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  • Author: Vijaya Ramachandran, Benjamin Leo, Robert Morello
  • Publication Date: 02-2015
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The need for infrastructure improvements is a top-tier economic, political, and social issue in nearly every African country. Although the academic and policy literature is extensive in terms of estimating the impact of infrastructure deficits on economic and social indicators, very few studies have examined citizen demands for infrastructure. In this paper, we draw upon survey data to move beyond topline estimates of national infrastructure access rates towards a more nuanced understanding of service availability and citizen demands at the regional, national, and sub-national level. We find a predictable pattern of infrastructure services across income levels—lower income countries have fewer services. The survey data also allows us to observe the sequencing of infrastructure services. On the demand side, survey respondents are most concerned with jobs and income-related issues, as well as with the availability of infrastructure: specifically transportation and sanitation. These priorities transcend demographic factors, including gender and location (urban/rural).
  • Topic: Health
  • Political Geography: Africa
  • Author: Katharina Hauck, Peter C. Smith
  • Publication Date: 09-2015
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: 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 diarrheal disease in children, and preventive policies such as improved access to clean water, or policies curtailing tobacco consumption? We use economic models of public choice, supported by examples, to explain how powerful interests groups, politicians or bureaucrats who pursue their own objectives, or voting and institutional arrangements in countries have shaped health priority setting. We show that it may be perfectly rational for policy makers to accommodate these constraints in their decisions, even if it implies departing from welfare maximizing solutions.
  • Topic: Health, Political Economy, Health Care Policy
  • Author: William Savedoff, Victoria Fan
  • Publication Date: 03-2014
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Almost every country exhibits two important health financing trends: health spending per person rises and the share of out-of-pocket spending on health services declines. We describe these trends as a "health financing transition" to provide a conceptual framework for understanding health markets and public policy. Using data over 1995-2009 from 126 countries, we examine the various explanations for changes in health spending and its composition with regressions in levels and first differences. We estimate that the income elasticity of health spending is about 0.7, consistent with recent comparable studies. Our analysis also shows a significant trend in health spending - rising about 1 percent annually - which is associated with a combination of changing technology and medical practices, cost pressures and institutions that finance and manage healthcare. The out-of-pocket share of total health spending is not related to income, but is influenced by a country's capacity to raise general revenues. These results support the existence of a health financing transition and characterize how public policy influences these trends.
  • Topic: Development, Economics, Health, Governance
  • Political Geography: United States
  • Author: Amanda Glassman, Juan Ignacio Zoloa
  • Publication Date: 10-2014
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: As Latin American countries seek to expand the coverage and benefits provided by their health systems under a global drive for universal health coverage (UHC), decisions taken today–whether by government or individuals-will have an impact tomorrow on public spending requirements. To understand the implications of these decisions and define needed policy reforms, this paper calculates long-term projections for public spending on health in three countries, analyzing different scenarios related to population, risk factors, labor market participation, and technological growth. In addition, the paper simulates the effects of different policy options and their potential knock-on effects on health expenditure.
  • Topic: Health, Governance, Reform
  • Political Geography: Brazil, Latin America, Mexico, Chile
  • Author: Dean Karlan, Pia Raffler, Greg Fischer, Margaret McConnell
  • Publication Date: 11-2014
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: In a field experiment in Uganda, we find that demand after a free distribution of three health products is lower than after a sale distribution. This contrasts with work on insecticide-treated bed nets, highlighting the importance of product characteristics in determining pricing policy. We put forward a model to illustrate the potential tension between two important factors, learning and anchoring, and then test this model with three products selected specifically for their variation in the scope for learning. We find the rank order of shifts in demand matches with the theoretical prediction, although the differences are not statistically significant.
  • Topic: Development, Health
  • Political Geography: Uganda, Africa
  • Author: Amanda Glassman, Denizhan Duran, Rachel Silverman, Victoria Fan
  • Publication Date: 10-2013
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: More than ever, global health funding agencies must get better value for money from their investment portfolios; to do so, each agency must know the interventions it supports and the sub-populations targeted by those interventions in each country.
  • Topic: Foreign Policy, Development, Economics, Health, Humanitarian Aid, Health Care Policy
  • Political Geography: India, Philippines, Ethiopia, Nigeria
  • Author: Owen Barder, Petra Krylová
  • Publication Date: 11-2013
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: The Commitment to Development Index ranks 27 of the world's richest countries on policies that affect the more than five billion people living in poorer nations. The CDI goes beyond measures of foreign aid to quantify performance in seven areas: Quantity and quality of foreign aid Openness to trade policies that encourage investment and financial transparency Openness to migration Environmental policies Promotion of international security Support for technology creation and transfer Why does the CDI matter? Because in an integrated world, the behavior of rich countries and powerful institutions can profoundly affect the lives of people in poor countries and because poverty and weak institutions in developing countries can breed public health crises, security threats, and economic crises that know no borders. Committing to policies that promote development and well-being is a global imperative: no human being should be denied the chance to live free of poverty and oppression and to enjoy a basic standard of education and health. The CDI countries all promote respect for human life and dignity; the Index looks at whether the policies of rich countries match these aspirations.
