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Health financing and payment, results-based financing, social protection, conditional cash transfer programs, noncommunicable disease, maternal and child health
Amanda Glassman is executive vice president and senior fellow at the Center for Global Development and also serves as chief executive officer of CGD Europe. Her research focuses on priority-setting, resource allocation and value for money in global health, as well as data for development. Prior to her current position, she served as director for global health policy at the Center from 2010 to 2016, and has more than 25 years of experience working on health and social protection policy and programs in Latin America and elsewhere in the developing world.
Prior to joining CGD, Glassman was principal technical lead for health at the Inter-American Development Bank, where she led policy dialogue with member countries, designed the results-based grant program Salud Mesoamerica 2015 and served as team leader for conditional cash transfer programs such as Mexico’s Oportunidades and Colombia’s Familias en Accion. From 2005-2007, Glassman was deputy director of the Global Health Financing Initiative at Brookings and carried out policy research on aid effectiveness and domestic financing issues in the health sector in low-income countries. Before joining the Brookings Institution, Glassman designed, supervised and evaluated health and social protection loans at the Inter-American Development Bank and worked as a Population Reference Bureau Fellow at the US Agency for International Development. Glassman holds a MSc from the Harvard School of Public Health and a BA from Brown University, has published on a wide range of health and social protection finance and policy topics, and is editor and coauthor of the books What's In, What's Out: Designing Benefits for Universal Health Coverage (Center for Global Development, 2017), Millions Saved: New Cases of Proven Success in Global Health (Center for Global Development 2016), From Few to Many: A Decade of Health Insurance Expansion in Colombia (IDB and Brookings 2010), and The Health of Women in Latin America and the Caribbean (World Bank 2001).
The Global Fund Board’s decision over the Affordable Medicines Facility – malaria (AMFm) rapidly approaches, and tensions within the malaria community are acute. In her global health blog for The Guardian, Sarah Boseley characterizes the rift as one of
“huge arguments and intense passions…[because] it is about the belief on one side that the private sector is the most effective way to get medicines to those who need them – and the certainty on the other side that bolstering the public sector to diagnose and treat people is a fairer and safer way to go. These are not just practical matters, but highly political.”
Happy November 7! The election is over and…things pretty much look the same way they did before. While I don’t expect the political gridlock in Washington to abate much over the next years, global health fortunately remains one of the few areas of bipartisan consensus in US policy. When dollar values are taken out of the equation, most policy makers can agree that saving lives of mothers, children and families from preventable, treatable diseases reflects American values and contributes to a safer, healthier world. Here are five things that should be at the top of the President’s global health agenda for the next four years.
"Every country, no matter how wealthy or how impoverished, cannot afford to waste money in healthcare on health technology that does not contribute to health."
These words were spoken by Harvey V. Fineberg, the President of the Institute of Medicine, at a recent event co-hosted by CGD and PAHO, which highlighted the importance of supporting health technology assessment (HTA) in the Americas. Low-and middle-income countries are increasingly interested in building capacity for priority setting, particularly in regards to public funding in a time where pressures to incorporate costly new technologies are on the rise and donor contributions are stagnating. Over the past five years Brazil, Chile, Costa Rica, Colombia, Croatia, Estonia, the Republic of Korea, Malaysia, and Uruguay have also added health technology assessment agencies—tasked with varying responsibilities, including the generation or coordination of health technology assessment and budget impact analysis, as well as the creation recommendations for coverage or reimbursement decisions related to public spending.
In this post, Gabriel Demombynes, Senior Economist in the Nairobi office of the World Bank, describes some of the issues raised at the Center for Global Development and the African Population & Health Research Center’s first meeting of the Data for African Development Working Group meeting last month. This blog was originally posted to the World Bank’s Development Impact Blog on October 1, 2012.
by Gabriel Demombynes
Recently I attended the inaugural meeting of the Data for African Development Working Group put together by the Center for Global Development and the African Population & Health Research Center here in Nairobi. The group aims to improve data for policymaking on the continent and in particular to overcome “political economy” problems in data collection and dissemination.
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 (HTA) studies and their use in the allocation of public budgets. The improved network would address problems identified in a working group report from the Center for Global Development (CGD) that urges the creation and strengthening of national and regional priority-setting institutions to improve the effectiveness of public spending on health.
The PAHO resolution to strengthen the Health Technology Assessment Network of the Americas (RedETSA), signed two weeks ago, will be celebrated on October 23 at the US launch of the CGD working group report, Priority-Setting in Health: Building Institutions for Smarter Public Spending. Speakers will include the president of the US Institute of Medicine, Dr. Harvey Fineberg; the director of the Pan American Health Organization, Dr. Mirta Roses Periago; and Amanda Glassman, director of global health policy and senior fellow at CGD.
