Are USAID programs high impact and good value for money? Do they work? Do they generate more results for less cost than if the agency just gave poor people cash? We don’t always know the answers to those questions, but USAID is trying to find out.
The United States Government has the requisite technical know-how, financial and logistical resources, and bipartisan political support to lead the response to enduring global health challenges, and it is critical that the United States is prepared to meet them. This memo’s six recommendations are the result of a roundtable discussion on how the next administration and Congress can update and improve on the US global health engagement model.
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Yet US global health approaches are based on increasingly outdated engagement models, which fail to reflect emerging challenges, threats, and financial constraints.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.
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.
Gavi, the Vaccine Alliance, pools donor funds to increase immunization rates in developing countries. Vaccines have saved millions of lives. Results from new research at the Center for Global Development suggest Gavi could save more lives by shifting support away from lower-cost vaccines provided to middle-income countries toward more underused vaccines and support to the poorest countries.
Despite improvements in censuses and household surveys, the building blocks of national statistical systems in sub-Saharan Africa remain weak. Measurement of fundamentals such as births and deaths, growth and poverty, taxes and trade, land and the environment, and sickness, schooling, and safety is shaky at best. The Data for African Development Working Group’s recommendations for reaping the benefits of a data revolution in Africa fall into three categories: (1) fund more and fund differently, (2) build institutions that can produce accurate, unbiased data, and (3) prioritize the core attributes of data building blocks.
PEPFAR is at a critical turning point in its decade-long existence. The next US Global AIDS Coordinator is uniquely positioned to set the course for the program’s future. A change in leadership at the President’s Emergency Plan for AIDS Relief creates an opportunity to ask questions about the organization and reflect in more general terms on the US response to the global AIDS epidemic.
This is the data set for Policy Paper 31, in which Victoria Fan, Denizhan Duran, Rachel Silverman, and Amanda Glassman analyze data on the Global Fund performance-based financing system to test the association between grant ratings and disbursements.
This brief summarizes and updates results of the Quality of Official Development Assistance (QuODA) index applied to health aid and compares these results to the overall QuODA assessment. Through quantifying performance on aid effectiveness, we hope to motivate improvements in health aid effectiveness and contribute to the definition of better, more empirically based measures of health aid quality.
Jacob Hughes, Amanda Glassman, and Walter Gwenigale discuss the design, opportunities, and limitations of the of Liberia Health Sector Pool Fund.
The authors apply Birdsall and Kharas’s Quality of Official Development Assistance (QuODA) methodology to rank donors across 23 indicators of aid effectiveness in health.
Data Set for Working Paper 287: “An Index of the Quality of Official Development Assistance in Health”
This data set allows replication of the results in CGD Working Paper 287, An Index of the Quality of Official Development Assistance in Health.