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February 26, 2016

Global Health Donors Viewed as Regulators of Monopolistic Service Providers: Lessons from Regulatory Literature - Working Paper 424

Controlling healthcare costs while promoting maximum health impact in the recipient countries is one the biggest challenges for global health donors. This paper views global health donors as the regulators of monopolistic service providers, and explores potential optimal fund payment systems under asymmetric information. It provides a summary and assessment of optimal price regulation designs for monopolistic service providers.

February 22, 2016

Family Planning Program Effects: A Review of Evidence from Microdata - Working Paper 422

This paper reviews empirical evidence on the micro-level consequences of family planning programs in middle- and low-income countries. In doing so, it focuses on fertility outcomes (the number and timing of births), women’s health and socio-economic outcomes, and children’s health and socio-economic outcomes throughout the life cycle. In practice, family planning programs may only explain a modest share of fertility decline in real-world settings, and may also have quantitatively modest - but practically meaningful - effects on the socio-economic welfare of individuals and families.

February 16, 2016

Next Generation Financing for Global Health: What, Why, When, How?

Many researchers and policymakers have hypothesized that funding models tying grant payments to achieved and verified results — next generation financing models — offer an opportunity for global health funders to push forward their strategic interests and accelerate the impact of their investments. This brief, summarizing the conclusions of a CGD working group on the topic, outlines concrete steps global health funders can take to change the basis of payment of their grants from expenses (inputs) to outputs, outcomes, or impact.

December 15, 2015

Aligning Incentives, Accelerating Impact: Next Generation Financing Models for Global Health

Founded in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) is one of the world’s largest multilateral health funders, disbursing $3–$4 billion a year across 100-plus countries. Many of these countries rely on Global Fund monies to finance their respective disease responses—and for their citizens, the efficient and effective use of Global Fund monies can be the difference between life and death.

December 8, 2015

Doing Business Differently with Subnationals: Recommendations for Global Health Donors in Highly Decentralized Countries

In the big decentralized countries where global disease burden is concentrated, such as India and Indonesia, most public money for health isn’t spent by the national ministry of health, the traditional counterpart for global health funders and technical agencies. Instead, most money is programmed and spent subnationally.

Greater subnational public spending reflects growing democratization, power-sharing, and local self-determination. It also responds to the conviction that local decision-makers understand local realities better than a bureaucrat sitting in the capital city. Yet evidence on the effectiveness of subnational spending on health care and outcomes is mixed at best, and incentives for greater spending and better performance can be weak.

December 7, 2015

Power to the States: Making Fiscal Transfers Work for Better Health

Most money and responsibility for health in large federal countries like India rests with subnational governments — states, provinces, districts, and municipalities. The policies and spending at the subnational level affect the pace, scale, and equity of health improvements in countries that account for much of the world’s disease burden: India, Indonesia, Nigeria, and Pakistan.

World Bank Photos flic.kr/p/5dokDX
November 30, 2015

Better Hospitals, Better Health Systems, Better Health – A Proposal for a Global Hospital Collaborative for Emerging Economies

Hospitals are central to building and maintaining healthy populations around the world. They serve as the first point of care for many, offer access to specialized care, act as loci for medical education and research, and influence standards for national health systems at large. Yet despite their centrality within health systems, hospitals have been sidelined to the periphery of the global health agenda as scarce financial resources, technical expertise, and political will instead focus on the expansion of accessible primary care.

July 20, 2015

Restructuring US Global Health Programs to Respond to New Challenges and Missed Opportunities

In the absence of effective international institutions, the United States has become the world’s de facto first responder for global health crises such as HIV/AIDS and new threats like Ebola. The US government has the technical know-how, financial and logistical resources, and unparalleled political support to act quickly and save lives. Initiatives such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative are widely considered among the most effective aid programs in the world.

Yet US global health approaches are based on increasingly outdated engagement models, which fail to reflect emerging challenges, threats, and financial constraints. The next US president, working closely with Congress, should modernize how US global health programs are organized, deployed, and overseen. By taking three specific steps, the United States can reduce the need for costly first responses and generate more health and economic impact for every US taxpayer dollar spent.

July 20, 2015

Strengthening Incentives for a Sustainable Response to AIDS: A PEPFAR for the AIDS Transition

Remarkable progress has been made in the global fight against HIV/AIDS. The number of people receiving treatment in low- and middle-income countries increased from 300,000 in 2003 to 13.7 million in 2015, including 7 million supported by the United States. These gains are primarily attributable to a 2003 US government initiative called PEPFAR (the President’s Emergency Plan for AIDS Relief) that provided major new multiyear funding for global HIV/AIDS and created a new entity, the Office of the Global AIDS Coordinator, headed by an ambassador-rank Global AIDS Coordinator who is authorized to allocate PEPFAR’s resources and coordinate all US bilateral and multilateral activities on HIV/AIDS.

However, without dramatic changes to PEPFAR, the next president risks being held responsible for the failure of a program that until now has been one of the United States’ proudest foreign assistance achievements. And because PEPFAR is a major component of US foreign assistance spending, the next president’s choices about PEPFAR will heavily influence any subsequent assessments of his or her humanitarian foreign assistance policies.

The Health Consequences of Aerial Spraying of Illicit Crops: The Case of Colombia
June 1, 2015

The Health Consequences of Aerial Spraying of Illicit Crops: The Case of Colombia - Working Paper 408

A joint US-Colombia antinarcotics program sprayed hundreds of thousands of acres of illicit crops in Colombia with the herbicide glyphosate over several years. The recent classification of glyphosate as a likely carcinogen raises questions about the health effects of that spraying campaign. In this study, two economists from Colombia’s Los Andes University, combine data on aerial spraying from 2003 to 2007 with comprehensive individual-level data on every visit to public health facilities during that period. They find that aerial spraying raised the incidence of miscarriages, skin conditions, and respiratory problems.

Adriana Camacho and Daniel Mejia
May 26, 2015

Data Set for "How Much Will Health Coverage Cost? Future Health Spending Scenarios in Brazil, Chile, and Mexico - Working Paper 382"

This is the data set for Working Paper 382 which examines the expansion of universal healthcare in Latin America. The authors calculate long-term projections for public spending on health in three countries and analyze different scenarios related to population, risk factors, labor market participation, and technological growth.

Amanda Glassman and Juan Ignacio Zoloa
The Cost and Cost-Effectiveness of Alternative Strategies to Expand Treatment to HIV-Positive South Africans: Scale Economies and Outreach Costs
April 23, 2015

The Cost and Cost-Effectiveness of Alternative Strategies to Expand Treatment to HIV-Positive South Africans: Scale Economies and Outreach Costs - Working Paper 401

The South African government is currently discussing various alternative approaches to the further expansion of antiretroviral treatment (ART) in public-sector facilities. Alternatives under consideration include the criteria under which a patient would be eligible for free care, the level of coverage with testing and care, how much of the care will be delivered in small facilities located closer to the patients, and how to assure linkage to care and subsequent adherence by ART patients.

Gesine Meyer-Rath , Mead Over , Daniel J. Klein and Anna Bershteyn
March 4, 2015

Benchmarking Supply Chains for Better Performance

Donors play a significant role in funding medicines and other commodities in global health. Of the approximately US $28.2 billion spent by donors in 2010, approximately 40% went towards medicines, vaccines and other health commodities, mainly in sub-Saharan Africa. The efficiency of this spend is therefore of great concern, given the large variability in supply chain costs.

Ananth Iyer , Gemma Berenguer , Prashant Yadav and Amanda Glassman

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