Many health improving interventions in low-income countries are extremely good value for money.
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.
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.
The US has an untapped opportunity to offer global leadership against drug resistance through the major global health programs it already supports, namely PEPFAR, the Global Fund, and the Presidents Malaria Imitative. In this memo, Victoria Fan and Amanda Glassman highlight considerations for Congress with respect to oversight of these key channels of US development assistance for health that greatly affect drug resistance.
Global Health and the New Bottom Billion: How Funders Should Respond to Shifts in Global Poverty and Disease Burden
After a decade of rapid economic growth, many developing countries have attained middle-income status, but poverty reduction in these countries has not kept pace with economic growth. Most of the world’s poor—up to a billion people—now live in these new middle-income countries. These countries also carry the majority of the global disease burden.
In the final installation of a three-part series, Mead Over estimates the fiscal burden of international AIDS treatment programs, and suggests ways that donors, governments, and patients can sustain current treatments while preventing future cases.
This essay proposes ways to improve the effectiveness of HIV prevention by strengthening incentives for both measurement and achievement. It builds upon a companion essay that proposes an “AIDS Transition”—that is, a gradual reduction in the number of people infected with HIV even as those inflected live longer—as a reasonable objective of donor and government AIDS policy.
Recognizing the donors’ obligation to sustain financing for the millions of AIDS patient who would not be alive today without it, this essay proposes a dynamic paradigm for the struggle with the AIDS epidemic—“the AIDS transition” —and argues that to most rapidly achieve an AIDS transition new funding of AIDS treatment should be tightly linked to dramatically improved and transparently measured prevention of HIV infections.
Donor spending on global health has surged, yet for many poor people in developing countries even basic prevention and treatment remain elusive. CGD’s newest book, Performance Incentives for Global Health: Potential and Pitfalls, shows how modest payments in cash or kind can get more health from health care spending. Informed by case studies and the Working Group on Performance-Based Incentives, co-authors Rena Eichler and CGD vice president Ruth Levine tell how to design and implement effective incentive programs—and what to avoid.
CGD policy analyst Lindsay Morgan summarizes the global health agendas various organizations have recommended to the Obama administration. She finds that the calls for a smarter, more harmonized, results-based global health agenda are clear.
Rena Eichler and Ruth Levine summarize the findings of their book, Performance Incentives for Global Health: Potential and Pitfalls. Through numerous case studies, they show that carefully designed and implemented performance-based incentive programs can improve developing country health care in many areas and strengthen overall health systems.
Prevention Failure: The Ballooning Entitlement Burden of U.S. Global AIDS Treatment Spending and What to Do About It - Working Paper 144
U.S. global AIDS spending is helping to prolong the lives of more than a million people, yet this success contains the seeds of a future crisis. Escalating treatment costs coupled with neglected prevention measures mean that AIDS spending is growing so rapidly that it threatens to squeeze out U.S. spending on other global health needs, even to the point of consuming half of the entire U.S. foreign assistance budget by 2016. Mead Over argues that AIDS treatment spending could quickly become a global entitlement since withdrawing funding for life-saving drugs would mean death for the beneficiaries. He offers suggestions for avoiding a ballooning AIDS treatment entitlement, including greatly stepped-up prevention efforts.
In 2004 a working group of experts was convened by the Center for Global Development to identify cases in which large-scale efforts to improve health in developing countries have succeeded—saving millions of lives and preserving the livelihoods and social fabric of entire communities. Seventeen of these cases were originally captured in CGD's enormously successful book Millions Saved: Proven Successes in Global Health. This brief is based on the new edition of the book, titled Case Studies in Global Health: Millions Saved published by Jones and Bartlett in 2007, which documents three new successes in Nepal, Chile, and India, and updates to the 17 original success stories.
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.
Generating Political Priority for Public Health Causes in Developing Countries: Implications From a Study on Maternal Mortality
Why do some serious health issues--such as HIV/AIDS--get considerable attention and others--such as malaria and collapsing health systems--very little? In this CGD brief, visiting fellow Jeremy Shiffman discusses nine factors that influenced the degree to which national leaders in five countries made maternal mortality--death from pregnancy-related complications--a political priority. Drawing on his comparison of these countries, Shiffman offers recommendations for public health priority-setting in developing countries. His bottom line: attaining public health goals is as much a political as it is a medical or technical challenge; success requires not only appropriate technical interventions but also effective political strategies.Learn more
This report of CGD's Global Health Forecasting Working Group, which was convened in early 2006 by senior fellow and director of programs Ruth Levine to sort out why demand forecasting has been so problematic, provides an elegant analysis of the problem and a sensible agenda for action. Their report offers specific recommendations that apply across a range of products and that could be implemented by identifiable public and private organizations.
Millions Saved: Proven Success in Global Health details 17 cases in which large-scale efforts to improve health in developing countries have succeeded, saving millions of lives and preserving the livelihoods and social fabric of entire communities.