Global Health and the New Bottom Billion: How Funders Should Respond to Shifts in Global Poverty and Disease Burden

Denizhan Duran
January 06, 2012

After a decade of rapid economic growth, many developing countries haveattained middle-income status. But poverty reduction in these countries hasnot kept pace with economic growth. As a result, most of the world’s poor—up to a billion people—now live in these new middle-income countries (MICs), making up a “new bottom billion.” As the new MICs are home to most of the world’s poor, they also carry the majority of the global disease burden. This poses a challenge to global health agencies, in particular the GAVI Alliance and the Global Fund, which are accustomed to disbursing funds on the assumption that the majority of poor people live in poor countries.

To better target aid to poor people, we recommend that funders focus on four areas:

  1. Eliminating country-income thresholds as across-the-board criteria for allocating global health funding.
  2. Setting up regional pooled procurement or pricing mechanisms.
  3. Building evidence-based priority-setting institutions.
  4. Establishing increased accountability mechanisms and providing technical support for MICs.

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