The CGD report shows that global health donors and both developed and developing countries could greatly reduce suffering from ill-health and save many more lives—and often money, too—by taking into account the cost-effectiveness of health interventions to better allocate healthcare funds. RedETSA aims to do just that.
“This is critically important work,” says Dr. Fineberg. “Poor and rich countries alike are faced with the challenge of allocating finite resources across a range of national priorities, new and existing technologies, and unmet need. Yet, health spending decisions often fail to take account of the costs and benefits of health interventions, and of the opportunity to reduce waste, and the result is less health than could be attained with the available resources.”
The CGD report calls for creating or strengthening national or regional HTA facilities to share know-how in areas such as economic evaluation, budget impact analysis, and deliberative processes for priority-setting.
It shows that regional institutions can help countries avoid repeating health technology assessments already done by others, instead pooling resources to carry out joint evaluations. The findings can then be made available to participating countries for deliberation and possible use in allocation decisions. The PAHO resolution provides the framework for this type of cooperation. Member countries may use the results in allocating healthcare funds but they are not required to do so.
“Using cost-effectiveness data in allocating healthcare funds shouldn’t be controversial. It’s a no-brainer,” says CGD’s Glassman.
“Without priority-setting institutions, countries face impossible situations, like the recent case in Brazil where a man successfully sued the government to pay for medicine that costs $440,000 per year. Just imagine how much more beneficial that money could have been had it been spent on eliminating the neglected tropical diseases that still afflict the poor in Brazil,” she adds.
“I’m delighted that PAHO members have agreed to strengthen this important network and that the US has demonstrated support,” Glassman says. “This can serve as an example for regional networks in other parts of the world.”
While the need for health technology assessment can seem straightforward, efforts to create institutions to do this work have sometimes been politically explosive. A proposal to include such assessments in the US healthcare reform legislation in 2008 sparked unfounded allegations that the government was moving to create “death panels.”
The legislation that eventually passed, the Patient Protection and Affordable Care Act, aims to control healthcare costs. But the organization established to evaluate health interventions, the Patient-Centered Outcomes Research Institute (PCORI), is instructed to consider only whether a specific treatment works. The law prohibits it from evaluating cost-effectiveness and using measures such as “dollars per quality-adjusted life year,” commonly used in global health circles to assess the value of healthcare interventions.
Although the US has signed the resolution and voiced its support, it has yet to identify an institution that will be actively involved in the network. Still, Glassman welcome US participation as a step in the right direction.
“US participation in RedETSA is good for the network and its developing country members, because of the vast wealth of medical knowledge we have in this country,” says Glassman. “And it’s good for the United States, too. I hope that the cost-effectiveness knowledge generated within the network can eventually be tapped to help improve health outcomes here at home.”
The CGD working group report, Priority-Setting for Health: Building Institutions for Smarter Public Spending, is available on the CGD website.
The Center for Global Development: CGD works to reduce global poverty and inequality through rigorous research and active engagement with the policy community to make the world a more prosperous, just, and safe place for all people. As a nimble, independent, nonpartisan, and nonprofit think tank, focused on improving the policies and practices of the rich and powerful, the Center combines world-class scholarly research with policy analysis and innovative outreach and communications to turn ideas into action.
Products to combat neglected diseases in low-income countries generate low profit margins and—without an obvious end market—research and development tend to be underfunded. In recent years, R&D funding for neglected diseases has remained low—$3.1 billion in 2010—and substantially less than the almost $150 billion price-tag over seven years recommended by the WHO.
On September 20, heads of state and officials from every country in the world will meet at the United Nations to discuss the non-communicable diseases (NCD) -- heart disease, cancers, diabetes, and asthma -- that are responsible for 63 percent of global deaths annually. Contrary to popular belief, NCD do not primarily affect those of us living in wealthy countries; rather, 80 percent of NCD deaths occur in developing countries, mostly the middle-income countries.
November 12th is fast approaching and with it comes world pneumonia day. Unfortunately, pneumococcal diseases still pose an enormous global threat--remaining the leading cause of death for children worldwide and taking the lives of 1.4 million children under five years annually. What’s more—a staggering 98% of these children live in developing countries.
Everyone seems to be throwing their hat into the ring in the battle against non-communicable disease (NCD), from George W. Bush to Lance Armstrong. Now it appears USAID has entered the mix as well. Despite the agency’s absence from a CGD sponsored panel discussion last week, the USAID communications department is shifting into full gear—implying that they plan to join the fight after all.