Ideas to Action:

Independent research for global prosperity

March 2010

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IN THIS ISSUE

COMING SOON

ALSO OF INTEREST

IN THIS ISSUE

CGD Working Group Publishes Final Report on Partnerships with the Private Sector in Health

In a new report, Partnerships with the Private Sector in Health, CGD’s Private Sector Advisory Facility Working Group addresses the critical role of the private sector in delivering health care to people in developing countries. Convened by former visiting fellow April Harding and former CGD senior fellow Ruth Levine, the working group set out to explore practical ways for donors and technical agencies to support successful public-private interactions in the health sector. The report outlines how governments in developing countries can partner with the private sector to expand access to high-priority health services to underserved populations. A new advisory facility would support developing-country governments by brokering knowledge, serving as an agent for change, providing strategic advice, and offering technical and implementation support (including contracting, social franchising, and accreditation). The report recommends the World Bank International Finance Corporation as a host institution for the advisory facility. Highlighting that roughly one-half of all health care—even in the world’s poorest communities—is provided by the private sector, the report confirms strong demand for the services provided by an advisory facility, citing as an example the Private Participation in Infrastructure Advisory Facility.

To learn more about the private sector’s success in supporting health initiatives in developing countries, visit the CGD website for a video featuring April Harding.

PopPov Research Network Holds Fourth Annual Conference in Cape Town

Researchers, policymakers, and donors met in Cape Town, South Africa in January for the fourth annual conference of the Population and Poverty (PopPov) Research Network. Prominent researchers from around the world shared their research results on the economic impacts of household fertility choices, family planning, and reproductive health. This year’s conference also highlighted the importance and challenge of translating research into policy. Current and former finance ministers from sub-Saharan Africa offered insights on how population researchers can reach economic decision makers, emphasizing the importance of considering contextual challenges and involving people in the poorest countries to ensure the research is relevant and ultimately used.

You can read more about the conference on CGD's website or listen to Rachel Nugent interviewed on CGD’s Global Prosperity Wonkcast.

HIV/AIDS Monitor Outlines Response to PEPFAR’s Five-Year Strategy

In January, HIV/AIDS Monitor partner Freddie Ssengooba of the University of Makerere School of Public Health in Uganda, wrote an article in New Vision about the implications of recent changes in PEPFAR policy for Ugandans. While PEPFAR’s first phase was extremely successful in providing treatment to millions of people, Ssengooba argues that responding to the epidemic as an emergency has led to weak national ownership. Ssengooba points to aspects of PEPFAR’s Phase I that might limit Uganda’s capacity to effectively maintain, sustain, and expand on current successes: 1) continued treatment for many Ugandans will rely on sustained funding from the American government, and 2) international NGOs continue to dominate PEPFAR funds and programming. While Ssengooba commends PEPFAR for simultaneously identifying challenges and placing greater responsibility on country governments, practical questions remain about how this transition will happen. Similar questions were raised in a joint blog with the HIV/AIDS Monitor team soon after the release of PEFPAR’s Five-Year Strategy.

CGD Participates in Design of U.S. Government Global Health Initiative Consultation Draft

The February 2nd release of the Global Health Initiative (GHI) consultation draft and FY2011 budget marked an exciting moment for the global health community, signaling the U.S. government’s increased commitment to global health. Nandini Oomman encouraged blog readers to comment on the draft, and she and other CGD senior health staff played a key role in drafting and revising the report.

Mead Over participated in a USAID-organized consultation to inform the “Maternal, Child Health, Family Planning and Nutrition” portion of the draft GHI. Mead suggested that collaboration between health service personnel could be improved through the systematic rotation of service providers, an idea that comes from Mead’s visit to a Kisomo clinic.

Rachel Nugent and Nandini were part of a similar group of experts convened by USAID and NIH to advise the GHI team on metrics, monitoring, and evaluation. Rachel proposed that specific outcomes be identified that would be meaningful to multiple sectors in order to encourage more integrated strategies and programming. In a meeting on creating a women-centered approach for the GHI, Nandini facilitated the development of indicators organized around health workforce, health financing, medical products/technologies, service delivery, information, and governance. In a separate consultation group focused on country ownership and strengthening health systems, Nandini recommended the development of specific metrics to increase accountability at all levels.

