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  • Author: Kalipso Chalkidou, Nishant Jain, Françoise Cluzeau, Amanda Glassman
  • Publication Date: 05-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Hailed as one of the largest publicly funded health insurance programs in the world, India’s “Modicare” has, since its launch a little more than six months ago, made universal healthcare coverage an election theme for the first time in the country’s history.[1] In this note, we describe the program, with an emphasis on its better-known secondary and tertiary care component, and offer policy recommendations to strengthen the scheme post-election to enhance its contribution to India’s vision for universal health coverage (UHC). In a country of almost 1.4 billion people that is home to one-third of global maternal deaths, where public spending for health accounts for roughly 1 percent of GDP and where 60 million people fall into poverty every year because of healthcare bills, fixing healthcare is a daunting task that will determine the world’s performance against the Sustainable Development Goals over the coming decade.
  • Topic: Health, Health Care Policy, Public Health, Health Insurance
  • Political Geography: India, Asia
  • Publication Date: 05-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Internationally set goals and guidelines directly influ­ence the setting of health care priorities at the national level, affecting how limited resources are generated and allocated across health care needs. The influence of global priority setting, such as through the formu­lation of overarching goals or normative guidelines for specific disease areas, is particularly significant in low- and middle-income countries that rely heavily on overseas development assistance. Because no sys­tematic approach exists for dealing with resource con­straints, however, which vary across countries, goals and guidance are often inappropriate for some country contexts; their implementation can, therefore, reduce the efficiency and equity of health care spending. The Working Group on Incorporating Economics and Modelling in Global Health Goals and Guidelines, co-convened by the Center for Global Development, Thanzi la Onse, and the HIV Modelling Consortium, has brought together disease specialists, policymakers, economists, and modelers from national governments, international organizations, and academic institutions across the globe to address these issues, to take stock of current approaches, and make recommendations for better practice. The Working Group deliberated on the roles and purposes of goals and guidelines and consid­ered how economic evidence might be formally incor­porated into policy recommendations and health care decision making. The target audiences for this report are international health institutions, large stakehold­ers in disease programs across the world, and national governments.
  • Topic: Development, Health, Health Care Policy, Public Health
  • Political Geography: Global Focus
  • Author: Liesl Schnabel, Cindy Huang
  • Publication Date: 06-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: In August 2017, widespread violence carried out with “genocidal intent” in Myanmar forced 745,000 Rohingya to flee to Bangladesh and settle in camps in Cox’s Bazar.[1] Fifty-two percent of the refugee population there are women and girls.[2] Those of reproductive age are in dire need of emergency and longer-term sexual and reproductive health and rights (SRHR)[3] services. Many have additional needs related to sexual trauma experienced in Myanmar and/or in Bangladesh.[4],[5] For many, these needs are not being fully met due to implementation and access barriers.
  • Topic: Gender Issues, Health, Women, Reproductive Rights, Sexual Health
  • Political Geography: Asia, Myanmar
  • Author: Janeen Madam Keller, William Savedoff
  • Publication Date: 06-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: The availability and affordability of health products—medicines, diagnostics, devices, and equipment—are critical to achieving universal health coverage and improving health outcomes. Yet low- and middle-income countries face multiple challenges in procuring health products related to institutional inefficiencies, market failure, and fragmented demand. At the same time, the world is evolving rapidly in ways that will affect health procurement, from changes in countries’ eligibility for foreign assistance to advances in information technologies. Looking forward, efforts to improve global health procurement must proactively address the sweeping changes on the horizon. Drawing on a range of political, economic, and social trends, this paper envisions how the global landscape might change between now and 2030, with a focus on the implications for global health, particularly the procurement of health products. The paper develops three possible but distinct futures—worlds characterized as atomistic, privately led, or multilateral.It concludes by describing the policy options and locus of action to improve global health procurement in light of these scenarios, emphasizing three areas of work: financing and modes of collaboration, procurement procedures and tools, and procurement capacity.
  • Topic: Health, Health Care Policy, Public Health, Health Crisis
  • Political Geography: Global Focus
  • Author: Rachel Silverman, Amanda Glassman, Kalipso Chalkidou, Janeen Madan Keller
  • Publication Date: 06-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive.
