This brief summarizes the findings of the CGD working group on IMF Programs and Health Spending, convened in fall 2006 to investigate the effect of International Monetary Fund (IMF) programs on health spending in low-income countries. The report offers clear, practical recommendations for improvements—for the IMF, the World Bank, the governments of countries working within IMF programs, and civil society organizations.
This report of the CGD working group on IMF Programs and Health Spending explores the controversy that surrounds IMF-supported programs in low-income countries and their effect on the health sector. Critics contend that programs unduly constrain health spending though macroeconomic, especially fiscal, policies that are too restrictive towards government spending and wage bill ceilings preventing a scaling up of the health workforce. The working group, chaired by CGD visiting fellow David Goldsbrough, examined the evidence through detailed case studies and cross-country data to make recommendations for the IMF and other relevant actors. They urge the IMF to explore a broader range of options on the fiscal deficit and government spending; clarify the role of the IMF with regards to aid projections; constrain the use of wage bill ceilings to very specific circumstances; and give greater emphasis to the smoothing of expenditures.
Performance-based Incentives for Health: Demand- and Supply-Side Incentives in the Nicaraguan Red de Protección Social - Working Paper 119
Nicaragua was one of the first low-income countries to try a conditional cash transfer (CCT) program. Under the program, poor families are paid for keeping their children in school and visiting preventive healthcare providers. Healthcare providers are paid based on their performance against predetermined targets. A rigorous evaluation of the program shows that the CCT program significantly increased the use of health services among the poor.
A Trickle or a Flood: Commitments and Disbursement for HIV/AIDS from the Global Fund, PEPFAR, and the World Bank's Multi-Country AIDS Program (MAP)
In response to both public health imperative and unprecedented political pressure, aid to fight HIV/AIDS has increased massively in recent years: global funding to combat the disease in low- and middle-income countries has more than tripled since 2001, from $2.1 billion to an estimated $8.9 billion in 2006. This paper, by Michael Bernstein and Myra Sessions, discusses the increase in aid commitments by the three main financing agencies--the President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank's Multi-Country HIV/AIDS Program (MAP)--and the receiving countries' ability, or lack thereof, to absorb the aid. It is one in a series of analyses of the sources of funding for HIV/AIDS programs in developing countries conducted under the Center for Global Development’s HIV/AIDS Monitor.
Challenges and Opportunities for the New Executive Director of the Global Fund: Seven Essential Tasks
In its first four years, the Global Fund to Fight AIDS, Tuberculosis and Malaria has become one of the most important aid agencies in the world. As the Global Fund undergoes its first leadership transition, this CGD Working Group Report identifies seven tasks for the new Executive Director, starting from country operations, where ultimate results are achieved; through supporting arrangements (such as technical assistance, performance-based funding, procurement and supply chain strategies, and secretariat operations) and ending with the overarching issues of financing and Board relationships. The report offers specific recommendations for the new Executive Director and for the Board.
In response to a request from the Millennium Challenge Corporation, CGD convened the Global Health Indicators Working Group to examine potential measures of a government's commitment to health. The group's report recommends eight indicators for consideration by the MCC and other donors as they assess recipient countries' readiness to make effective use of foreign assistance. Learn more
Donors are considering committing in advance to purchase vaccines against diseases concentrated in low-income countries to spur research and development on vaccines for neglected diseases. How much money is needed? The authors of this paper find that a commitment comparable in size to the average sales of recently launched commercial products (adjusted for lower marketing costs)—about $3 billion per disease when products are at a relatively early stage in development —would be a highly cost-effective way to address major killers, such as malaria, tuberculosis and HIV/AIDS. The paper includes a link to a Web-based spread sheet for readers to conduct their own sensitivity analysis.Learn more