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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.
Those who follow CGD will be familiar with our branded meme: “Cash on Delivery” aid, or COD. Many are enthusiastic about COD’s potential to revolutionize aid effectiveness. Yet within some global development organizations, leadership and staff alike express common concerns: is COD practical in the real world? Have you thought about this problem, or that constraint? How would this work in the context of our organization? And if we decided to move forward, how would we design a COD grant?
The global commitment to universal health coverage—target 3.8 of the Global Goals for Sustainable Development—is as ambitious as it is energizing. Ensuring everyone, everywhere around the world has access to quality health care without being forced into poverty will require stronger health systems that generate better patient services and improve people’s health. And, to that end, investments in hospitals and their performance will be key.
Globally, over a billion people are likely to experience a mental disorder in their lifetime, with the majority in low- and middle-income countries (LMIC). Mental illnesses are responsible for 7.4% of global disease burden, and frequently among the top causes of disability including in middle-income countries. These illnesses impose a severe economic burden not only on the individuals suffering from these illnesses but on their families, communities, healthcare systems, and governments.
One of the things I am proudest of having done in Washington was having the idea as Chief Economist of the World Bank that the Bank should devote its annual World Development Report to making the case for improving both the quantity and quality of global health investment.
Many health improving interventions in low-income countries are extremely good value for money. So why has it often proven difficult to obtain political backing for highly cost-effective interventions such as vaccinations, treatments against diarrhoeal disease in children, and preventive policies such as improved access to clean water, or policies curtailing tobacco consumption?
After a successful replenishment earlier this year, the board of Gavi, the Vaccine Alliance, is thinking through how to maximize the impact of the money it has raised. One hot issue is graduation from Gavi support. Currently, the Alliance uses an income cutoff loosely based on eligibility for IDA — soft loans from the World Bank.
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.