  • Topic: Security, Development, Education, Health, Poverty, Fragile/Failed State
  • Author: Amanda Glassman, Denizhan Duran
  • Publication Date: 02-2012
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Health is one of the largest and most complex aid sectors: 16 percent of all aid went to the health sector in 2009. While many stress the importance of aid effectiveness, there are limited quantitative analyses of the quality of health aid. In this paper, we apply Birdsall and Kharas's Quality of Official Development Assistance (QuODA) methodology to rank donors across 23 indicators of aid effectiveness in health. We present our results, track progress from 2008 to 2009, compare health to overall aid, discuss our limitations, and call for more transparent and relevant aid data in the sector level as well as the need to focus on impact and results.
  • Topic: Development, Health, Human Welfare, Humanitarian Aid, Foreign Aid
  • Author: Victoria Fan, Anup Karan, Ajay Mahal
  • Publication Date: 06-2012
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: In 2007, the state of Andhra Pradesh in southern India began rolling out the Aarogyasri health insurance to reduce catastrophic health expenditures in households “below the poverty line.” We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that, within the first year of implementation, Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population.
  • Topic: Health, Poverty, Health Care Policy
  • Political Geography: India, Asia, Andhra Pradesh
  • Author: Kevin Ummel
  • Publication Date: 08-2012
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The Carbon Monitoring for Action (CARMA) database provides information about the carbon dioxide emissions, electricity production, corporate ownership, and location of more than 60,000 power plants in over 200 countries. Originally launched in 2007, CARMA is provided freely to the public at www.carma. org and remains the only comprehensive data source of its kind. This paper documents the methodology underpinning CARMA v3.0, released in July, 2012. Comparison of CARMA model output with reported data highlights the general difficulty of precisely predicting annual electricity generation for a given plant and year. Estimating the rate at which a plant emits CO2 (per unit of electricity generated) generally faces fewer obstacles. Ultimately, greater disclosure of plant-specific data is needed to overcome these limitations, particularly in major emitting countries like China, Russia, and Japan. For any given plant in CARMA v3.0, it is estimated that the reported value is within 20 percent of the actual value in 85 percent of cases for CO2 intensity, 75 percent for annual CO2 emissions, and 45 percent for annual electricity generation. CARMA's prediction models are shown to offer significantly better estimates than more naïve approaches to estimating plant-specific performance.
  • Topic: Climate Change, Environment, Health, Industrial Policy
  • Political Geography: Russia, Japan, China
  • Author: Nora Lustig
  • Publication Date: 11-2012
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: We apply a standard tax-and-benefit-incidence analysis to estimate the impact on inequality and poverty of direct taxes, indirect taxes and subsidies, and social spending (cash and food transfers and in-kind transfers in education and health). The extent of inequality reduction induced by direct taxes and transfers is rather small (2 percentage points on average), especially when compared with that found in Western Europe (15 percentage points on average). What prevents Argentina, Bolivia, and Brazil from achieving similar reductions in inequality is not the lack of revenues but the fact that they spend less on cash transfers—especially transfers that are progressive in absolute terms—as a share of GDP. Indirect taxes result in that net contributors to the fiscal system start at the fourth, third, and even second decile on average, depending on the country. When in-kind transfers in education and health are added, however, the bottom six deciles are net recipients. The impact of transfers on inequality and poverty reduction could be higher if spending on direct cash transfers that are progressive in absolute terms were increased, leakages to the nonpoor reduced, and coverage of the extreme poor by direct transfer programs expanded.
  • Topic: Development, Economics, Education, Health, Poverty
  • Political Geography: Brazil, Argentina, Latin America, Mexico, Peru, Bolivia
  • Author: Amanda Glassman, Andy Sumner, Denizhan Duran
  • Publication Date: 01-2012
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: After a decade of rapid economic growth, many developing countries have attained middle-income status. But poverty reduction in these countries has not kept pace with economic growth. As a result, most of the world's poor—up to a billion people—now live in these new middle-income countries (MICs), making up a “new bottom billion.” As the new MICs are home to most of the world's poor, they also carry the majority of the global disease burden. This poses a challenge to global health agencies, in particular the GAVI Alliance and the Global Fund, which are accustomed to disbursing funds on the assumption that the majority of poor people live in poor countries.
  • Topic: Development, Economics, Health, Poverty
  • Author: Amanda Glassman, Paul Wilson
  • Publication Date: 07-2012
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: Malaria kills hundreds of thousands of people every year and is among the leading causes of death for children under five. While funding for malaria control increased dramatically in recent years, gains are fragile and budgets are now stagnating. In that fiscal reality, getting better value for money is more important than ever. In this brief, we present a framework for increasing the efficiency of malaria-control initiatives that addresses where to intervene, what interventions are best, and how to deliver them most effectively. Much of what is spent on malaria control is already spent well, but health policymakers and practitioners could get better value and save more lives by implementing the following recommendations: Improve procurement procedures for bednets. Reduce overlap of insecticide-spraying and bednet programs. Expand the use of rapid diagnostics. Scale up intermittent presumptive treatment for pregnant women and infants.
