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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.
With aid budgets shrinking and even low-income countries increasingly faced with cofinancing requirements, this is the right time for global health funders such as the Global Fund and their donors to formally introduce Health Technology Assessment (HTA), both at the central operations level and at the national or regional level in recipient countries. In this CGD Note, we explain why introducing HTA is a good idea. Specifically, we outline six benefits that the application of HTA could bring to the Global Fund, the countries it supports, and the broader global health community.
McDonald's has just gone global with its commitment to serve chicken free from antibiotics that are critically important to human health. Building on a similar phase-out in its US chicken supply in 2016, the company will ban critical antibiotic use from sourced chicken in a handful of high-income countries and Brazil in 2018, expanding to a longer list of “designated markets” by 2027. That's evidence of both the potential to reduce global antibiotic use in livestock and the vital role consumers can play in speeding progress.
With the US Congress considering cuts to foreign assistance and aid budgets in other donor countries coming under increased pressure, evidence about what works in global development is more important than ever. Evidence should inform decisions on where to allocate scarce resources—but to do so, evaluations must be of good quality.
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.
We assessed the methodological quality of global health program evaluations from five major funders between 2009 and 2014. We found that most evaluations did not meet social science methodological standards in terms of relevance, validity, and reliability. Nevertheless, good quality evaluations made it possible to identify ten recommendations for improving evaluations, including a robust finding that early planning is associated with better quality.
Without global action, by 2050 there could be as many as 10 million antimicrobial resistance-related deaths each year. An important—and often overlooked—part of the problem is the overuse of antibiotics in farm animals. CGD recently convened a roundtable discussion with technical experts to discuss possible ways to strengthen global cooperation to address livestock’s contribution to AMR. Drawing on that productive discussion, we outline steps that could help make inroads into the problem.
Our concluding message to young professionals and young people in general is this: engage with us. Tell us what you think is working in development, what isn’t, and why. You will help advance CGD’s mission to fight poverty through innovative, evidence-based policies by keeping the dialogues we foster energetic, fresh, and as inclusive as possible.
In 2006, CGD published a working group report that addressed the insufficient number of rigorous impact evaluations of social programs in low- and middle-income countries. Last week —marking 10 years since the report’s release—CGD and J-PAL co-hosted the event, “Improving Development Policy through Impact Evaluation,” which echoed three key messages of the 2006 report: 1) conduct more and better evaluations; 2) connect evaluators and policymakers; and 3) recognize that impact evaluations are an important global public good that requires more unconstrained funding.
Are genetically modified organisms (GMOs) likely to play a significant role in tackling malnutrition and reducing poverty in Africa? Our short answer is "it depends." In a new CGD policy paper and brief, we examine the evidence and conclude that currently available GMOs are of limited relevance for most developing countries, especially in Africa.
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.