Global Health Policy Research Network Update

1. Tracking AIDS Funding: A Comparative Analysis of PEPFAR, Global Fund and World Bank


2. Framework and Case Study of Political Priority for Maternal Mortality


3. New Working Group on Drug Resistance


4. Working Group Report: Does the IMF Constrain Health Spending in Poor Countries?


5. Demand Forecasting Events & Updates


6. Advocacy by the Numbers: Vertical vs. Horizontal Health Programs


7. AIDS Treatment and Prevention Programs: Economics and Implications


8. Developing a Healthy Agricultural Policy


9. Staff Updates


10. Global Health Policy Blog

Tracking AIDS Funding: A Comparative Analysis of PEPFAR, Global Fund and World Bank

On October 10, the HIV/AIDS Monitor launched a new paper on "Following the Funding for HIV/AIDS: A Comparative Analysis of the Funding Practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda, and Zambia" at an event featuring presentations by HIV/AIDS Monitor Director Nandini Oomman and Field Director William Okedi. The panel included high-level representatives from each of the donors and from recipient organizations. The paper compares the donors' current actions against the tenets of the Paris Declaration on Aid Effectiveness to help inform recommendations for each donor. In addition to organization-specific recommendations, the authors advise that all AIDS donors: 1) jointly coordinate and plan activities to support the National AIDS Plan; 2) assist the government in tracking total national AIDS funds; 3) focus on building and measuring capacity; 4) develop strategies with host governments and other donors to ensure financial sustainability; and 5) strengthen financial data collection and disclosure.

Framework and Case Study of Political Priority for Maternal Mortality

Former Visiting Fellow Jeremy Shiffman's work on political priorities in global health appears in the Lancet, just in time to inform the Women Deliver Conference in London (http://www.womendeliver.org/). The new paper draws on Jeremy's extensive research concerning global safe motherhood initiatives to propose a broader framework concerning factors that shape political priority for global health initiatives such as HIV/AIDS and malnutrition. Jeremy proposes a formal way to understand how some health issues become priorities -- and others don't -- based on his earlier work on safe motherhood policies in India as well as a broader cross-country study of political priority for maternal health in Guatemala,Honduras, India, Indonesia and Nigeria. Those studies show an important role for factors such as: efforts to establish a global norm about the unacceptabilityof maternal death; provision of financialand technical resources; cohesion among nationalsafe motherhood policy communities; nationalpolitical champions to promote the cause; credible evidence to show policymakers a problem existed; clear policy alternatives to demonstrate the problemwas surmountable; and attention-generatingevents to create national visibility for the issue. The framework offers guidance on how politicalpriority can be generated for other health causes in developingcountries. This was the topic of a CGD seminar in July.

New Working Group on Drug Resistance

The problem of drug resistance is gaining increasing importance globally as greater numbers of patients in developing countries get access to needed drug therapy, delivery systems face increasing pressures and new drug pipelines can't keep up with demand. Resistance has emerged in response to first- and second-line therapies for AIDS, malaria, tuberculosis and other bacterial infections. Health system weaknesses contributing to the problem include: stock-outs of drugs and diagnostics because of a broken supply chain; an inability of patients to obtain timely and continuous care; health workers who don't have the wherewithal to follow up assiduously and make sure patients are completing a course of treatment; non-existent surveillance systems; the widespread availability of fake drugs; and more. These long-standing problems have become more acute with new infectious disease burdens and treatment initiatives.

Multilateral organizations, donors to global public health, the pharmaceutical firms, and health care providers all have an interest in reducing the development and spread of drug resistance. CGD is convening a new Working Group to address this pressing challenge and help point the way to positive outcomes. Led by Senior Health Program Associate Rachel Nugent, the Working Group will publish a final report in late 2008 identifying practical and feasible recommendations for the global donor community, while pointing out opportunities and needs at the local, national, and intra-institutional levels. For more information, please contact Jessica Pickett (jpickett@cgdev.org).

Working Group Report: Does the IMF Constrain Health Spending in Poor Countries?

In fall 2006, the Center for Global Development convened a Working Group to explore the interaction between IMF-supported macroeconomic policies and government health spending, drawing upon background analyses and detailed case studies of Mozambique, Rwanda, and Zambia. Through deep background research and careful deliberations, the working group concluded that IMF-supported fiscal programs have often been too conservative or risk-averse; that the IMF Board and management have not made sufficiently clear what is expected of IMF staff in exploring the macroeconomic consequences of alternative aid scenarios; and that wage bill ceilings have been overused in IMF programs and should be limited to circumstances where a loss of control over payrolls threatens macroeconomic stability. These findings along with six concrete recommendations for change are outlined in the final report Does the IMF Constrain Health Spending in Poor Countries? Evidence and an Agenda for Action, as well as the accompanying policy brief, which were launched at a standing-room only event on September 7, 2007.

