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Global Health Policy Research Network UpdateJune 2008In this Issue:
1. New Findings on Long-Term Financial Implications of HIV/AIDS Commitments U.S. global AIDS spending is helping to prolong the lives of more than a million people and is widely seen as a foreign policy and humanitarian success. Yet this success contains the seeds of a future crisis. Life-long treatment costs are increasing as those on treatment live longer, and the number of new HIV infections continues to outpace the number of people receiving treatment. Escalating treatment costs coupled with neglected prevention measures threaten to squeeze out U.S. spending on other global health needs, even to the point of consuming half of all foreign assistance by 2016, assuming no major expansion in the rest of the budget. A CGD Working Paper by Senior Fellow Mead Over describes the dimensions of these problems and argues that the United States has created a new global "entitlement" to U.S.-funded AIDS treatment that currently costs about $2 billion per year and could grow to as much as $12 billion a year by 2016—a figure representing more than half of what the U.S. spent on total overseas development assistance in 2006. Additionally, the AIDS treatment entitlement would continue to grow, potentially squeezing out spending on HIV prevention measures or other critical development needs, all of which would be considered "discretionary" by comparison. Over suggests ways to substantially restructure the President's Emergency Plan for AIDS Relief (PEPFAR) to avert a crisis in which Americans would have to choose among indefinitely increasing foreign assistance spending or withdrawing the medicine that millions of people depend on to stay alive. 2. HIV/AIDS Monitor Paper on PEPFAR Database The HIV/AIDS Monitor has released for the first time a detailed database on PEPFAR funding and a new paper analyzing the data. The paper, by Nandini Oomman, Michael Bernstein, and Steven Rosenzweig, provides new evidence on four key issues related to PEPFAR funding: the effect of congressionally-mandated global funding earmarks on country level allocations for prevention, treatment and care; the role of faith-based organizations; the role of host country governments; and capacity-building through support for local recipients. The authors call on PEPFAR to regularly publish official data on obligations to recipients of the funds to improve transparency and allow accurate analyses of its cost-effectiveness to be carried out. They suggest that PEPFAR remove congressional earmarks on funding to improve flexibility and responsiveness of locally allocated funds; reevaluate its strategies of emphasizing faith-based organizations, many of which are international; work more closely with host country governments to coordinate their efforts with those of non-governmental recipients; and expand its efforts to build the capacity of local groups by ensuring that more of its funds reach local recipients. In the works are global-level papers that examine the supply chain for antiretrovirals, the HIV/AIDS donors' recent efforts to re-examine gender strategies, and the role of performance in the donors' funding decisions. Forthcoming country-level papers will look at the role of performance in donor funding decisions and the effects of HIV/AIDS funding on the broader health systems in Mozambique, Uganda, and Zambia. Findings from the latter will be presented in a satellite session at the International AIDS Conference in Mexico City on August 6 from 6:30-8:30pm and will feature a discussion among a high-level panel of donor and host country officials. Stay tuned for more details! 3. The Path of Least Resistance CGD's Drug Resistance Working Group, launched in November 2007, unites global drug resistance experts across geographic regions, disease areas and professional sectors (including academia, industry, national and international policy, NGO, and advocacy organizations) to develop key recommendations for dealing with this growing global health concern. Drawing on the strength of its diverse composition , the Working Group brings together communities that have an interest in drug resistance, but rarely have the opportunity to forge joint solutions. The Group will offer realistic, credible and actionable recommendations in spring 2009 that will aim to orient key actors who can influence policy to slow drug resistance emergence and transmission (See this Q&A for more details, or the accompanying video interview with Rachel Nugent). To learn more about this and other interim Working Group products, we urge you to subscribe to the monthly Drug Resistance and Global Health Update. The Update covers the Working Group's ongoing activities and includes highlights from recent drug resistance research and global policy developments, as well as guest columns from experts on resistance. 4. Advance Market Commitments: One Step Closer to a Pneumococcal Pilot Just over three years ago, CGD published Making Markets for Vaccines: Ideas to Action proposing an Advance Market Commitment (AMC) for vaccines. Since then, Italy, the United Kingdom, Canada, Russia, Norway and the Bill & Melinda Gates Foundation committed $1.5 billion towards a pilot AMC for pneumococcal disease, and GAVI and the World Bank have been working to establish the framework contracts with input from economists, global health experts, medical practitioners and scientists from developing and industrialized countries, manufacturers and civil society organizations ( Ruth Levine and Michael Kremer participated in this process). The Economic Expert Group released its final recommendations in April for consideration by the donors (see their response here). A report summarizing the broader consultation and advisory process is now available as well. These efforts will come to fruition when the stakeholders sign all legal agreements to "officially" implement the first AMC. 5. IOM Global Health Committee Seeks to Inform Priorities in Next U.S. Administration The Institute of Medicine's Board on Global Health is conducting a 14-month consensus study to examine and articulate the case for why multiple agencies from government and the private sector in the U.S. should make a deeper commitment to global health. This study aspires to be a broader and more complete exploration of the subject than the milestone 1997 IOM report, America's Vital Interest in Global Health.+ The Committee on U.S. Commitment to Global Health, which includes Ruth Levine, held its first meeting on March 24, hearing from study sponsors and a range of global health experts. CGD researchers Michael Clemens and Rachel Nugent have been invited to provide specific input to the Committee on health worker migration and non-communicable disease burden, respectively. The second public committee meeting is on July 21 in Washington, DC; online meeting registration is available via the project website. 