The Global Fund is currently finalizing design and implementation of its New Funding Model (NFM), which includes a focus on strengthened measurement and an impact-based investment strategy.
Afghanistan’s progress against mortality reflects the success of providing health aid that differed radically from the bulk of American aid to Afghanistan during the war. The USAID program that contributed to the decline was a multilateral effort coordinated by Afghanistan’s own Ministry of Public Health. Results were verified by random sampling, and some funding was linked to measures of performance. This internal policy experiment, however, was destined to provoke resistance. More surprising is the source of resistance to an aid program that attempted to stop simply throwing money at a problem and focus on building sustainable systems: auditors.
In just five years, India’s Rashtriya Swasthya Bima Yojana (RSBY, translated as “National Health Insurance Programme”) has expanded health-care access. Where dozens of “microinsurance” and NGO pilots failed to scale up, RSBY has already provided more than 110 million people (almost 10 percent of India’s population) with heavily subsidized health insurance, providing up to US$550 annually to finance secondary hospital care. Although the research evidence on RSBY is still developing, early results are encouraging: increased utilization and hospitalization; some indication of reduced out-of-pocket payments for healthcare; and a means of identification with a clearly linked entitlement. While RSBY still faces challenges, particularly on the quality of care of increased hospitalization rates, RSBY has aligned incentives for both public and private hospitals to deliver better care.
In this essay, Victoria Fan tells the story of how RSBY came into being under the leadership of Anil Swarup—whom she describes as an “unassuming officer of the Indian Administrative Service”—and outlines the program’s early successes and opportunities for future progress.
In this essay, Toby Ord explores the moral relevance of cost-effectiveness, a major tool for capturing the relationship between resources and outcomes, by illustrating what is lost in moral terms for global health when cost-effectiveness is ignored.