  • Topic: Health, Infectious Diseases
  • Author: Amanda Glassman, Kalipso Chalkidou
  • Publication Date: 06-2012
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: Health donors, policymakers, and practitioners continuously make life-and-death decisions about which type of patients receive what interventions, when, and at what cost. These decisions—as consequential as they are—often result from ad hoc, nontransparent processes driven more by inertia and interest groups than by science, ethics, and the public interest. The result is perverse priorities, wasted money, and needless death and illness. Examples abound: In India, only 44 percent of children 1 to 2 years old are fully vaccinated, yet open-heart surgery is subsidized in national public hospitals. In Colombia, 58 percent of children are fully vaccinated, but public monies subsidize treating breast cancer with Avastin, a brand-name medicine considered ineffective and unsafe for this purpose in the United States.
  • Topic: Development, Health, Foreign Aid
  • Political Geography: United States, India, Colombia
  • Author: Amanda Glassman, Denizhan Duran
  • Publication Date: 05-2012
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: Health is one of the largest and most complex sectors of foreign aid: in recent years, about 15 cents of every aid dollar went to global health. While health is often cited as one of the few undisputed aid success stories, there is little quantitative analysis of the quality of health aid, and some studies suggest that health aid does not necessarily improve health outcomes.
  • Topic: Development, Globalization, Health, Foreign Aid, Health Care Policy
  • Author: David Roodman
  • Publication Date: 10-2012
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: Why does the CDI matter? Because in an increasingly integrated world, the behavior of rich countries can profoundly affect the lives of people in poor countries and because poverty and weak institutions in developing countries can breed public health crises, security threats, and economic crises that know no borders. Committing to policies that promote develop- ment and well-being is a global imperative—no human being should be denied the chance to live free of poverty and oppression and to enjoy a basic standard of education and health. The CDI countries, all democracies, preach concern for human life and dignity within their own borders; the Index looks at whether rich countries' actions match their words.
  • Topic: Development, Economics, Education, Health, Poverty
  • Author: Rachel Nugent, Andrea B. Feigl
  • Publication Date: 01-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Health conditions in developing countries are becoming more like those in developed countries, with non-communicable diseases (NCDs) predominating and infectious diseases declining. The increased awareness of changing health needs, however, has not translated into significant shifts in resources or policy-level attention from international donors or governments in affected countries. Driven by changes in lifestyle related to nutrition, physical activity, and smoking, the surging burden of NCDs in poor countries portends painful choices, particularly for countries with weak health systems that are struggling to manage persistent infectious disease burdens and to protect the poor from excessive out-of-pocket expenses.
  • Topic: Development, Health, Poverty, Third World, Foreign Aid
  • Author: Todd Moss, Benjamin Leo
  • Publication Date: 03-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Even under conservative assumptions, IDA will likely face a wave of country graduations by 2025. We project that it will lose more than half of its client countries and that the total population living in IDA-eligible countries will plunge by two-thirds. The remaining IDA-eligible countries will be significantly smaller in size and overwhelmingly African, and a majority are currently considered fragile or post-conflict. This drastically altered client base will have significant implications for IDA's operational and financial models. We conclude with three possible options for IDA and recommend that World Bank shareholders and management begin frank discussions on its future sooner rather than later.
  • Topic: Demographics, Development, Health, World Bank, Health Care Policy
  • Political Geography: Africa
  • Author: Amanda Glassman, Lisa Carty, J. Stephen Morrison, Margaret Reeves
  • Publication Date: 06-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: On June 13, the GAVI Alliance convenes its first pledging conference in London with the aim of securing $3.7 billion to immunize an additional 250 million children by 2015. Founded in 2000, GAVI is an innovative partnership that combines donors, partner governments, UNICEF, WHO, civil society, and the private sector. It is designed to accelerate the financing and delivery of selected vaccines and related health services to the world's most disadvantaged populations. As GAVI enters its second decade of operations, it has established itself as a quiet success. And as it strives to sustain and expand its model of operations, it simultaneously strives to make itself better known and understood; better led, managed, and resourced; better assured of essential high-level political and financial support; and better served by well-functioning relations with its many essential partners.
  • Topic: Development, Economics, Health, Foreign Aid
  • Author: Charles Kenny, Ursula Casabonne
  • Publication Date: 05-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Casabonne and Kenny argue that two major factors underlie improved global health outcomes: first, the discovery of cheap technologies that can dramatically improve outcomes; second, the adoption of these technologies, thanks to the spread of knowledge. Other factors have played a role. Increased income not only allows for improved nutrition, but also helps to improve access to more complex preventative technologies. Institutional development is a second key to the spread of such complex technologies. Nonetheless, evidence of dramatic health improvements even in environments of weak institutions and stagnant incomes suggests that the role of these factors may be secondary.
