Using publicly available information, we describe all seven DIBs, and evaluate the three “health DIBs” in more detail, comparing their stakeholders, implementation, and outcome structures. We offer three recommendations to improve evaluation and inform development of DIBs in the future.
The Medium-Run and Scale-Up Effects of Performance-Based Financing: An Extension of Rwanda’s 2006 Trial Using Secondary Data - Working Paper 497
Rwanda’s performance-based incentives were effective for some indicators, but unconditional financing also induced improvements. The incentive effects persisted in the mediumrun and as the program was scaled-up.
The Declaration of Alma-Ata at 40: Realizing the Promise of Primary Health Care and Avoiding the Pitfalls in Making Vision Reality
In October, world leaders renewed their commitment to Primary Health Care. Now is an opportune time to identify lessons learned and key challenges from the past 40 years, and to acknowledge the work that remains to be done to make vision reality.
The Impact of Civil Conflict on Child Malnutrition and Mortality, Nigeria, 2002-2013 - Working Paper 494
In this paper, we show a strong association between living close to a conflict zone and acute malnutrition in Nigerian children in 2013. This is related to the severity of the conflict, measured both in terms of the number of conflict deaths and the length of time the child was exposed to conflict.
In recent years, many global health institutions have adopted eligibility and transition frameworks for the countries they support, generating questions about how these frameworks apply in practice—and whether global health progress will be put at risk through premature or poorly planned transition processes.
Using Supervised Learning to Select Audit Targets in Performance-Based Financing in Health: An Example from Zambia - Working Paper 481
We examine alternative strategies for targeted sampling of health clinics for independent verification. Our results indicate that machine learning methods, particularly Random Forest, outperform other approaches and can increase the cost-effectiveness of verification activities.
Does Deforestation Increase Malaria Prevalence? Evidence from Satellite Data and Health Surveys - Working Paper 480
In this paper we combine fourteen years of high-resolution satellite data on forest loss with individual-level survey data on malaria in more than 60,000 rural children in 17 countries in Africa, and fever in more than 470,000 rural children in 41 countries in Latin America, Africa, and Asia. We did not find that deforestation increases malaria prevalence nor that intermediate levels of forest cover have higher malaria prevalence.
Perspective in Economic Evaluations of Healthcare Interventions in Low- and Middle-Income Countries: One Size Does Not Fit All
As developing nations are increasingly adopting economic evaluation as a means of informing their own investment decisions, new questions emerge. The right answer to the question “which perspective?” is the one tailored to these local specifics. We conclude that there is no one-size-fits-all and that the one who pays must set or have a major say in setting the perspective.
Healthcare Systems as Intelligent Payers: What Can the Global Health Community Learn from the English National Health Service?
Today, politicians are under growing pressure to squeeze more out of every dollar and guarantee greater access to better, more affordable healthcare for their citizens. In such a resource-constrained environment, wasting trillions of dollars on health every year is not viable. This note provides an overview of some of the approaches and policy options that the National Health Service in England has been using to maximise value for money.
Despite the considerable interest in Development Impact Bonds, only a few have reached the implementation phase. We use information from stakeholder interviews to describe the design of one DIB in-depth and use lessons from a range of impact bonds to develop recommendations for potential partners to future DIBs. Lessons from the set of impact bonds reveal a need to reset expectations, particularly around the time and effort needed to develop and market a DIB.
The Sustainable Development Goals are an ambitious set of targets for global development progress by 2030 that were agreed by the United Nations in 2015. A review of the literature on meeting "zero targets" suggests very high costs compared to available resources, but also that in many cases there remains a considerable gap between financing known technical solutions and achieving the outcomes called for in the SDGs. In some cases, we (even) lack the technical solutions required to achieve the zero targets, suggesting the need for research and development of new approaches.
This post previews preliminary answers to one initial question: what can we say about the size and nature of health commodity markets in low- and middle-income countries? We share early insights; list the data sources we used, while also signalling others we hope to draw on going forward; and highlight our assumptions and caveats.
Keynote Address by Canadian Minister of International Development, Marie-Claude Bibeau, at the Third Annual Birdsall House Conference on Women
On December 7, 2017, Marie-Claude Bibeau, Minister of International Development and La Francophonie, Government of Canada, gave a keynote address at the the third annual Birdsall House Conference on Women, "Reproductive Choices to Life Chances: The Links between Contraception and Women’s Economic Empowerment."
Family Planning and Women’s Economic Empowerment: Incentive Effects and Direct Effects among Malaysian Women - Working Paper 471
Although family planning programs can improve women’s welfare directly through changes in realized fertility, they may also have important incentive effects by increasing parents’ investments in girls not yet fertile. We study these potential incentive effects, finding that family planning may have raised raise girls’ educational attainment substantially. We also find that these early investments are linked to gains in women’s paid labor at prime working ages and to greater support for women’s elderly parents (a marker for women’s bargaining power within the household). Notably, these incentive effects may be larger than the direct effects of family planning alone.
Family Planning and Fertility Behavior: Evidence from Twentieth Century Malaysia - Working Paper 470
There is longstanding debate about the contribution of family planning programs to fertility decline. Studying the staggered introduction of family planning across Malaysia during the 1960s and 1970s, we find modest responses in fertility behavior. Overall, Malaysia’s total fertility rate declined by about one quarter birth under family planning, explaining only about 10 percent of the national fertility decline between 1960 and 1988. Our findings are consistent with growing evidence that global fertility decline is predominantly due to underlying changes in the demand for children.
With aid budgets shrinking and even low-income countries increasingly faced with cofinancing requirements, this is the right time for global health funders such as the Global Fund and their donors to formally introduce Health Technology Assessment (HTA), both at the central operations level and at the national or regional level in recipient countries. In this CGD Note, we explain why introducing HTA is a good idea. Specifically, we outline six benefits that the application of HTA could bring to the Global Fund, the countries it supports, and the broader global health community.
We analyzed a large-scale municipal water disinfection program in Mexico in 1991 that rapidly increased access to chlorinated water. Our results suggest that childhood diarrheal disease mortality in Mexico would have declined by 86 percent if all municipalities had good quality infrastructure—a decline consistent with historical experience.
Different Strokes for Different Folks: Experimental Evidence on the Effectiveness of Input and Output Incentive Contracts for Health Care Providers with Different Levels of Skills - Working Paper 464
A central issue in designing performance incentive contracts is whether to reward the production of outputs versus use of inputs: the former rewards efficiency and innovation in production, while the latter imposes less risk on agents.