In 2015, India's system of fiscal devolution underwent a radical transformation. This paper uses the experience of Brazil, China, and Mexico to draw important lessons on how India can use the opportunity of fiscal devolution to create a better system of health financing through better policy coordination between federal and local governments.
Nigeria Will Become Polio-Free: Challenges, Successes, and Lessons Learned for the Quest to Eradicate Polio
Despite no reported cases of polio in two years in Nigeria, on August 11, 2016, the WHO announced two new wild polio cases had been discovered in Northern Nigeria. While undoubtedly a setback, Nigeria has mobilized its immunization forces and will look to take heed of four key lessons learned during almost three decades of anti-polio efforts: 1) establishing and sustaining trust is critical to the success of eradication campaigns; 2) frequent, independent monitoring and evaluation are key to tracking the progress of an intervention and making modifications; 3) holding all actors accountable is essential to pushing an intervention forward; and 4) contextualized health initiatives are key in fighting polio and other diseases. These lessons will reinforce a cohesive, multilateral strategy that builds on past successes to secure a polio-free Nigeria.
In July 2012, world leaders gathered in London to support the right of women and girls to make informed and autonomous choices about whether, when, and how many children they want to have. There, low income-country governments and donors committed to a new partnership—Family Planning 2020 (FP2020). Since then, the focus countries involved in the FP2020 partnership have made significant progress. Yet as FP2020 reaches its halfway point, and new, even more ambitious goals are set as part of the Sustainable Development Goals, gains fall short of aspirations.
Attention presidential transition teams: The first hundred days of the new administration should kick start an ambitious agenda in global health alongside long-needed reforms to enhance the efficiency and effectiveness of US action. Building on our earlier work, we suggest seven priority actions within three broad categories.
Since 2015, India has devolved an increasing share of its national tax yield to state governments and undertaken reforms to other kinds of centre-to-state grants. For many, the increased revenue via the tax devolution was considered good news but some health experts worried that states would give little priority to health under these conditions of greater autonomy. We find that at least two states, Bihar and Uttar Pradesh, have much more to spend in general and are budgeting more for health in 2015-2016 as compared to previous fiscal years.
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.
Estimating the Avertable Disease Burden and Cost-Effectiveness in Millions Saved Third Edition - Working Paper 429
Millions Saved (2016) is a new edition of detailed case studies on the attributable impact of global health programs at scale. As an input to the book, this paper provides an independent assessment of the cost-effectiveness of a selection of the cases using ex post information from impact evaluations, with the objective of illustrating how economic evaluation can be used in decision making and to provide further evidence on the extent of health gains produced for the funding provided.
Millions Saved is a collection of success stories in global health—remarkable cases in which large-scale efforts to improve health in developing countries have succeeded.
Global health action has been remarkably successful at saving lives and preventing illness in many of the world’s poorest countries. This is a key reason that funding for global health initiatives has increased in the last twenty years. Nevertheless, financial support is periodically jeopardized when scandals erupt over allegations of corruption, sometimes halting health programs altogether.
Can Access to Contraception Deliver for Women’s Economic Empowerment? What We Know – and What We Must Learn
Theory and some empirical evidence suggest the two goals – reproductive rights for women and women’s economic empowerment – are connected: reproductive rights should strengthen women’s economic power. But our understanding of the magnitude of the possible connection and the nature of any causal link (vs. coevolution or reverse causation) in different times and places is limited. In this note we summarize what we know up to now and what more we could learn about that connection, and set out the data requirements and methodological challenges that face researchers and policymakers who want to better understand the relationship.
Making Room for Mental Health: Recommendations for Improving Mental Health Care in Low- and Middle-Income Countries
Development assistance for health has increased dramatically over the last decade, but investment in mental health has been minimal. Less than 1 percent of development assistance for health goes to mental disorders although they represent at least one-fourth of the years lost to disability and about 10 percent of the global burden of disease. Spending a little on mental health could achieve a lot.
On April 7, 2016, CGD’s vice president for programs and director of global health policy Amanda Glassman testified before the Senate Foreign Relations Subcommittee on Africa and Global Health Policy at a hearing examining progress made in addressing the West Africa Ebola epidemic and its secondary effects.
The debate over genetically modified organisms (GMOs) has been raging for twenty years and there is still more heat than light around the topic. While some developing countries have embraced the technology, much of Africa has followed the European Union’s precautionary approach. While not a panacea, GMOs could be part of a new green revolution in Africa if governments address the policy and institutional weaknesses that prevented Africa from participating in the first one, and if GM technology continues to develop.
There is longstanding debate in population policy about the relationship between modern contraception and abortion. Although theory predicts that they should be substitutes, the existing body of empirical evidence is difficult to interpret. In this paper, we study Nepal’s 2004 legalization of abortion provision and subsequent expansion of abortion services.
This paper uses contract theory to suggest simple contract designs that could be used by the Global Fund. Using a basic model of procurement, we lay out five alternative options and consider when each is likely to be most appropriate. We ultimately provide a synthesis to guide policy makers as to when and how 'results-based' incentive contracts can be used in practice.
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.
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.
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.