paper examines existing research on the cost-effective prevention and treatment of diarrheal diseases, highlighting how much more is known about the impact and cost-effectiveness of public health interventions to prevent diarrheal disease than about environmental approaches. In spite of the lack of knowledge around the effectiveness of environmental health interventions, the authors say it is critical to consider them because "the marginal cost of expanding the child health interventions to uncovered populations may be high, even though the average cost of the interventions are often relatively low." They recommend three new avenues of research in environmental health, including: evaluating alternative transmission interruption mechanisms, improving the understanding of determinants of individual-level technology adoption in the water and sanitation sector, and assessing the quality of infrastructure maintenance under different management schemes.



Evaluating the Impact of ARVs in Africa
Two CGD researchers, Mead Over and Harsha Thirumurthy, have been working with collaborators in several countries to collect and analyze data on the household and facility level determinants of patients’ adherence to treatment programs. Over is working with Damien de Walque of the World Bank and with researchers in Ghana, Burkina Faso, Mozambique, India and South Africa to collect data on the households of AIDS patients.



HIV/AIDS Monitor Update
The Lancet recently published a paper by CGD Senior Fellow Steve Radelet which identifies characteristics of Global Fund grants that are correlated with both high and low evaluation scores. Radelet found that programs implemented by non-governmental recipients receive higher scores than those implemented by the government; evaluations scores are higher in countries with more physicians per capita and high immunization rates; and grants in countries with fewer donors or where Global Fund grants are a larger share of donor funding receive higher scores. These findings could be used to guide the allocation of Global Fund resources for oversight and risk management. Additional recommendations to the Global Fund as well as PEPFAR and the World Bank MAP program are expected to emerge from the four-country study that the HIV/AIDS Monitor is currently undertaking on "Tracking the Funding," which will explore AIDS funding levels, funding recipients, and the types of activities being funded.



Progress on AMC for Pneumococcal Disease
On May 10, the Global Health Council, the GAVI Alliance, PATH, PneumoADIP, and the International AIDS Vaccine Initiative co-hosted a Capitol Hill briefing on Innovative Financing for Life-Saving Vaccines, with Orin Levine, Fred Were, myself and others in a discussion of Advance Market Commitments. More than 80 people attended, and many expressed interest in adding their voices to the call for U.S. support. This event came on the heels of several related sessions at the BIO International Convention in Boston earlier that same week, where we heard resounding interest from the private sector. With $1.5 billion already committed from Italy, the United Kingdom, Canada, Russia, Norway and the Bill & Melinda Gates Foundation, GAVI and the World Bank are now actively moving forward to establish the framework contracts for a pilot AMC for pneumococcal disease. As part of this effort, they are currently holding a call for nominations for experts in health economics, vaccine business development and contract law to join the Independent Assessment Committee. More details are available here; nominations should be sent to IAC@gavialliance.org.



Job Opportunity: GHPRN Program Coordinator
CGD is now accepting applications for a Program Coordinator to manage and support the work of the CGD Global Health team. To learn more about this opportunity, please see the full position description.



CGD Bids Farewell to Aaron Pied & Jessica Gottlieb
Aaron Pied, who provided administrative and web support to the CGD’s global health program for two years, has recently left to pursue opportunities in Thailand. Aaron was our "go to" team member and contributed in many ways, large and small, to keeping on track our growing number of projects. We wish him the very best for his future adventures!


Jessica Gottlieb also is leaving us after two years, on her way to Stanford University for doctoral work. Over the past two years, while serving as a Program Coordinator at CGD, Jessica has been a driving force behind much of our global health work: She coordinated the process of updating Millions Saved: Proven Successes in Global Health, and prepared two new case write-ups for the new edition; she organized all the consultations for the Evaluation Gap Working Group and its follow-up, including meetings in South Africa, Mexico, India and Bellagio and Italy; and helped to coordinate the publication and launch of the Working Group’s report last year. Moreover, she has been a core team member, working with Nancy Birdsall, Bill Savedoff and myself on every aspect of our work to promote more and better impact evaluation. Finally, she has worked closely with Rena Eichler and myself on the Working Group on Performance-Based Incentives, and will be a co-author of the final report, to be published by early 2008. Throughout her time with us, Jessica has brought to each and every task a special and unfailing combination of brainpower, wisdom and diplomatic persistence. We will miss her very much, and will looking forward to seeing her many future successes.



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:



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



Regards,


Ruth Levine
Vice President for Programs and Operations
Center for Global Development