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12. Global Immunization and Gavi: Five Priorities for the Next Five Years
- Author:
- Amanda Glassman, Cordelia Kenney, and 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, and Immunization
- Political Geography:
- Global Focus
13. Tackling the Triple Transition in Global Health Procurement
- Author:
- Rachel Silverman, Janeen Madan Keller, Amanda Glassman, and 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, and Procurement
- Political Geography:
- Global Focus
14. Development Impact Bonds Targeting Health Outcomes
- Author:
- Lorcan Clarke, Kalipso Chalkidou, and 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, and Humanitarian Intervention
- Political Geography:
- Global Focus
15. The Face of African Infrastructure: Service Availability and Citizens' Demands
- Author:
- Vijaya Ramachandran, Benjamin Leo, and 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
16. The Politics of Priority Setting in Health: A Political Economy Perspective
- Author:
- Katharina Hauck and 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, and Health Care Policy
17. The Health Financing Transition: A Conceptual Framework and Empirical Evidence
- Author:
- William Savedoff and 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, and Governance
- Political Geography:
- United States
18. How Much Will Health Coverage Cost? Future Health Spending Scenarios in Brazil, Chile, and Mexico
- Author:
- Amanda Glassman and 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, and Reform
- Political Geography:
- Brazil, Latin America, Mexico, and Chile
19. To Charge or Not to Charge: Evidence from a Health Products Experiment in Uganda
- Author:
- Dean Karlan, Pia Raffler, Greg Fischer, and 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 and Health
- Political Geography:
- Uganda and Africa