This is the data set for Policy Paper 27 , “The Financial Flows of PEPFAR: A Profile,” in which Victoria Fan, Rachel Silverman, Denizhan Duran, and Amanda Glassman track the financial flows of the President's Emergency Plan for AIDS Relief (PEPFAR) from donor agencies via intermediaries and to pr
Little is known about the President’s Emergency Plan for AIDS Relief (PEPFAR) financial flows within the United States (US) government, to its contractors, and to countries. We track the financial flows of PEPFAR – from donor agencies via intermediaries and finally to prime partners. We reviewed and analyzed publicly available government documents; a Center for Global Development dataset on 477 prime partners receiving PEPFAR funding in FY2008; and a cross-country dataset to predict PEPFAR outlays at the country level. We present patterns in Congressional appropriations to US government implementing agencies; the landscape of prime partners and contractors; and the allocation of PEPFAR funding by disease burden as a measure of country need.
When Is Prevention More Profitable than Cure? The Impact of Time-Varying Consumer Heterogeneity - Working Paper 334
We argue that in pharmaceutical markets, variation in the arrival time of consumer heterogeneity creates differences between a producer’s ability to extract consumer surplus with preventives and treatments, potentially distorting R&D decisions. If consumers vary only in disease risk, revenue from treatments—sold after the disease is contracted, when disease risk is no longer a source of private information—always exceeds revenue from preventives. The revenue ratio can be arbitrarily high for sufficiently skewed distributions of disease risk. Under some circumstances, heterogeneity in harm from a disease, learned after a disease is contracted, can lead revenue from a treatment to exceed revenue from a preventative. Calibrations suggest that skewness in the U.S. distribution of HIV risk would lead firms to earn only half the revenue from a vaccine as from a drug. Empirical tests are consistent with the predictions of the model that vaccines are less likely to be developed for diseases with substantial disease-risk heterogeneity
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.
The authors carry out a systematic review of studies on CCTs that report maternal and newborn health outcomes, including studies from eight countries. We find that CCTs have increased antenatal visits, skilled attendance at birth, delivery at a health facility, and tetanus toxoid vaccination for mothers, and reduced the incidence of low birth weight. The programs have not had a significant impact on fertility or Caesarean sections while impact on maternal and newborn mortality has not been well documented thus far.
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.
Given the vital importance of child vaccination programs to US national security interests, intelligence-community participation in public health services should be explicitly banned. Doing so might help restore confidence in vaccination programs—benefiting those immunized and the health and security of Americans here at home.
In this paper, Saugato Datta and non-resident fellow Sendhil Mullainathan explore the implications of behavioral economics in policy areas as diverse as health, education, agricultural policy, and the design of cash-transfer programs.
In this paper, the authors discuss the rationale for investing in vaccination and construct a metric to measure country commitment to vaccination that would promote accountability and better tracking of performance.
This is the data set underlying Policy Paper 009, “A Commitment to Vaccination Index: Measuring Government Progress toward Global Immunization.”
This brief presents a framework for increasing the efficiency of malaria-control initiatives that addresses where to intervene, what interventions are best, and how to deliver them most effectively.
William Savedoff looks at the long history of global multipolarity and forecasts what recent geopolitical changes mean for the future of international cooperation.
State Health Insurance and Out-of-Pocket Health Expenditures in Andhra Pradesh, India - Working Paper 298
The authors of this working paper analyze the effects of the Aarogyasri health insurance program deployed in 2007 in Andhra Pradesh to reduce catastrophic health expenditures in households below the poverty line.
The paper outlines potential goal areas based on the original Millennium Declaration, the timeframe for any MDGs 2.0 and attempts to calculate some reasonable targets associated with those goal areas.
These two sets include input data and Stata files to replicate the results in CGD Working Paper 278, “More Money or More Development: What Have the MDGs Achieved?” and CGD Working Paper 297 “MDGs 2.0: What Goals, Targets, and Timeframe?”
Decisions about which type of patients receive what interventions, when, and at what cost often result from ad hoc, nontransparent processes driven more by inertia and interest groups than by science, ethics, and the public interest. Reallocating a portion of public and donor monies toward the most cost-effective health interventions would save more lives and promote health equity.
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.
This paper examines opportunities for improved efficiency in malaria control, analyzing the effectiveness of interventions and current trends in spending. Overall, it appears that resources for malaria control are well spent—however, there remain areas for improved efficiency, including (i) improving procurement procedures for bed nets, (ii) developing efficient ways to replace bed nets as they wear out, (iii) reducing overlap of spraying and bed net programs, (iv) expanding the use of rapid diagnostics, and (v) scaling up intermittent presumptive treatment for pregnant women and infants.