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With shifting disease burdens, growing uncertainties about the future of development assistance for health, and rising demands for more expensive and complex healthcare comes the need for a greater focus on value for money. International health funders and agencies want to know how to make resources stretch further by focusing on the highest impact interventions among the most affected populations. Whether through more efficient procurement systems and supply chains, results-based financing, or more detailed assessments of the effectiveness of health technology, CGD’s work aims to make health funding go further to save, prolong, and improve more lives.
India has fallen behind in both health expenditure and health outcomes compared to other lower-middle-income countries. Its burdens of tuberculosis and malaria, and increasingly noncommunicable diseases like diabetes, are one of the largest. Infant mortality and child malnutrition rates rival those in sub-Saharan Africa.
Christmas came early this year for the wonkiest of PEPFAR-watchers. Our gift: the preliminary report on the pilot of PEPFAR’s Expenditure Analysis Initiative, an important and exciting move by PEPFAR towards evidence-based decision making and greater transparency.
The New England Journal of Medicine recently published the results of “the Oregon experiment” based on the 2008 US Medicaid program expansion in Oregon. The study is one of very few randomized control trials on publicly-subsidized health insurance that exists to guide health policy, and found what some commentators considered a disappointing result: while health care utilization increased and households were protected from financial hardship, expanding Medicaid coverage had “no significant impact on measured physical health outcomes over a 2-year period.”
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.
Universal health coverage (UHC) is now firmly on the global health agenda, and carries with it the ambitious goal of providing “access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost.” So where do we start? A critical first step to delivering on the aspirations of UHC is deciding which services and policies to prioritize and make available. While resources for health care are growing, they are not infinite and hard choices must be made.