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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 chief operating officer and senior fellow at the Center for Global Development and also serves as secretary of the board. 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 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).
Jeremy Gaines, Center for Global Development, firstname.lastname@example.org
Danny O’Connor, The London School of Economics and Political Science, email@example.com
London – The Global Fund to Fight AIDS, Tuberculosis and Malaria asserts that it and its partners have saved 27 million lives—but researchers say that more evidence and data collected using rigorous and transparent methods is needed to back up that claim, in a new analysis published in The Lancet this week.
The analysis, written by Dr. Rocco Friebel of The London School of Economics and Political Science (LSE) and Rachel Silverman, Amanda Glassman, and Dr. Kalipso Chalkidou of the Center for Global Development (CGD), calls on The Global Fund to publish more robust data and be more transparent in its official impact reports, and highlights ways the financing organisation can improve its evidence base.
The authors note that The Global Fund likely has had a positive impact, having distributed over $39 billion of aid funding around the world, but suggest improvements that The Global Fund and others could adopt for their impact measurement and reporting, including:
More rigorous performance evaluations: Rather than relying on theoretical, modelled results alone, more rigorous performance evaluations would help assess whether The Global Fund’s grant recipients are delivering the services and products being financed.
Structuring grants to prioritize evidence from the start: Taking this step would help ensure the most effective projects and products are being funded.
Expanding the scope of impact evaluation: The Global Fund should expand the scope of its evaluations and refocus on areas where evidence is most needed, like particularly large projects and programs using new and untested strategies.
Publishing the data and models used to estimate impact: Where empirical evidence isn’t available, The Global Fund should at least make the data and models used to estimate impact available to researchers and the public.
The analysis also details current shortcomings of The Global Fund’s evaluations, including:
Opaque methodology: Without further details in the public domain, the methodology used by The Global Fund in calculating the lives it has saved cannot be verified or reproduced by external researchers. More transparency with regard to its modelling methodology, the authors argue, would build confidence in the organisation’s claims among funders and external researchers. Since the draft of the analysis was shared, The Global Fund has revised its methodology statement on its website, but the authors call for further improvements.
Distinguishing The Global Fund’s institutional impact from the impact of the broader partnership: The authors’ analysis suggests The Global Fund results report conflates the impact of The Global Fund “partnership”—encompassing other donors, NGOs, and country governments—with the impact of The Global Fund as a standalone institution with a roughly $4bn per year annual budget. The authors argue that more clearly breaking out the activities of The Global Fund from activities carried out by partner organisations would make its impact much clearer. For example, domestic policies in large countries such as India and South Africa have led to significant investments to tackle tuberculosis and HIV. In addition, economic growth is estimated to be responsible for a significant reduction in maternal and child deaths from 1990-2010. The impact of both of these external factors is not distinguished in The Global Fund’s claim of saving 27 million lives.
Unreliable data: Much of the data comes from countries where statistical systems are weak or non-existent. The authors acknowledge the difficulties of working with data in these scenarios—it would be unrealistic, for example, to produce reliable and up-to-date data in these countries for the number of people who died from each of the diseases covered by The Global Fund—but reiterate their call for data collected in rigorous performance evaluations to supplement the results of modelling exercises.
“There is no doubt that organisations like The Global Fund do great work but to ensure continuous donor investment they need to be more open and honest with their reporting,” said Dr. Rocco Friebel, Assistant Professor of Health Policy at LSE. “The methods and underlying data of the modelling exercise conducted by The Global Fund and others should be released and subject to public scrutiny. The organisation should be clear about its methodology, share relevant data and open itself up to peer review. Taking these steps toward openness will instil confidence in partners and lead to more sustainable fundraising for aid relief.”
“Funders have tough choices to make, and a more grounded and evidence-based assessment of The Global Fund’s actual impacts would help the organisation make its case in the difficult replenishment cycle ahead,” said Amanda Glassman, chief operating officer at the Center for Global Development.
“Our concerns are not new,” said Kalipso Chalkidou, director of global health policy at the Center for Global Development. “For years, we’ve called for The Global Fund to stand on firmer ground when estimating the lives its work has saved. The Global Fund does important work, and in order to make sure everyone has confidence in that work, it’s time for the organisation to take our calls for transparency seriously.”
“Global health partnerships, including The Global Fund, hold a position of immense responsibility as the stewards of scarce aid dollars,” said Rachel Silverman, policy fellow at the Center for Global Development. “To best serve the populations in need of that assistance—and to attract additional resources in the upcoming replenishment cycle—we hope that The Global Fund and other funders will embrace the highest standards of evidence and accountability.”
To read the analysis, visit the Lancet’s site here.
Despite improvements in censuses and household surveys, the building blocks of national statistical systems in sub-Saharan Africa remain weak. Measurement of fundamentals such as births and deaths, growth and poverty, taxes and trade, land and the environment, and sickness, schooling, and safety is shaky at best. The Data for African Development Working Group’s recommendations for reaping the benefits of a data revolution in Africa fall into three categories: (1) fund more and fund differently, (2) build institutions that can produce accurate, unbiased data, and (3) prioritize the core attributes of data building blocks.
Decisions about which type of patients receive what interventions, when, and at what cost often result from ad hoc, nontransparent processes driven more by inertia and interest groups than by science, ethics, and the public interest. Reallocating a portion of public and donor monies toward the most cost-effective health interventions would save more lives and promote health equity.
Global health action has been remarkably successful at saving lives and preventing illness in many of the world’s poorest countries. This is a key reason that funding for global health initiatives has increased in the last twenty years. Nevertheless, financial support is periodically jeopardized when scandals erupt over allegations of corruption, sometimes halting health programs altogether.
Despite improvements in censuses and household surveys, the building blocks of national statistical systems in sub-Saharan Africa remain weak. Measurement of fundamental statistics such as births and deaths, growth and poverty, taxes and trade, land and the environment, and sickness, schooling, and safety is shaky at best.
Millions Saved (2016) is a new edition of detailed case studies on the attributable impact of global health programs at scale. As an input to the book, this paper provides an independent assessment of the cost-effectiveness of a selection of the cases using ex post information from impact evaluations, with the objective of illustrating how economic evaluation can be used in decision making and to provide further evidence on the extent of health gains produced for the funding provided.
Many health improving interventions in low-income countries are extremely good value for money. So why has it often proven difficult to obtain political backing for highly cost-effective interventions such as vaccinations, treatments against diarrhoeal disease in children, and preventive policies such as improved access to clean water, or policies curtailing tobacco consumption?
As Latin American countries seek to expand the coverage and benefits provided by their health systems under a global drive for universal health coverage (UHC), decisions taken today – whether by government or individuals – will have an impact tomorrow on public spending requirements.
Across multiple African countries, discrepancies between administrative data and independent household surveys suggest official statistics systematically exaggerate development progress. We provide evidence for two distinct explanations of these discrepancies.
Amid debate about whether adolescent pregnancy is a problem in and of itself or merely symptomatic of deeper, ingrained disadvantage, this paper aggregates recent quantitative evidence on the socioeconomic consequences of and methods to reduce of teenage pregnancy in the developing world.
This paper examines opportunities for improved efficiency in malaria control, analyzing the effectiveness of interventions and current trends in spending. Overall, it appears that resources for malaria control are well spent—however, there remain areas for improved efficiency, including (i) improving procurement procedures for bed nets, (ii) developing efficient ways to replace bed nets as they wear out, (iii) reducing overlap of spraying and bed net programs, (iv) expanding the use of rapid diagnostics, and (v) scaling up intermittent presumptive treatment for pregnant women and infants.