In addition, Ruth Levine and CGD consultant Jim Rosen authored a forthcoming CGD background paper titled Mainstreaming Adolescent Girls into Indicators of Health Systems Strengthening. The paper’s recommendations were incorporated into the writing of the consultation document and adolescent girls now figure prominently in the new GHI strategy.

Rachel Nugent Speaks on Capitol Hill on World TB Day

On March 24th, Rachel Nugent participated in a Congressional Briefing sponsored by the Global Health Council to mark World TB Day. Speaking alongside a panel of experts, Rachel discussed drug resistant TB, its impact on global health, and the common drivers of resistance across diseases. More information on the event can be found here.

New Report from the IOM on Cardiovascular Disease in Developing Countries

The National Academies Institute of Medicine released a report on Monday, March 22, entitled Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. Rachel Nugent is a member of the committee that produced the report after a year-long study of the growing epidemic of chronic disease in developing countries. The committee found that cardiovascular disease has a significant effect on economic productivity, and threatens the long-term growth potential of developing countries.

Ruth Levine Joins USAID

Ruth Levine, vice president for programs and operations and senior fellow, left CGD at the beginning of March to serve as USAID’s director of evaluation, policy analysis and learning. Under the leadership of administrator Rajiv Shah, Ruth will lead efforts to strengthen USAID’s ability to employ available evidence to guide effective program implementation and informed policy decisions. As the author of numerous publications, including Millions Saved: Proven Successes in Global Health; Making Markets for Vaccines: Ideas to Action;and Start with a Girl: A New Agenda for Global Health, Ruth established an international reputation for proposing and demonstrating improvements in global health evaluation and measurement. We look forward to working with Ruth in her new role.

CGD Health Team Welcomes Bill Savedoff’s Contributions as Senior Fellow

Bill Savedoff has been working for more than 20 years on economic and social development issues with special attention to improving the quality of social services in developing countries through attention to incentives, institutions, and political economy. He has been a CGD visiting fellow and senior advisor to Nancy Birdsall on global health and now will take on an expanded role with the Global Health Policy team as a CGD senior fellow. Bill is working on applying CGD’s new COD Aid initiative to global health and collaborating with the Global Health Policy team on a variety of topics. He is the author and editor of many publications, including Governing Mandatory Health Insurance (co-edited with Pablo Gottret) and Diagnosis Corruption (co-edited with Rafael Di Tella). Bill’s most recent book, Cash on Delivery: A New Approach to Foreign Aid (co-authored by Nancy Birdsall with Ayah Mahgoub and Kate Vyborny) was released this month and was presented at a launch event hosted by CGD on Tuesday, March 23rd.

COMING SOON

Reports from the HIV/AIDS Monitor

The HIV/AIDS Monitor will publish two new reports in March. The first examines how PEPFAR, the Global Fund, and the World Bank’s Multi-Country HIV/AIDS Program for Africa collect and use information about past performance in decisions on future funding. The report synthesizes research on AIDS donor practices in Mozambique, Uganda, and Zambia and finds that only the Global Fund systematically follows a performance-based financing model, however it is limited by weak information systems. The Monitor team recommends that the Global Fund strengthen information systems on performance and PEPFAR and the World Bank develop clear rules and processes for basing funding decisions on performance. This report will be accompanied by a background paper that describes donor policies on performance-based financing. The second report analyzes the incentives for different stakeholders in the global anti-retroviral supply chain to increase the access and availability of ARVs. The report identifies a number of areas where misaligned incentives act as barriers to getting quality medicines to all those who need them.

In April, the HIV/AIDS Monitor will publish a report on workforce capacity. One conclusion is that PEPFAR, the Global Fund, and the World Bank should move away from short term fixes to better support coordinated national efforts at long term and sustainable improvements in workforce capacity.

ALSO OF INTEREST

In the Media

  • Reuters cited Rachel Nugent on the implications of chronic diseases on economic growth in developing countries. (3/22/10)
  • In an article about substandard antimalarial drugs in Africa, the Associated Press quoted Rachel Nugent. (2/08/2010)
  • Nature News quoted Ruth Levine on demand forecasting in an article entitled “Better forecasting urged to avoid drug waste.” (1/11/2010)
  • Nandini Oomman was interviewed for an American Abroad podcast, AIDS: the Politics of Prevention. Nandini’s segment focused on the history of prevention programming within PEPFAR and its future under the Obama Administration. (1/6/2010)

Recent Events


Counterfeit and Substandard Drugs

Rachel Nugent participated in a panel discussion with Roger Bate of the American Enterprise Institute at the Global Health Council on March 10th. The event, entitled Counterfeit and Substandard Drugs in Low-Income Countries, aimed to identify the major issues facing low income countries pertaining to the production, sale, and trade of counterfeit and substandard pharmaceuticals.