The goal of all CGD working groups is to see report recommendations put into action. On that count, the report has begun to have an impact on the debate inside and outside the IMF. The report was disseminated widely within the IMF, which issued a staff response, and recent decisions by the IMF board have already begun to modify policies in the direction called for in the report, including to cut back sharply on the use of wage bill ceilings and to take greater account of the long-term consequences of expenditure decisions when setting fiscal policy. Now, in a new article on "The IMF and Spending for the MDGs" in the latest issue of the UNDP Poverty in Focus, Working Group chair David Goldsbrough and former CGD Research Assistant Ben Elberger build on the Working Group's findings to urge the IMF to focus more on analysis and less on specific conditionality in low-income countries.

David also shares his thoughts on the role of donors and civil society in a highly-relevant and easily comprehensible Q&A and tackles the underlying assumptions about the effectiveness of additional aid spending in a related blog post.

Demand Forecasting Events and Updates

Since the launch of A Risky Business: Saving Money and Improving Global Health through Better Demand Forecasts last May, we have witnessed significant new interest in this topic and emerging support for moving the recommendations forward. For example, improved demand forecasting was highlighted as a key priority in the recent OECD Noordwijk Medicines Agenda. A tuberculosis market analysis by the Global Alliance for TB Drug Development endorsed the infomediary proposal, which was in turn mentioned in both The Lancet and The Lancet Infectious Diseases; the infomediary was also endorsed in a related brief from the International AIDS Vaccine Initiative. The ACT risks and incentives audit, conducted under the auspices of the Global Health Forecasting Working Group, has informed wide-ranging discussions of supply chain policy in the field of malaria.

The World Health Organization hosted a public discussion of the Working Group's recommendations on September 11, 2007, featuring a presentation by IMS Health on their potential role in establishing an infomediary, and report co-author Neelam Sekhri will present the group's findings at the Global Forum for Health Research in Beijing on November 1, 2007, and at the Vaccine Congress in Amsterdam on December 11, 2007. Please contact Jessica Pickett (jpickett@cgdev.org) for more information about these events or to request a copy of the report.

Advocacy by the Numbers: Vertical vs. Horizontal Health Programs

Ruth Levine weighs in on the vertical-horizontal debate in an article on "Unhealthy Competition" from the PAHO magazine Perspectives in Health, which describes the nature of disease-specific advocacy in global health. She argues that real progress depends on reaching a truce in diseases versus disease advocacy in favor of investing in underlying system weaknesses, with an eye toward both program outcomes and genuine, measurable health impacts.

Ruth makes other points about the critiques of vertical programs in a recent blog post, "Should All Vertical Programs Just Lie Down," where she writes: "By using the shorthand of 'vertical vs. horizontal,' we are not pushing ourselves hard enough to really understand the nature of the problems - either the problems caused by particular ways of spending money, or the systemic problems that disease-focused programs are often established to work around."

AIDS Treatment and Prevention Programs: Economics and Implications

Senior Fellow Mead Over has recently co-authored several articles on the economics of AIDS treatment in Thailand and the costs of scaling up HIV prevention programs. Based partly on these analyses, Mead is now researching the long-term implications of donor funding decisions for AIDS prevention and treatment. For example, he questions whether the moral imperative to continue funding AIDS treatment means that all other assistance programs will appear to be discretionary.

Developing a Healthy Agricultural Policy

Chronic diseases are an emerging challenge in the developing world, but have received relatively little attention from donors and policymakers. Rachel Nugent and Senior Fellow Kim Elliott brought attention to one dimension of the issue the relationship between agricultural policies and diet-related health problems at a recent CGD event on "A Healthy US Farm Policy in a Globalized World."

Staff Updates

Over the past year, CGD's global health program benefited from the presence of two visiting scholars. Jeremy Shiffman conducted research on how donor priorities in global health are established, while on sabbatical from the Maxwell School of Public Policy at Syracuse University. Retired IMF official David Goldsbrough led a working group examining the impact of IMF programs on levels and allocations of health sector spending in low-income countries. In addition, CGD's 2007 post-doctoral fellow, Harsha Thirumurthy, undertook research on the social and economic benefits from the provision of antiretroviral therapy in Kenya; he is now continuing that work as an assistant professor at the University of North Carolina School of Public Health. We are very grateful for their contributions and wish them the best in their new endeavors!

We are also pleased to welcome some new faces on CGD's health team. Rena Pacheco-Theard joined us in June as a Special Assistant for Ruth Levine, and more recently Danielle Kucyznski has joined CGD to work on population dynamics, performance-based incentives and other projects in her role as a Program Coordinator. Finally, former intern Steve Rosenzweig will be continuing to work with the HIV/AIDS Monitor in his new position as a Program Coordinator.

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:

• Debate over the role of social marketing in the distribution of malaria bednets.


• Recommendations for how AIDS programs could use their leverage to increase access to pain medication for the poor.


• Evidence that user fees can actually increase the utilization of water purification products


• The impact of concurrent relationships and trade exports on AIDS in Africa


• Creative thinking about mechanisms to insure against pandemic flu

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

Regards,

Ruth Levine
Vice President for Programs and Operations

Rachel Nugent
Senior Health Program Associate

Center for Global Development