6. Performance Incentives in Health: A Growing Focus across the International Community Convened in February 2006, the Center for Global Development's Working Group on Performance-Based Incentives looked at how incentives are used in health care to change provider and patient behavior, and their ultimate impact on health outcomes. Their book is now in press, and it reviews a range of experiences with performance incentives, drawing lessons for donor agencies and policymakers in developing countries seeking to expand the menu of ways to improve health systems. As an offshoot of that work, the World Bank and CGD co-hosted the first meeting of the Interagency Working Group (IWG) for Results-Based Financing in Health on March 26 and 27, bringing together representatives of donor and technical agencies interested in the use of incentives in health systems at multiple levels. Norway, Australia, the U.S. and other donor governments are actively exploring the use of these aid mechanisms in the health sector. With support from the Rockefeller Foundation, CGD is working with Paul Gertler and Kristi Raube at the University of California-Berkeley, and Rena Eichler of Broad Branch Associates, to identify country settings where contracting arrangements involving performance incentives either are being tried or hold promise. A report on this is due out in the fall. 7. Learning While Doing: A 12-Step Program for Policy Change This essay by Lawrence MacDonald and Ruth Levine describes a variety of approaches and techniques that the Center has used to bridge the research-to-action gap. Many of these lessons initially emerged from the working group approach that is a hallmark of the GHPRN, and which has since spread to many other areas of CGD. It outlines an emerging 12-step program that the Center's staff has applied successfully in a variety of policy contexts, with particular attention to how the Center has tracked the impact of these initiatives. The essay concludes with suggestions for improving the evaluation of policy and advocacy efforts. 8. Demography for Development Lecture Series on the Horizon Relatively little attention has been given in policy circles in recent years to some of the key forces shaping social and economic prospects: changes in the growth and distribution of populations. On July 15, CGD is launching a new lecture series highlighting research at the Center and elsewhere that explores the ways in which demographic changes will affect global development in the first half of the 21 st century. The talks will address the pathways through which population change affects development including: changing age structures and the demands placed on public services and public finances, the development effects of international migration, population size and impacts on climate change, urbanization, and what to understand about regions with persistently high population growth and regions with population loss. The first lecture will be presented by Professor Joel Cohen, director of the Population Laboratory of Rockefeller University, on the subject of global demographic trends and demography-development links. His lecture will be commented on by Peter Timmer, Non-Resident Fellow at CGD, who will also discuss the implications of population growth for food security, a timely and critical issue that has received renewed attention with the recent food price crisis. We hope that this lecture, and the ones that follow, will help to share policy-relevant research with those outside of the demographic community. We are saying goodbye this month to Jessica Pickett, who has been a key team member in our global health policy program for the past three years. Jessica has focused her work on issues around product development and access, from her early work on follow-up from the AMC Working Group to her coordination of the Forecasting Working Group to her most recent contributions to the Drug Resistance Working Group and Global Health Frontiers, a project looking at the dynamics of the pharmaceutical sector in emerging economies. Jessica has been a tremendous asset to our work, and we wish her all the best as she pursues Doctoral studies at the Wharton School of the University of Pennsylvania. And we say hello and welcome to Kristie Latulippe, who joins our team as a GHPRN Program Coordinator. Kristie holds an MPH from Tulane with a focus on global health and infectious disease. She currently works across the street on outreach and communications with the Brookings Institution"s Global Economy and Development Program, and has prior field experience as a Peace Corps volunteer in Nepal. Also leaving is HIV/AIDS Monitor Program Coordinator Michael Bernstein. As a member of the HIV/AIDS Monitor team, Michael has worked on research analyzing the policies of PEPFAR, the Global Fund, and the World Bank MAP. His work has focused on donor financing policies, performance-based funding approaches, donor interactions with national health systems, and the global ARV supply chain. Michael has been an invaluable contributor to the HIV/AIDS Monitor team, and we wish him the best of luck as he pursues a Masters in Public Administration in International Development at Harvard's Kennedy School of Government. Last but not least, David Wendt has joined the HIV/AIDS team as a Policy Analyst. David holds an MPhil from the Institute of Development Studies in the UK. He has worked as a Monitoring and Evaluation Officer and a Research Team Manager at the Institute of Development Studies and in Uganda with a variety of local NGOs on information and communication technology for development. Welcome David! Multiple health team members contributed to articles in The Economist in the past month. Ruth Levine served as a background source for an article on emerging pharmaceutical markets, while Rachel Nugent was quoted in an article on antimalarial resistance. Another recent Economist story on HIV/AIDS propaganda cites expert Mead Over. A blog by Ruth Levine on April Fool's day was also quoted in the New York Times; however, she was only half fooling when she discussed the concept of donor attention deficit disorder for global health priorities. On June 1, Eduardo Gomez presented his paper on "Strategic Internationalization, Institutions, and Civil Society", which seeks to explain how Brazil outpaced the U.S. in building an effective national AIDS program and policy framework. On May 27, Peter Boone presented his paper entitled "Reducing Child Mortality in Low Income Countries: The Value of Knowledgeable Parents". The presentation described two large aid projects currently being implemented by Effective Intervention, in partnership with the London School of Hygiene and Tropical Medicine in West Africa and India. The programs aim to rapidly reduce child deaths and test, through a randomized design, whether modest foreign assistance can save large numbers of lives. Also on May 27, an event at the World Bank highlighted "Girls Count: A Global Investment and Action Agenda" by Ruth Levine, Cynthia Lloyd, Margaret Greene and Caren Grown that 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. Read the full report online. Check out our calendar for other exciting events! Blogs from members of the CGD staff touched on many topics of interest in the global health world. Comments welcome!
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Ideas to action: independent research for global prosperity