This is a joint post with Rachel Silverman.
Through our Value for Money working group, we’ve spent much of the past year immersed in the world of global health funding agencies. With so many new agencies, particularly in the last quarter century (Figure 1), understanding the intricacies of the global health family can be daunting, even for the most devoted observers.
In recent weeks, the public health world and political pundits alike have been abuzz about results from the “Oregon Experiment,” a study published in the New England Journal of Medicine that finds no statistical link between expanded Medicaid coverage and health outcomes such as high cholesterol or hypertension. Limitations of the study aside, the Oregon Experiment is a good example of the importance of rigorously testing all US health programs, rather than just assuming ‘more care = better health’. The Innovation Center at the United States Centers for Medicaid and Medicare Services, created under the umbrella of the Affordable Care Act, represents a new and encouraging approach to address this problem, an approach that we think has important lessons for global health.
The New England Journal of Medicine recently published the results of “the Oregon experiment” based on the 2008 US Medicaid program expansion in Oregon. The study is one of very few randomized control trials on publicly-subsidized health insurance that exists to guide health policy, and found what some commentators considered a disappointing result: while health care utilization increased and households were protected from financial hardship, expanding Medicaid coverage had “no significant impact on measured physical health outcomes over a 2-year period.”
The World Bank’s Africa Health Forum: Finance & Capacity for Results during its 2013 Spring Meetings brought together ministers of finance and of health from 30 African countries in a unique opportunity for mutual listening between countries and partners. One recurring theme in forum and in the first panel was that results-based financing (RBF) – where financing is conditioned on achievement of results in health – is a key approach to driving value for money. In short: RBF = more money for more health. (You can watch the recorded ministerial discussion here.)
The global health legacy of 2012 will be twofold, a year of both increased commitments to health and flat lining budgets. Just look at this past summer: world leaders made a call to end preventable child deaths, the London Summit on Family Planning has resulted in $2.6 billion of commitments, and the International AIDS Conference saw a commitment to the “beginning of the end of AIDS.” While these are all great news, it is still uncertain as to who will pay for these ambitious goals: biggest donors are already scaling down their health aid budgets, and there remains a tremendous resource gap to reach the end of AIDS.
It’s that magical time of the year when we bring you the top 10 most read entries on the CGD Global Health Policy Blog. Together, these top posts had a total almost 20,000 unique page views. This year the blog asked for your feedback on evaluating the quality of health aid, addressed the debate over entities like the GHI and AMFm, and discussed everything from cash transfers to priority-setting.
This is a joint post with Alex Ezeh.
Maybe you missed it–but this past Sunday, November 18, was African Statistics Day.
It’s the 12th celebration of the day, and a good time to note that substantial gaps remain in the availability and quality of data on basic indicators of human well-being such as income, poverty and cause of death in Africa.
After a year-long period of upheaval and reform, the Board of the Global Fund for AIDS, TB and Malaria today named Mark R. Dybul as its new Executive Director.
At the IAS conference, protestors turned out to oppose one reform under consideration at the Global Fund for AIDS, Tuberculosis, and Malaria: allocating funding ex ante instead of having countries propose the amount they would like to receive. Mohga Kamal-Yanni of Oxfam writes:
This month, both Health Affairs and the Journal of Acquired Immune Deficiency Syndrome (JAIDS) released special thematic issues on the US President’s Emergency Plan for AIDS Relief (PEPFAR) in which the articles – mainly commentaries but some analyses – provide an exceptionally positive readout on PEPFAR’s past performance and future direction. In principle, this is great – any insights into PEPFAR are always welcome, and it’s clearly valuable to discuss and disseminate lessons learned from the program. If these articles were posted on the PEPFAR website, or released as official PEPFAR reports, we wouldn’t bat an eye. But within scientific, peer-reviewed journals, the articles read more like PEPFAR PR rather than commentary and analysis from independent, third-party observers and stakeholders. A quick skim of the titles in the table of contents illustrates this point (see word cloud of selected title excerpts), and a closer look at the contributors sheds some light on why this may be the case: most authors of the articles are somehow affiliated with PEPFAR or with organizations that have received money from the program.