  • Topic: Health, Public Health, Pandemic, Procurement, Medicine
  • Political Geography: Global Focus
  • Author: Roxanne Oroxom, Amanda Glassman
  • Publication Date: 06-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: With a vision of “creating equal access to new and underused vaccines,” Gavi set several coverage-specific targets for 2020 as part of its Phase IV strategy, including the immunization of an additional 300 million children, increased pentavalent 3 and measles-containing vaccine (MCV) 1 coverage, and greater equity in coverage across wealth quintiles.[1] The strategy also called for broadening protection through improved routine coverage and the introduction of new vaccines.[2]
  • Topic: Health, Children, Public Health, Vaccine
  • Political Geography: Global Focus
  • Author: Amanda Glassman, Cordelia Kenney, Janeen Madan Keller
  • Publication Date: 06-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: Child vaccination remains among the most cost-effective uses of public and aid monies.[1] In a highly contested funding environment where priorities must be set for the allocation of scarce concessional resources, investment in expanding the availability and coverage of cost-effective vaccination must come at the top of the list. Gavi’s mission—saving children’s lives and protecting people’s health by increasing equitable use of vaccines—remains highly relevant. Gavi and its partners have made enormous progress towards increasing equity in the introduction of vaccines; children living in the lowest-income countries now have access to the same set of vaccines as those living in high-income countries. Gavi and partners have also contributed to increased coverage; immunization rates are higher in Burundi and Rwanda, for example, than in many places in the United States and Europe. Yet the effects of under-immunization anywhere can have global implications everywhere, as recent outbreaks illustrate. New or dormant threats are also a new reality—newly vaccine-preventable diseases like Ebola or virulent flu strains can spread swiftly and lethally in an interconnected world.
  • Topic: Health, Public Health, Vaccine, Immunization
  • Political Geography: Global Focus
  • Author: Rachel Silverman, Janeen Madan Keller, Amanda Glassman, Kalipso Chalkidou
  • Publication Date: 07-2019
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive. Access to medicines, diagnostics, devices, and equipment is driven in large part by the efficiency of their procurement. Procurement is, therefore, central to the efforts of low- and middle-income countries to improve health, meet the Sustainable Development Goals, and achieve universal health coverage. Health product purchasing in low- and lower-middle-income countries already makes up a sizeable share of overall health spending; in fact, in just a subset of these countries, spending on health products totals an estimated $50 billion per year.[1] Procurement is not only essential to the missions of global health entities like the Global Fund, Gavi, UNICEF, UNFPA, and PEPFAR, but it also represents big money. In the case of the Global Fund, health product procurement accounts for $2 billion per year,[2] or almost half of its 2017 disbursements.[3] Yet despite its importance, procurement is an underappreciated health system function. Today’s procurement systems are hobbled by inefficiencies that leave some of the poorest countries paying some of the highest drug prices in the world.
  • Topic: Health, Public Health, Transition, Procurement
  • Political Geography: Global Focus
  • Author: Lorcan Clarke, Kalipso Chalkidou, Cassandra Nemzoff
  • Publication Date: 12-2018
  • Content Type: Working Paper
  • Institution: Center for Global Development
  • Abstract: As of December 2018, seven development impact bonds (DIBs) have been launched across seven countries with nearly US$55million in cumulative outcome funding. DIBs fund public services through contracts where private investors provide upfront flexible funding to service providers and outcome funders repay these investors based on the outcomes achieved by people receiving services. Three DIBs specifically target health outcomes: the Humanitarian Impact Bond, the Utkrisht Impact Bond, and the Cameroon Cataract Bond. The three “health DIBs” involve US$26.5 million in upfront investment, US$38.1 million in outcome funding and aim to impact the health of at least 31,600 people. Using publicly available information, we describe all seven DIBs, and evaluate the three “health DIBs” in more detail, comparing their stakeholders, implementation, and outcome structures. Building on a scoping review of relevant literature, we outline health DIBs in the pipeline and note that the potential of DIBs as a funding structure is hindered by the lack of publicly available information on their estimated impact and value for money. We offer three recommendations to improve evaluation and inform development of DIBs in the future: (1) publish plans and evaluations, (2) create and use consistent reporting guidelines, and (3) allocate funding to evaluate impact and value for money.
  • Topic: Development, Health, Humanitarian Intervention
  • Political Geography: Global Focus
  • 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, 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, 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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