The Long Road to Universal Health Coverage: A Century of Lessons for Development Strategy

In his recent seminar at CGD, Jesse Bump, Harvard School of Public Health Takemi fellow in international health policy, investigated the historical origins of universal health care systems and analyzed the politics surrounding national decisions to implement them. Dr. Bump focused on the development of the two main financing models—social health insurance (in Germany) and general taxation (in the United Kingdom)—utilized to achieve universal health care over the past century.

When the Lights Go Out: Permanent Health Effects of Transitory Shocks

In a February 23rd seminar, Alfredo Burlando, a Ph.D. candidate at Boston University, discussed health effects that result from power blackouts around the world. Relying on 350 household surveys and 20,000 birth records, he showed that a month-long blackout in Zanzibar reduced average birth weights for children born seven to nine months later and increased the probability of low birth weight. Mr. Burlando concluded that the most likely cause of birth weight reduction was maternal under-nutrition caused by the temporary reduction in earnings during the blackout. Only women who were in the early stages of pregnancy were affected, suggesting that visibly pregnant women maintained proper nutrition despite the income loss.

Global Governance on Chronic Disease Policy

Rachel Nugent attended the World Economic Forum annual meeting in Davos as a member of the WEF’s Global Agenda Council on Chronic Disease and Well-Being. The expert group is developing a proposal to improve global governance on chronic disease policy. Rachel also participated in a brainstorming session on population and global institutions.

The Safety of Food and Drug Imports

CGD Visiting Fellow Tom Bollyky spoke among a panel of experts at the Center for Strategic and International Affairs on February 4th. The panel discussion focused on the challenges and opportunities ahead in ensuring safe food and drug imports into the United States. Dr. Margaret Hamburg, Commissioner of Food and Drugs at the United States Department of Health & Human Services, gave the keynote speech.

Start With A Girl Highlighted by Secretary of State Hillary Clinton and Melinda Gates

The significance of Ruth Levine’s most recent publication, Start with a Girl: A New Agenda for Global Health, was highlighted by prominent figures at two recent events. Secretary of State Clinton emphasized the importance of increasing girls’ access to primary and secondary schooling at a CGD-hosted speech on January 6th entitled “Development in the 21st Century.” Subsequently, at the “Setting the Stage for the Girl Effect” event at the World Economic Forum in Davos, Melinda Gates referenced the report and affirmed that adolescent girls are one of her priorities.

Global Health Policy Blog

Making the Case for Healthier Hearts in the Developing World, Rachel Nugent

Weak Incentives are the Weak Link in the Global ARV Supply Chain, David Wendt

GlaxoSmithKline’s Evolving Business Model: For Profit and For Greater Good? Nandini Oomman

Community Programming, the Final Frontier: Going Where No World Bank Evaluation has Gone Before, Christina Droggitis

Death Toll from Haiti’s Earthquake in Perspective, Mead Over

FDA Goes Global: A New Approach to Food and Drug Import Safety, Tom Bollyky

Daddy Healthbucks: How Will the Gates Foundation Leverage the New $10 Billion for Vaccines and Immunization? Ruth Levine

U.S. Global Health Initiative: An Opportunity to Provide Short (and Useful) Comments on a Tall Order, Nandini Oomman

A Global Tour of Drug Resistance, Rachel Nugent

Adult Male Circumcision as an HIV Prevention Tool: Should the Scale Up of an Efficacious Intervention Be Evaluated?, Mead Over

Scaling-up for Success: PEPFAR's Prevention Challenge, Nandini Oomman

The End of Exile for Sexual and Reproductive Health and Rights, Rachel Nugent

Evaluation, Evaluation Everywhere: IOM Progress on Evaluating the Impact of PEPFAR, David Wendt

Clinton Stresses the Need to Re-balance Health Assistance Away from AIDS Treatment, Mead Over

A Public Health Time Bomb, Rachel Nugent

Girls Count, So Why Don’t We Count Girls? Ruth Levine