  • Topic: Development, Health, Poverty, Foreign Aid
  • Author: Nemat Shafik
  • Publication Date: 05-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Development finance is at a turning point. There is talk about a "triple revolution of goals, actors and tools." As much of Asia grows its way out of poverty, aid will increasingly be focused on Africa and on countries plagued by instability, or with governments unable to meet the basic needs of their populations. A growing share of development finance will be directed to tackling global public goods-like climate change, conflict prevention, and public health. Responsibility for addressing global challenges will increasingly be borne by coalitions that cut across states, the private sector, and civil society. These networks to address poverty and global issues will become a feature of the international architecture in a multipolar world. The rules of the game and the tools of development assistance need to evolve to focus on transparency, results, accountability, a market-driven division of labor and flexible partnerships for the future development finance system to become an effective tool of global problem solving.
  • Topic: Conflict Prevention, Climate Change, Development, Environment, Health
  • Author: Nancy Birdsall, Benjamin Leo
  • Publication Date: 04-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The global community faces a number of critical challenges ranging from climate change to crossborder health risks to natural-resource scarcities. Many of these so-called global commons problems carry grave risks to economic growth in the developing world and to the livelihoods and welfare of their people. Climate change is the classic example. Despite the risks involved, donor governments have funded programs addressing global challenges such as climate change at far lower levels than traditional programs of country-based development assistance. The prospects for dealing with such global challenges will depend at least in part on new collective financing mechanisms.
  • Topic: Climate Change, Development, Health, Humanitarian Aid, Foreign Aid
  • Author: Amanda Glassman, William Savedoff
  • Publication Date: 07-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Global health aid is exceedingly complex. It encompasses more than one hundred bilateral agencies, global funds, and independent initiatives that interact with an equally complex and diverse set of institutions involved in financing and providing health care in developing countries. Numerous efforts have been made to better coordinate these activities in the interest of making them more effective. The Health Systems Funding Platform (the Platform) is one of the most recent of these initiatives. Established in 2009, the Platform has advanced farthest in two countries, Ethiopia and Nepal, and is currently expanding to several others. This paper briefly assesses the Platform and argues that the way the initiative is proceeding differs little from prior initiatives, such as sector- wide approaches and budget support. However, the initiative does represent an opportunity to make global health aid more effective if it were to deepen its commitment to improving information for policy, link funding explicitly to well-chosen independently verified indicators, and establish an evaluation strategy to learn from its experience.
  • Topic: Development, Health, International Cooperation, International Organization, Foreign Aid
  • Political Geography: Nepal, Ethiopia
  • Author: Amanda Glassman, Andy Sumner, Denizhan Duran
  • Publication Date: 10-2011
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: After a decade of rapid growth in average incomes, many countries have attained middle-income country (MIC) status. At the same time, the total number of poor people hasn't fallen as much as one might expect and, as a result, most of the world's poor now live in MICs. In fact, there are up to a billion poor people or a 'new bottom billion' living not in the world's poorest countries but in MICs. Not only has the global distribution of poverty shifted to MICs, so has the global disease burden. This paper examines the implications of this 'new bottom billion' for global health efforts and recommends a tailored middle-income strategy for the Global Fund and GAVI. The paper describes trends in the global distribution of poverty, preventable infectious diseases, and health aid response to date; revisits the rationale for health aid through agencies like GAVI and the Global Fund; and proposes a new MIC strategy and components, concluding with recommendations.
  • Topic: Development, Globalization, Health, Poverty
  • Author: Katie Stein
  • Publication Date: 04-2011
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: With a new executive director appointed in November 2010, the United Nations Population Fund (UNFPA) is in a position to re-assert its role and lead the world's effort toward landmark achievements in improving women's health and well-being. The Fund's performance will literally be a matter of life or death for millions of women and children. The numbers speak for themselves: an estimated 215 million women lack access to modern contraceptives, and there are approximately 350,000 maternal deaths each year. As the lead agency for the United Nations' work on population and reproductive health, UNFPA can reduce this terrible and unnecessary toll of lost lives.
  • Topic: Demographics, Development, Gender Issues, Health, United Nations
  • Author: Jenny Ottenhoff
  • Publication Date: 09-2011
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: The World Bank is a multilateral financial institution that provides financial and technical assistance for development in low- and middle-income countries. Finance is allocated through low-interest loans and grants for a range of development sectors such as health and education, infrastructure, public administration, financial and private-sector development, agriculture, and environmental and natural resource management.
  • Topic: Development, Education, Environment, Health, Foreign Aid, Infrastructure, World Bank
  • Political Geography: Pakistan, Indonesia, India
  • Author: Amanda Glassman, Kate McQueston
  • Publication Date: 08-2011
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: Noncommunicable diseases (NCDs) such as cancer, diabetes, respiratory and cardiovascular diseases, and mental illnesses are the leading cause of death and disability worldwide. Surprisingly, the burden is especially high in developing countries, which bear 80 percent of deaths due to NCDs. Four main factors are at fault: tobacco use, physical inactivity, unhealthy diets, and alcohol use. The good news is that much of the NCD burden can be prevented through interventions that are affordable in most countries. The United States can help now by taking five low-cost or no-cost steps:End tariff-reducing trade practices for tobacco.Partner with public and private donors.Leverage U.S. influence in multilateral development institutions.Exploit synergies between disease control and other development projects.Encourage evidence-informed budget allocation.
