With rigorous economic research and practical policy solutions, we focus on the issues and institutions that are critical to global development. Explore our core themes and topics to learn more about our work.
In timely and incisive analysis, our experts parse the latest development news and devise practical solutions to new and emerging challenges. Our events convene the top thinkers and doers in global development.
With shifting disease burdens, growing populations, and rising expectations comes a greater focus on value for money. International health funders and agencies want to know how to make the most of money spent by focusing on the highest impact interventions among the most affected populations. Whether through better procurement systems for health commodities, results-based financing, or more detailed assessments of the effective ness of health technology, CGD’s work aims to make health funding go further to save, prolong and improve more lives.
Current shortcomings in the system of demand forecasting for essential drugs, vaccines and diagnostics are constraining access to these products in developing countries, resulting in poor health and unnecessary deaths from disease like AIDS, TB and malaria. Ruth Levine, Director of Programs and Senior Fellow at CGD and the chair of a new Global Health Forecasting Working Group, explains how the global community can work together to solve this urgent challenge.
To learn more, read and comment on the Working Group’s consultation report (pdf, 1MB).
Q: What is demand forecasting and why is it so important now?
A: Demand forecasting is a bread-and-butter part of virtually every business that supplies goods. It's the ongoing process of projecting which products will be purchased where, when, and in what quantities. To forecast demand, you combine information about need – like incidence and prevalence of disease – with information about funding, health care coverage, losses in the supply chain, consumption patterns and other factors that affect demand. Getting good forecasts certainly is not a new challenge in the pharmaceutical supply chain in developing countries, but has become much more urgent recently. There is more money for global health products, many of them are quite costly to produce, and they need to be supplied steadily. Without the ability to forecast effective demand with a reasonable degree of certainty, increased funding for drugs will not improve health or get to the people who need it. Without good demand forecasts, manufacturers cannot increase production capacity, make commitments to suppliers of raw materials, or see a business case for investment in costly clinical trials and other activities to develop future products. National governments and international funders also need good demand forecasts for budgeting purposes, while health programs and implementing agencies depend on forecasts to plan their supply chain logistics.
Q: If everyone would benefit from better forecasts, why hasn't the situation already been fixed? What is the underlying problem?
A: I think it's a combination of factors. Clearly, it's partly because forecasting in global health hasn’t quite caught up with what's happening in the market. There has been a relatively recent surge in the amount of health funding and products available for the developing world and a rapid increase in the number of donors, suppliers, buyers and intermediaries. But there has not yet been a corresponding improvement in forecasting methods or institutional roles.
There's really no question that the underlying problem is about risk: within the current market, risks are unequally distributed across key actors whose decisions affect supply of and demand for these products. Those who suffer the direct financial and health consequences of the risks – primarily manufactures and patients - are not in a position to reduce them; conversely, the funders and intermediaries who could take specific action to address the underlying budgetary, policy-related and logistics risks only feel the consequences indirectly.
As a result of this, there are systematic problems. Not all stakeholders have incentives to develop better forecasts and greater access to critical medical technologies. And because of the limited market potential in developing countries, the private sector invests relatively little in market research and other sources of information that are common in developed markets. As we see it, the core challenge is to understand and take steps to correct the misaligned incentives by reducing and sharing risk.
Q: Are there any feasible, near-term solutions?
A: There are definitely things that can be done and would make a big difference. First, I think there should be a very clear recognition by a variety of stakeholders in global health that forecasting deserves attention and that it’s a function that needs to be clearly separated from advocacy and other activities. Second, there’s an opportunity to establish an information intermediary (or "infomediary") that would mobilize and share information and baseline forecasts in a coordinated way. This is a function that is quite common in other types of supply chains. Third, funders need to accept more of the risk; they can use creative contracting mechanisms to share risk more efficiently. These constitute a coherent package; we think that implementing these recommendations would enhance the relationship among funders, suppliers, intermediaries and users of health products, and go a significant distance toward aligning incentives towards increased access to quality health technologies. These are the recommendations that we’re hoping to get feedback on during the consultation process we’re undertaking right now. I am really looking forward to hearing views about these ideas.
Q: Where will this get us, and what's left?
A: Taken together, I think the Working Group’s recommendations have the potential to dramatically improve demand forecasting at the global level, and that would contribute to improved access to health products. At the same time, better forecasting can only get us so far when there are so many sources of underlying uncertainty. Dealing with those problems requires a broader and longer-term agenda that many people are working on, in one way or another -- strengthening health systems and building supply chain capacity in-country; increasing the market-orientation of product development activities; enhancing the regulatory regimes and enforcement; and improving the predictability of donor funding. Those are extremely important to work on, while we also do what we can today to make a real difference.
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.
Achieving better health in poor countries depends in part on giving companies that produce drugs, vaccines and diagnostics incentives to invest in their production by improving their ability to forecast which products will be purchased by whom in what quantities. This brief reviews the findings of CGD's Global Health Forecasting Working Group, which was convened in early 2006 to study the challenges surrounding demand forecasting, and offers recommendations for better forecasting, including the creation on an "infomediary" to mobilize, coordinate and disseminate information about product demand.
The success of global health programs largely depends on the availability of essential health products when and where they are needed. But weak links in the global health value chain are currently constraining on-the-ground access to drugs, vaccines and diagnostics--despite increased funding and ongoing scientific advances. Shortcomings in demand forecasting in particular have led to unnecessarily high prices, supply shortages, and reluctance to invest in R&D for developing country diseases.
This event marks the launch of a new report by the Global Health Forecasting Working Group, issuing key recommendations for donors to make strategic investments that would increase access to information and better align forecasting incentives, as well as suggestions for ways that donors could use innovative financing mechanisms to further reduce uncertainty and diversify and share risk in the supply chain. Their proposed improvements could have profound benefits for funders, suppliers and implementers in terms of both financial and health outcomes.
The Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) was established very quickly in 2001 in response to a widespread perception that a rapid scale-up in financing was critical in the fight against the three diseases. Since it began operations in January 2002, GFATM has made important progress. It has raised substantial funding and become the world’s largest donor for TB and malaria. 70% of the programs reaching the two-year renewal stage are showing solid results. Rwanda, for example, has put over 4,000 people on ARV treatment, more than double its program target, and GFATM programs in aggregate have financed ARV treatment for 130,000 people to date.
At the IAS conference, protestors turned out to oppose one reform under consideration at the Global Fund for AIDS, Tuberculosis, and Malaria: allocating funding ex ante instead of having countries propose the amount they would like to receive. Mohga Kamal-Yanni of Oxfam writes:
Looming budget cuts for FY2012 and recent reports about the decline in AIDS funding from the USG in FY2010 relative to FY2009 have triggered the classic Washington, D.C. tug-of-war; global health and development advocates are pushing to maintain funding levels, if not to increase them, and the U.S. Congress is looking for ways to increase oversight and management of taxpayer dollars. Advocates are rightly pointing out what would happen if we don’t have the money and Congress is rightly signaling that the party is over. What’s new? Nothing.
A new pay-for-performance approach to spur the 35 states of India to perform better in the health sector was recently announced. For the first time, central government funding to individual states under the country's 'flagship' health program, the National Rural Health Mission (NRHM), will depend on the state's performance. According to a Times of India news article, states that fail to perform on certain areas – primarily a more equitable distribution of doctors and nurses – will have their NRHM budget reduced, while states demonstrating performance on other areas, such as providing free generic drugs at public facilities, can earn additional outlays.