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Working Group on the Future of Global Health Procurement
Many low-and lower-middle-income countries currently procure a large portion of their health commodities—drugs, devices, diagnostics, and vector control tools—through centralized, donor-managed procurement mechanisms, and often at subsidized prices or as donations. Over the next several decades, however, the landscape of global health procurement will change dramatically as countries grow richer and lose aid eligibility; disease burdens shift; and technological breakthroughs change the portfolio of commodity needs. To consider how the global health community can ensure the medium- to long-term relevance, efficiency, quality, affordability, and security of global health procurement, the Center for Global Development (CGD) launched the Working Group on the Future of Global Health Procurement in July 2017. A final report is expected in late 2018. Throughout this process, CGD will engage key global health stakeholders—country representatives, procurement agents, funders, and industry partners—to reflect the range of views on these issues and encourage the adoption of proposed recommendations.
In recent decades, the world has made great strides toward improving global access to lifesaving health commodities, including medicines, diagnostics, medical devices, and vector control tools.* This increase in access has in large part resulted from the investments of international health partnerships such as UNICEF, UNFPA, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and bilateral aid programs such as PEPFAR, DFID, and USAID. To deliver these lifesaving global health commodities to where they are needed most, these funders have also set up centralized procurement mechanisms to purchase drugs, diagnostics, devices, and vector control tools from manufacturers, and to subsequently make them available to countries at subsidized prices or as donations.
Over the next decade, however, most low-income countries will become middle-income countries that are ineligible for aid under current rules, spend more domestic public monies on health, and self-procure most needed health commodities. At the same time, demographic and epidemiological changes will affect the size and composition of demand for health care and related products; infectious diseases will diminish in importance while non-communicable diseases increase. Other factors—such as growing drug resistance, the pace of economic growth and its impact on public spending, the trend towards increasing decentralization of procurement and service delivery, and the continual development of new technologies in the context of rising expectations for more comprehensive health benefits—will also put new pressures on global health procurement. In this context, policymakers should be prepared to take preemptive action to ensure the medium- to long-term relevance, efficiency, quality, affordability, and security of global health procurement. This Working Group considers how global health procurement mechanisms can adapt to this changing landscape.
Working group meetings were held on July 25, 2017 in Washington, DC and February 6-7, 2018 near Geneva, Switzerland. A supplementary technical workshop was hosted in April 2018 in Toulouse, France. The third meeting will be held on July 19-20, 2018 in London, England and a final report is expected in late 2018.
*Note: This working group does not consider vaccines.
Michael Anderson, CDC Group Amie Batson, PATH Francisco Blanco, World Health Organization Christa Cepuch, MSF Access Campaign Kalipso Chalkidou, Center for Global Development Clinton De Souza, Imperial Logistics John Crowley, USAID, Supply Chain for Health Division Francesco Decarolis, Boston University and Einaudi Institute for Economics and Finance Todd Dickens, PATH James Droop, DFID Rebecca Forman, Center for Global Development Akthem Fourati, UNICEF Amanda Glassman, Center for Global Development Eduardo González-Pier, Mexican Institute of Social Security and Ministry of Health, Mexico Lisa Hare, USAID, Malaria Division Supply Chain Branch Jay Heavner, USAID Global Health Supply Chain – Procurement and Supply Management Project Beverly Lorraine Ho, Department of Health, Philippines Christine Jackson, Crown Agents Sneha Kanneganti, World Bank Navjot Khosa, Kerala Medical Service Corporation Ltd., India Biljana Kozlovic, Consultant and formerly National Health Insurance Fund, Serbia Wesley Kreft, Partnership for Supply Chain Management (PFSCM) Neel Lakhani, Clinton Health Access Initiative Beverly Lorraine Ho, Department of Health, Philippines Janeen Madan Keller, Center for Global Development Melissa Malhame, GAVI Alliance Susan Nazzaro, Bill & Melinda Gates Foundation Cassandra Nemzoff, Center for Global Development Roxanne Oroxom, Center for Global Development Ed Rose, NHS England Daniel Rosen, AfRx Consulting Group Rajeev Sadanandan, Government of Kerala William Savedoff, Center for Global Development Eugene Schneller, Arizona State University Andreas Seiter, World Bank Rachel Silverman, Center for Global Development Paul Stannard, Population Services International Netnapis Suchonwanich, National Health Security Office, Thailand Mariatou Tala Jallow, Global Fund Greg Vistnes, William Davidson Institute, University of Michigan Brenda Waning, Global Drug Facility Barnaby Wiles, World Bank Tommy Wilkinson, PRICELESS SA Hongwei Yang, National Health and Development Centre, China
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.
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.
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.
What can we say about the relative size and composition of health commodity markets across different countries? We took a stab at piecing together publicly available data sources to find an initial answer for low- and middle-income countries as part of the background work to inform the CGD Working Group on the Future of Global Health Procurement.
Whether it’s called strategic purchasing, evidence-informed commissioning, or value-based insurance, the quest to squeeze better value out of existing resources is global. But lack of clarity regarding global and national healthcare investment goals, coupled with low technical capacity in ministries of health and insurance funds and multiple competing interests for attracting healthcare dollars, all make proactive evidence-informed buying hard to achieve. The global health community ought to help Ghana and countries like it strengthen their national systems for allocating resources including when selecting, negotiating prices, and procuring medicines for their populations.
The Global Fund’s Office of the Inspector General (OIG) released a new audit report on Wambo.org, its online procurement platform for drugs and other health commodities. The headline: despite high marks from its users, Wambo.org is not yet on track to deliver the projected savings. But more than the headline, a close read of the report narrative helps us understand why reality does not yet reflect the Global Fund’s optimistic assumptions—and, reading between the lines, suggests three important lessons for the Global Fund and other international funders