  • Topic: Development, Health, Poverty
  • Political Geography: United Nations
  • Author: Mead Over
  • Publication Date: 11-2011
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: An unprecedented surge in donor support for HIV/AIDS treatment over the last decade has lengthened and improved the lives of millions of people living with HIV/AIDS. But because the rate of new infections outpaces the rate of AIDS-related deaths, the number of people living with AIDS—and therefore the number of people needing treatment—is growing faster than the funding needed to treat them. In 2009, about 1.8 million people died from AIDS-related illnesses while about 2.6 million were newly infected with HIV, increasing the total number of people living with HIV/AIDS by more than three-quarters of a million.
  • Topic: Development, Health, Foreign Aid
  • Author: Amanda Glassman, Thomas Bollyky
  • Publication Date: 10-2011
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: More than a billion people suffer from neglected diseases, and millions die each year. Effective remedies have been few because of low investment, but with a surge in funding in the past decade, dozens of candidate drugs and vaccines are now in the pipeline. Before these products can reach the people who need them, they must be tested in large-scale clinical trials that are expensive, time-consuming, and risky. These trials must be conducted with highly vulnerable patients in resource-and infrastructure-poor countries where the neglected disease burden exists. There is not enough funding to support the costs and regulatory oversight of these clinical trials. A two-pronged approach to improve the quality and lower the cost of clinical trials in the developing world is needed.
  • Topic: Development, Health, Poverty, Infrastructure
  • Author: Thomas Bollyky
  • Publication Date: 06-2010
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: There has been tremendous progress over the last decade in the development of health products for neglected diseases. These include drugs, vaccines, and diagnostics for malaria and tuberculosis, which kill millions of people annually, plus other diseases like chagas and dengue fever, which may less familiar, but nonetheless exact a large and often lethal toll in the world's poorest communities. Led by product development public private partnerships (PDPs) and fueled by the support of the Bill Melinda Gates Foundation, the National Institutes of Health, and other donors, there are now dozens of candidate products in the pipeline.
  • Topic: Development, Health, Humanitarian Aid, Infectious Diseases
  • Author: David Wendt, Nandini Oomman, Christina Droggitis
  • Publication Date: 04-2010
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: Billions of dollars have been allocated to fight HIV/AIDS in poor countries over the past decade, yet less than half of those requiring treatment receive it, and for every two people put on treatment, five more become infected. This situation, in combination with the global economic crisis and the growing pressure to respond to broader global health objectives, is forcing donors to consider how to do more with their available funds. One way to improve the effectiveness of HIV/AIDS programs is to tie funding decisions to performance. Performance-based funding rewards effective programs and gives incentives for poor performers to improve. Donors have experimented with this approach, but they should do much more to ensure that funding decisions reflect and respond to how well funding recipients meet the objectives of their programs.
  • Topic: Health, Third World, Foreign Aid
  • Author: David Wendt, Nandini Oomman, Christina Droggitis
  • Publication Date: 04-2010
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: Billions of dollars have been allocated to fight HIV/AIDS in poor countries over the past decade, yet less than half of those requiring treatment receive it, and for every two people put on treatment, five more become infected. This situation, in combination with the global economic crisis and the growing pressure to respond to broader global health objectives, is forcing donors to consider how to do more with their available funds. One way to improve the effectiveness of HIV/AIDS programs is to tie funding decisions to performance. Performance-based funding rewards effective programs and gives incentives for poor performers to improve. Donors have experimented with this approach, but they should do much more to ensure that funding decisions reflect and respond to how well funding recipients meet the objectives of their programs.
  • Topic: Health
  • Author: Rachel Nugent
  • Publication Date: 06-2010
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: We are rapidly losing our ability to cure an alarming number of the most serious and common diseases of the developing world because of an invisible adversary: drug resistance. Resistance is inevitable—but careless practices in drug supply and use are hastening it unnecessarily. Without an immediate global effort to safeguard lasting treatment effectiveness, drug resistance will quickly become a widespread threat—claiming lives, raising the cost of curing patients, and making future generations increasingly vulnerable to deadly diseases that were easily cured in the past.
  • Topic: Health, War on Drugs
  • Author: Nandini Oomman, Christina Droggitis
  • Publication Date: 09-2010
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: For the past decade, global AIDS donors—including the U.S. President's Emergency Plan for AIDS Relief (PEFPAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), and the World Bank's Multi-Country HIV/AIDS Program for Africa (the MAP)—have responded to HIV/AIDS in sub-Saharan Africa as an emergency. Financial and programmatic efforts have been quick, vertical, and HIV-specific. To achieve ambitious HIV/AIDS targets, AIDS donors mobilized health workers from weak and understaffed national health workforces. The shortages were the result of weak data for effective planning, inadequate capacity to train and pay health workers, and fragmentation and poor coordination across the health workforce life-cycle. Ten years and billions of dollars later, the problem still persists. The time has passed for short-term fixes to health workforce shortages. As the largest source of global health resources, AIDS donors must begin to address the long-term problems underlying the shortages and the effects of their efforts on the health workforce more broadly.
