With rigorous economic research and practical policy solutions, we focus on the issues and institutions that are critical to global development. Explore our core themes and topics to learn more about our work.
In timely and incisive analysis, our experts parse the latest development news and devise practical solutions to new and emerging challenges. Our events convene the top thinkers and doers in global development.
Janeen Madan Keller is a senior policy analyst and assistant director of global health at the Center for Global Development. Since joining CGD in June 2015, her research has covered a range of topics including global health financing and aid effectiveness, among others. Previously, she spent two years in Dakar, Senegal, where she worked with the UN World Food Program supporting nutrition and food security programs across West Africa. She has also worked with UNICEF in Mali and conducted research on health behavior change in Niger. Originally from Mumbai, India, she holds an MS in public health nutrition and food security from Tufts University and a BA with honors in political science and French from Vassar College.
Researchers highlight big issues with drug purchasing and generic drug markets
Eva Taylor Grant
Center for Global Development
WASHINGTON – Basic, everyday drugs can cost up to 20 to 30 times more in some poor countries than others, according to a new study released today by the Center for Global Development. The study examined billions of dollars of health spending on common, life-saving medicines in developing countries, mostly in Africa and Asia. To date, it is one of the largest-ever studies on global health procurement.
“Developing countries are often paying far more for everyday drugs than they should be. Why do some poor countries pay 20 to 30 times as much as others for common medicines to relieve pain or treat hypertension? In large part, because of flawed drug buying practices and broken generic medicines markets,” said Amanda Glassman, one of the authors of the study and the executive vice president at the Center for Global Development.
“A robust market for generic drugs is a core part of an affordable health system. But in way too many countries, generic drug markets are broken and patients are paying the price,” said Kalipso Chalkidou, the director of global health policy at the Center for Global Development and an author of the study. “You need enough competition to keep prices low and quality assurance that consumers trust, or essential medicines are going to be much more expensive than they should be.”
The study had three main findings:
In developing countries, prices for basic generic medicines can vary widely and far exceed wealthy-country prices. Some purchasers in low- and middle-income countries pay as much as 20 to 30 times more for basic generic medicines like omeprazole, used to treat heartburn, or acetaminophen (also known as paracetamol), a common pain reliever.
Low- and middle-income countries purchase more expensive branded generic drugs rather than unbranded quality-assured generics. In the US, most drugs are either on-patent medicines or unbranded generics, but in many developing countries more expensive brand-name generics are widely used, because people are concerned about unsafe or counterfeit drugs. In the poorest countries, unbranded generics are only 5 percent of the pharmaceutical market by volume—in comparison to the US where unbranded quality-assured generics are 85 percent of the market by volume.
There is little competition in the supply of essential medicines in low- and middle-income countries. The largest seller of products like contraceptives, cancer medicines, and antiparasitics can account for upwards of 85 percent of all sales in some countries.
“We’re talking about access to common medications for pain or high blood pressure, not the latest cutting-edge cancer drugs,” Glassman said.
“It’s not as exciting to talk about procurement as new health technologies or biotech breakthroughs,” she continued. “But drug purchasing is incredibly important, and if it’s done badly you end up with the poorest countries in the world paying some of the highest drug prices.”
You can read the full study at www.cgdev.org/better-health-procurement.
Evaluations are key to learning and accountability yet their usefulness depends on the quality of their evidence and analysis. This brief summarizes the key findings of a CGD Working Paper that assessed the quality of aid agency evaluations in global health. By looking at a representative sample of evaluations—both impact and performance evaluations—from major health funders, the study authors developed 10 recommendations to improve the quality of such evaluations and, consequently, increase their usefulness.
Health products—including drugs, devices, diagnostics, and vector control tools—are essential for meeting the healthcare needs of any population. Right now, many low- and lower-middle-income countries rely on donor-managed mechanisms to procure a large share of these health commodities. But this status quo won’t stay static for long, and the global health community must prepare for sweeping changes in global health and procurement over the next 10–20 years. Here’s some of what we see happening now and on the immediate horizon.
The international family planning community has made impressive gains in increasing global access to high-quality, voluntary family planning services. However, significant challenges remain with maintaining current support and meeting the growing need projected for family planning services and commodities across low- and middle-income countries (LMICs).
The most essential feature of a social impact bond (SIB) is measuring impact. But what happens if the impact metric is questioned or unclear? A recent dispute over measuring the impact of a SIB for early childhood development in Utah yields two important practical lessons for this innovative financing tool. First, SIB implementers should be careful not to exaggerate the precision of their success indicators. Second, they need to be clear to everyone about which objectives they are pursuing.
Health aid pays for life-saving medicines, products, and services in the poorest countries in the world. Funding for such uses needs to be smooth and uninterrupted. But when fraud is detected, funds are subject to sudden stops and starts—the result of a sequence of events set off by the scandal cycle in health aid. We examine this idea in a new CGD policy paper.