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The Pan American Health Organization (PAHO) is moving to tackle one of the most difficult and important challenges of health policy: strengthening regional mechanisms for assessing which health technologies are cost effective and therefore appropriate for public funding. It's a sensitive issue that vexes poor and rich countries alike--including the United States. A recent PAHO resolution signed by the United States, Canada, and countries in Latin America and the Caribbean will strengthen a network created last year to improve the quality of Health Technology Assessment studies and their use in the allocation of public budgets.

Over the last 15 years, development economists have carefully accumulated rigorous evidence about what works and what does not in promoting health in poor countries. While each individual evaluation tests specific questions or sets of questions in specific contexts, the large number of studies now means that it is possible to draw more general conclusions. In addition, randomized evaluations are increasingly being designed to test fundamental questions about how people behave and thus generate lessons that are relevant for the design of different types of programs. In this seminar, Michael Kremer will discuss a new research paper co-authored with Rachel Glennerster, Lessons from Randomized Evaluations for Improving Health in Developing Countries, which summarizes lessons from the growing body of randomized evaluations of health programs in developing countries. The paper finds considerable evidence that consumers do not always invest optimally in health. In particular, consumers underinvest in cost-effective products for prevention and non-acute care of communicable disease and are very sensitive to the price and convenience of these products. This underinvestment does not simply reflect a lack of information of the benefits of preventative health. While this suggests the need for government intervention, many government health systems perform poorly and there is little accountability and few incentives for health care providers. Of the approaches designed to improve accountability, community or nongovernmental monitoring has had mixed results but district-level contracting has been quite successful. Many programs can improve health without excessive reliance on dysfunctional health delivery systems—delivering health products through schools for example, or improving health through water treatment.

In recent years the idea of strong health systems as a component of population health has been noted by both global health donors and national governments alike. Consequently, the question of how to measure the effectiveness of health systems interventions has become ever more pressing. But it remains unclear if efforts to assess health systems are providing enough information to establish a link between investments and improved health outcomes. How do we know if increased investments in the sector are creating the desired impact? This panel discussion will explore the linkage between health system strengthening activities and improving health outcomes and provide a platform for determining the efficacy of health systems investments. Panelists will address methodologies for analyzing health systems, beyond a mere compilation of indicators, and will explore innovative methods to measure health system performance.

Funding for HIV/AIDS has increased massively in the past few years. But is the money being used in the best possible way? In this short clip, CGD experts Nandini Oomman and Mead Over describe the HIV/AIDS monitor initiative which analyzes how PEPFAR, The Global Fund, and the World Bank deliver aid. The initiative has pushed for greater information disclosure and has made an impact on HIV/AIDS aid effectiveness.

Most people understand the personal risks associated with smoking, but surprisingly few understand its impact globally. Every year, more people die form tobacco related illnesses than from HIV/Aids, TB and malaria combined. Nevertheless, governments and international aid agencies have yet ot pay serious attention to what some believe to be one of hte most needless disease burdens in human history.

Here to breathe some fresh air into the fight to curb smoking is senior fellow Bill Savedoff, who joins me this week to discuss his latest blog post, Death by Tobacco: A Big Problem Needs Bigger Action. Upon returning from a meeting on tobacco control in New York City last month. Bill set out to raise the alarm about something he found to be shockingly little-known: the shockingly low cost of highly effective tobacco controls.

In a recent speech, USAID Administrator Rajiv Shah said “The evidence is clear: vaccines are the best public health investment we can make.” As the Global Alliance for Vaccines and Immunization (GAVI) prepares for its June 2011 pledging conference, CGD hosted a panel to look back at global efforts to support vaccination funding in developing countries over the past decade and reflect on lessons learned and future potential. The panel also looked to the issues and challenges facing vaccination financing in the 2010s.

CGD is pleased to host Sir Andrew Dillon, chief executive of the UK National Institute for Health and Clinical Excellence (NICE), and Dr. Kalipso Chalkidou, Director of NICE International, to discuss the relevance of institutions such as NICE to improving value for money in health and the characteristics, strengths and limitations of current institutions in the developed and developing world.

Heart disease, high blood pressure, diabetes and cancers are usually considered diseases of the rich world, the result of too much food and too little exercise. But these serious diseases are already a huge problem in the developing world, accounting for about half of the burden of disease. Yet new research from the Center for Global Development has found that barely 3% of foreign aid and philanthropic spending for developing world health addresses these often overlooked diseases.

My guest this week is the lead author of that research, Rachel Nugent, CGD deputy director of global health. In a forthcoming working paper co-authored with Andrea Feigl – Scarce Donor Funding for Non-Communicable Diseases: Will it Contribute to a Health Crisis? – Rachel examines the impact of non-communicable diseases in the developing world and assesses the response of international donors. In the Wonkcast, we discuss her findings and recommendations for addressing this challenge.