  • Topic: Development, Globalization, Health, Human Welfare, Humanitarian Aid, Foreign Aid
  • Political Geography: Africa
  • Author: Miriam Temin
  • Publication Date: 08-2010
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: Improving adolescent girls' health and wellbeing is critical to achieving virtually all international development goals, from reducing infant and child deaths to stimulating economic growth and encouraging environmental sustainability. Governments and donors seem to recognize this, but they have yet to take the specific actions needed to genuinely invest in adolescent girls' health and, thereby, the health and wellbeing of generations to come.
  • Topic: Development, Gender Issues, Health, Human Rights, Border Control
  • Political Geography: Africa, China
  • Author: Michael Kremer, Alaka Holla
  • Publication Date: 01-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: This paper surveys evidence from recent randomized evaluations in developing countries on the impact of price on access to health and education. The debate on user fees has been contentious, but until recently much of the evidence was anecdotal. Randomized evaluations across a variety of settings suggest prices have a large impact on take-up of education and health products and services. While the sign of this effect is consistent with standard theories of human capital investment, a more detailed examination of the data suggests that it may be important to go beyond these models. There is some evidence for peer effects, which implies that for some goods the aggregate response to price will exceed the individual response. Time-inconsistent preferences could potentially help explain the apparently disproportionate effect of small short-run costs and benefits on decisions with long-run consequences.
  • Topic: Development, Economics, Education, Health, Human Welfare, Markets
  • Author: Mead Over
  • Publication Date: 02-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The slower spread of AIDS in South Asian countries, combined with the fact that most South Asian countries have higher per capita incomes than the most severely affected countries of other regions imply that the various impacts of the disease will be smaller in South Asia than in the worst affected countries in other regions. While justified with respect to the impact of the disease on economic output, on poverty, or on orphanhood, this conclusion does not follow with respect to the health sector, where the relatively minor public role in health care delivery and the entrepreneurial and heterogeneous private health and pharmaceutical sectors combine to magnify the potential impact of the epidemic.
  • Topic: Health, Humanitarian Aid
  • Political Geography: South Asia, Asia
  • Author: Tom Slayton
  • Publication Date: 03-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The world rice market was aflame last spring and for several months it looked as if the trading edifice that had exhibited such resilience over the last two decades was going to burn to the ground. World prices trebled within less than four months and reached a 30- year inflation-adjusted high. Many market observers thought the previous record set in 1974 would soon be toast. The fire was man-made, not the result of natural developments. While the governments in India, Vietnam, and the Philippines did not to set the world market on fire, that was the unintended result of their actions which threatened both innocent bystanders (low-income rice importers as far away as Africa and Latin America) and, ultimately, poor rice consumers at home. This paper describes what sparked the fire and the accelerants that made a bad situation nearly catastrophic. Fortuitously, when the flames were raging at peak intensity, rain clouds appeared, the winds [market psychology] shifted, and conditions on the ground improved, allowing the fire to die down. It remains to be seen, however, if the trading edifice has been seriously undermined by the actions of decision makers in several key Asian rice exporting and importing countries. In describing the cascading negative effects of these seemingly rational domestic policies, this paper aims to help policy makers in the rice exporting and importing nations to avoid a repeat of the disastrous price spike of 2008.
  • Topic: Agriculture, Economics, Health, Humanitarian Aid, Markets, Political Economy
  • Political Geography: Africa, India, Asia, Latin America
  • Author: Ethan B. Kapstein, Josh Busby
  • Publication Date: 08-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: This paper examines the role of policy entrepreneurs and global activists in shaping the international market for antiretroviral drugs to combat HIV/AIDS. When ARVs first came on the market in the 1990s they were exceedingly expensive; the cost of treatment was upwards of $10,000 per year. These drugs were thus accessible only to those patients who had high incomes. But in 2006, the “international community,” meeting at a United Nations General Assembly Special Session (UNGASS), made an astonishing pledge to those who were infected with HIV. It proclaimed that there should be universal access to ARV treatment. This UNGASS, following up on an earlier historic UN special session devoted entirely to AIDS in 2001, marked the first time in history that the international community pledged itself to chronic care for the ill, which in this case includes the approximately 30 million people around the world estimated to be HIV positive. How do we explain the transformation of ARVs from private goods, which only a few could afford, into merit goods that were (at least declaratively) to be made available to everyone? In other words, how does a norm of “universal access to treatment”—that no person should be denied these life-extending drugs—become the ethical basis for global public policy with respect to pharmaceutical allocation? What are the lessons of the ARV story for other global issues? These are the primary questions we explore in this paper. Briefly, we argue that the policy entrepreneurs and activists who promoted the creation of a universal access to treatment regime—of the transformation of ARVs into global merit goods—relied on a combination of moral arguments and ideas with favorable material circumstances. From the ethical perspective, the task of these entrepreneurs was to convince the “international community” that access to ARVs was a “human right,” or conversely to convince decision-makers that it was morally wrong to allocate these life-enhancing drugs solely on the basis of ability to pay. But from a material standpoint, these arguments were greatly facilitated by the lowering prices of ARVs caused by a combination of differential pricing (that is, lower prices for drugs in the developing world than in the advanced welfare states) and competition from generics producers, coupled with increases in foreign aid spending devoted to HIV/AIDS and other diseases.
