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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: G. Lee Robinson, Euan Ritchie, Charles Kenny
  • Publication Date: 07-2019
  • Content Type: Research Paper
  • Institution: Center for Global Development
  • Abstract: The UK has considerably increased the amount of aid it spends on research in recent years. This policy follows statements by DFID that research is among the best ways of spending aid. It also follows the UK legislating a commitment to spend 0.7 percent of GNI as foreign aid. In pursuing this target, the UK has decreased the proportion of bilateral aid spent through DFID and has channelled more through other departments. BEIS and the Department for Health and Social Care have been big recipients, and research accounts for much of their increased share of aid budgets. The information associated with the majority of this research aid is vague, raising questions about transparency. A large amount of the research is financed using an allocation mechanism that effectively ties it to UK institutions. There are also questions as to the poverty focus of some of the research conducted, given the explicit intention of the UK government to find existing activity to reclassify as ODA following the legislating of the 0.7 percent target. We suggest reporting reforms that will increase transparency and allow greater scrutiny of the way UK research aid is spent. We also call for the UK to live up to its reporting to the OECD that all British aid is untied.
  • Topic: Health, Research, Academia, Funding
  • Political Geography: United Kingdom, Europe
  • Author: Kalipso Chalkidou
  • Publication Date: 07-2019
  • Content Type: Policy Brief
  • Institution: Center for Global Development
  • Abstract: As Health Secretary Matt Hancock returns to his role as part of Boris Johnson’s premiership, he has an opportunity to make good on the UK’s renewed confidence and ambition by drawing on what the new prime minister calls the “best healthcare [system]” to drive improvements in health globally. The UK’s Department of Health and Social Care controls its biggest-ever official development assistance (ODA) budget, doubling between 2017 and 2018 to just under £200m, or 1.3 percent of the country’s aid allocation. This places the UK’s secretary of state for health in a unique position to truly make a difference in countries’ journeys towards universal healthcare coverage (UHC), whilst also defending (and making a case for more of) the ODA money his department has been allocated, even to development aid’s harshest critics. Here are five things he can do to make this happen, both using his own department’s ODA budget and influencing how DFID’s majority share is spent.
  • Topic: Health, Governance, Health Care Policy, Leadership
  • Political Geography: United Kingdom, Europe