Lord Nicholas Stern delivers the Third Annual Richard H. Sabot Lecture, June 26, 2008.
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.
The President's Emergency Plan for AIDS Relief (PEPFAR) is the single largest funder of global AIDS relief programs, but it does not regularly release data on how its money is spent. In this report, CGD's HIV/AIDS Monitor Team analyzes a newly available dataset of PEPFAR funding. They find, among other things, that only 30% of funds in 15 focus countries have gone to local organizations. They urge PEPFAR to regularly publish such funding data to improve transparency and strengthen coordination with host country governments and other stakeholders, and they suggest actions PEPFAR should take to improve the effectiveness and sustainability of its programs.
The President's Emergency Plan for AIDS Relief (PEPFAR) provides more than $5 billion per year to prevent and treat HIV/AIDS. Exactly how is that money spent? Donors, recipients, and even PEPFAR staff are often left guessing, because much of the extensive data the U.S. government collects on the program isn't released. In this new CGD note, Michael Bernstein and Sarah Jane Staats (Hise) urge the U.S. Congress to require that PEPFAR regularly release this data. They argue that this would improve coordination between PEPFAR and other donors, help PEPFAR staff assess progress and hold recipients accountable, and increase cost-effectiveness. Some of the data will soon be available anyway: CGD's HIV/AIDS Monitor is preparing to release PEPFAR funding data for Fiscal Years 2004-2006 obtained by a partner organization through a Freedom of Information Act request.
Generation of Political Priority for Global Health Initiatives: A Framework and Case Study of Maternal Mortality - Working Paper 129
This week, public health advocates gather in London to mark the 20th anniversary of the global safe motherhood initiative, launched in 1987 to reduce the number of mothers who die or suffer injury giving birth. Despite the advocates' work, the initiative has yet to gain the political traction needed for success. Why? This new working paper by CGD visiting fellow Jeremy Shiffman and Stephanie Smith examine why some global health initiatives, such as HIV/AIDS, become policy priorities while others do not. They find that a problem is more likely to garner attention when political leaders express sustained concern, when the organizations they lead enact policies to address the problem; and when appropriate resources are made available.
Following the Funding for HIV/AIDS: A Comparative Analysis of the Funding Practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia
Donor funding for HIV/AIDS has skyrocketed in the last decade: from US$ 300 million in 1996 to US$ 8.9 billion in 2006. Yet, surprisingly little is known about how this money is spent. Following the Funding for HIV/AIDS, by CGD's HIV/AIDS Monitor team, analyzes the policies and practices of the world's largest AIDS donors—the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank's Multi-Country HIV/AIDS Program for Africa (MAP)—as they are applied in three case study countries: Mozambique, Uganda and Zambia. The report urges all three funders to improve country-level coordination, tracking of funds, and the collection and disclosure of data. It also identifies the strengths and shortcomings of each of the funders and offers suggestions for improvement.
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.
Patents, Price Controls and Access to New Drugs: How Policy Affects Global Market Entry - Working Paper 61
We consider how patent rights and price regulation affect whether new drugs are marketed in a country, and how quickly. The analysis covers a large sample of 68 countries at all income levels and includes all drug launches over the period 1982-2002. It uses newly compiled information on legal and regulatory policy, and is the first systematic analysis of the determinants of drug launch in poor countries. Price control tends to discourage rapid product entry, while the results for patents are mixed. There is evidence that local capacity to innovate matters and that international pricing externalities may play a role.
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.