  • Topic: Globalization, Health, Markets
  • Political Geography: United Nations
  • Author: Prashant Yadav
  • Publication Date: 09-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The emergence and spread of drug resistance is draining available resources and threatening our ability to treat infectious diseases in developing countries. Countering drug resistance requires pharmaceutical companies, government regulators, doctors, and patients to make difficult choices about drug treatment in order to balance efficacy, cost, safety, and sustainability of drugs. These complex tradeoffs are faced along the drug supply chain from the development of new products, procurement of drugs for donor and government distribution, distribution steps to ensure treatment heterogeneity along with quality and availability, and dispensing and use that requires affordability, patient adherence and rational use of drugs and diagnostics. An analysis of the incentives and risks in the drug supply chain reflects that many stakeholders who can influence optimal prescribing of existing drugs; affect higher patient compliance; and ensure the quality of drugs have weak incentives to carry out these activities optimally. This implies a high potential for drug resistance to accelerate. This paper recommends specific measures to better align the incentives of these stakeholders with resistance- countering activities.
  • Topic: Development, Health, Human Welfare, Third World
  • Author: Ethan Kapstein, Josh Busby
  • Publication Date: 08-2009
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: This paper examines the role of policy entrepreneurs and global activists in shaping the international market for antiretroviral drugs to combat HIV/AIDS. When ARVs first came on the market in the 1990s they were exceedingly expensive; the cost of treatment was upwards of $10,000 per year. These drugs were thus accessible only to those patients who had high incomes. But in 2006, the “international community,” meeting at a United Nations General Assembly Special Session (UNGASS), made an astonishing pledge to those who were infected with HIV. It proclaimed that there should be universal access to ARV treatment. This UNGASS, following up on an earlier historic UN special session devoted entirely to AIDS in 2001, marked the first time in history that the international community pledged itself to chronic care for the ill, which in this case includes the approximately 30 million people around the world estimated to be HIV positive. How do we explain the transformation of ARVs from private goods, which only a few could afford, into merit goods that were (at least declaratively) to be made available to everyone? In other words, how does a norm of “universal access to treatment”—that no person should be denied these life-extending drugs—become the ethical basis for global public policy with respect to pharmaceutical allocation? What are the lessons of the ARV story for other global issues? These are the primary questions we explore in this paper. Briefly, we argue that the policy entrepreneurs and activists who promoted the creation of a universal access to treatment regime—of the transformation of ARVs into global merit goods—relied on a combination of moral arguments and ideas with favorable material circumstances. From the ethical perspective, the task of these entrepreneurs was to convince the “international community” that access to ARVs was a “human right,” or conversely to convince decision-makers that it was morally wrong to allocate these life-enhancing drugs solely on the basis of ability to pay. But from a material standpoint, these arguments were greatly facilitated by the lowering prices of ARVs caused by a combination of differential pricing (that is, lower prices for drugs in the developing world than in the advanced welfare states) and competition from generics producers, coupled with increases in foreign aid spending devoted to HIV/AIDS and other diseases.
  • Topic: Health, Human Welfare, Humanitarian Aid, Political Economy
  • Author: David Wendt, Nandini Oomman, Christina Droggitis
  • Publication Date: 08-2009
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: Few people doubt that gender inequality influences the spread of HIV/AIDS. Yet public health efforts tend to focus on changing individual behavior rather than addressing structural factors—social, economic, physical and political—that influence the spread and effects of HIV and AIDS.
  • Topic: Gender Issues, Health, Social Stratification
  • Author: Rena Eichler, Ruth Levine
  • Publication Date: 05-2009
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: Global health donors, like national governments, have traditionally paid for inputs such as doctors' salaries or medical equipment in the hope that they would lead to better health. Performance incentives offered to health workers, facility managers, or patients turn the equation on its head: they start with the performance targets and let those most directly affected decide how to achieve them. Funders pay (in money or in kind) when health providers or patients reach specified goals. Evidence shows that such incentives can work in a variety of settings. But making them effective requires careful planning, implementation, and monitoring and evaluation.
  • Topic: Health, Humanitarian Aid, Third World, Foreign Aid
  • Author: Carsten Fink
  • Publication Date: 06-2008
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Over the past fifteen years, the United States and other developed countries have employed trade agreements to substantially strengthen the protection of intellectual property rights for pharmaceutical products in the developing world. The associated rules changes have already had an effect on pharmaceutical prices in developing countries, prompting conflicts between developing country governments seeking to promote drug access and Western pharmaceutical companies wishing to protect their exclusive rights. If anything, such conflicts are bound to intensify as more patent protected drugs enter pharmaceutical markets outside rich countries. This paper describes the global shift in intellectual property policies and employs economic analysis to evaluate its consequences for developing countries. It also puts forward several recommendations for policymakers in developing countries and in the United States, seeking to better reconcile innovation incentives and access needs.
  • Topic: Economics, Health, Science and Technology
  • Political Geography: United States
  • Author: Ferdinando Regalía, Leslie Castro
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Nicaragua's Red de Protección Social (RPS) is one of the first conditional cash transfer (CCT) programs implemented in a low-income country. Demand-side incentives, in the form of monetary transfers, are provided to poor households on condition that their children attend school and visit preventive health care providers. The design of the program is unique among CCT programs because these demand-side incentives are complemented by supply-side incentives aimed at improving the provision of health care. Health care providers are paid on the basis of their performance against predetermine d targets. Both private and nonprofit health care providers contracted by the government extend the coverage of services to previously underserved areas.
  • Topic: Education, Health, Non-Governmental Organization, Poverty
  • Political Geography: Nicaragua
  • Author: Amanda Glassman, Jessica Todd, Marie Gaarder
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: In order to support poor families in the developing world to seek and use health care, a multi-pronged strategy is needed on both the supply and the demand side of health care. A demand-side program called Conditional Cash Transfer s (CCTs) strives to reduce poverty and also increase food consumption, school attendance, and use of preventive health care. Since 1997, seven countries in Latin America have implemented and evaluated CCT programs with health and nutrition components. The core of the program is based on encouraging poor mothers to seek preventive health services and attend health education talks by providing a cash in centive for their healthy behavior (with healthy behavior representing performance). Evaluations of these programs measured outputs in the utilization of services; health knowledge, attitudes, and practice; food consumption; the supply and quality of services; as well as outcomes in vaccination rates; nutritional status; morbidity; mortality; and fertility.
  • Topic: Education, Health, Poverty
  • Political Geography: South America, Latin America, Central America, Caribbean
  • Author: Rena Eichler, Paul Auxila, Uder Antoine, Bernateau Desmangles
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: USAID launched a project in 1995 to deliver basic health services in Haiti. The project began by reimbursing contracted NGOs for documented expenditures or inputs. In 1999, payment was changed to being based partly on attaining performance targets or outputs. The project also provided technical assistance to the NGOs, along with opportunities to participate in an NGO network and other cross-fertilization activities. Remarkable improvements in key health indicators have been achieved in the six years since payment for performance was phased in. Although it is difficult to isolate the effects of performance-based payment on these improved indicators from the efforts aimed at strengthening NGOs and other factors, panel regression results suggest that the new payment incentives were responsible for considerable improvements in both immunization coverage and attended deliveries. Results for prenatal and postnatal care were less significant, perhaps suggesting a strong patient behavioral element that is not under the influence of provider actions.
  • Topic: Development, Education, Health, Poverty
  • Political Geography: Haiti
  • Author: Rena Eichler, Diana Weil, Alexandra Beith
  • Publication Date: 04-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Tuberculosis is a public health emergency in Africa, Eastern Europe, and Central Asia. Of the estimated 1.7 million deaths from TB, 98 percent are in the developing world, the majority being among the poor. In order to reach the MDG and the Stop TB partnership targets for 2015, TB detection rates need to double, treatment success rates must increase to more than 7075 percent, and strategies to address HIV-associated TB and multi-drug resistant TB must be aggressively expanded. DOTS, the internationally-recommended TB control strategy is the foundation of TB control efforts worldwide. A standard recording and monitoring system built on routine service-based data allows nearly all countries in the world to track progress in case detection and treatment completion through routine monitoring. This provides a good base for measuring the impact of different strategies for improving TB control outcomes.
  • Topic: Health, International Organization, Poverty
  • Political Geography: Africa, Europe, Asia
  • Author: Jeremy Shiffman, Stephanie Smith
  • Publication Date: 10-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Why do some global health initiatives receive priority from international and national political leaders while others receive minimal attention? We propose a framework for analyzing this question consisting of four categories of factors: the strength of the actors involved in the initiative, the power of the ideas they use to frame the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself.
  • Topic: Health, International Cooperation, Politics
  • Author: Jeremy Shiffman
  • Publication Date: 05-2007
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Why do some serious health issues—such as HIV/AIDS—get considerable attention and others—such as malaria and collapsing health systems—get very little? Why and under what conditions do political leaders consider an issue worthy of sustained attention, and back up that attention with money and other resources? In this CGD Brief, visiting fellow Jeremy Shiffman, an associate professor of public administration at the Maxwell School of Syracuse University, discusses nine factors that influenced the degree to which national leaders in five countries made one public health issue—maternal mortality—a political priority. Pregnancy-related complications are the leading cause of mortality globally among adult women of reproductive age, with more than half a million deaths annually. But in some countries maternal health has become a priority and maternal deaths have fallen, while in other countries this has not yet occurred. Drawing on his comparison of these countries, Shiffman offers recommendations for public health priority-setting in developing countries. His bottom line: attaining public health goals is as much a political as it is a medical or technical challenge; success requires not only appropriate technical interventions but also effective political strategies.
  • Topic: Globalization, Health, Political Economy, Third World