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Health financing and payment, results-based financing, social protection, conditional cash transfer programs, noncommunicable disease, maternal and child health
Amanda Glassman is executive vice president and senior fellow at the Center for Global Development and also serves as chief executive officer of CGD Europe. Her research focuses on priority-setting, resource allocation and value for money in global health, as well as data for development. Prior to her current position, she served as director for global health policy at the Center from 2010 to 2016, and has more than 25 years of experience working on health and social protection policy and programs in Latin America and elsewhere in the developing world.
Prior to joining CGD, Glassman was principal technical lead for health at the Inter-American Development Bank, where she led policy dialogue with member countries, designed the results-based grant program Salud Mesoamerica 2015 and served as team leader for conditional cash transfer programs such as Mexico’s Oportunidades and Colombia’s Familias en Accion. From 2005-2007, Glassman was deputy director of the Global Health Financing Initiative at Brookings and carried out policy research on aid effectiveness and domestic financing issues in the health sector in low-income countries. Before joining the Brookings Institution, Glassman designed, supervised and evaluated health and social protection loans at the Inter-American Development Bank and worked as a Population Reference Bureau Fellow at the US Agency for International Development. Glassman holds a MSc from the Harvard School of Public Health and a BA from Brown University, has published on a wide range of health and social protection finance and policy topics, and is editor and coauthor of the books What's In, What's Out: Designing Benefits for Universal Health Coverage (Center for Global Development, 2017), Millions Saved: New Cases of Proven Success in Global Health (Center for Global Development 2016), From Few to Many: A Decade of Health Insurance Expansion in Colombia (IDB and Brookings 2010), and The Health of Women in Latin America and the Caribbean (World Bank 2001).
As the Global Fund’s November board meeting approaches – where the future of the Affordable Medicines Facility for Malaria (AMFm) hangs in the balance – there is much anxiety that AMFm will be terminated in 2013. The reason for such anxiety is clear: no donors have pledged funding commitments for after December 2012. But there’s another elephant in the room: the US government’s apparent lack of support, particularly its legislated “opt-in” stance on AMFm: “the Global Fund should not support activities involving the ‘Affordable Medicines Facility-malaria’ or similar entities pending compelling evidence of success from pilot programs as evaluated by the Coordinator of United States Government Activities to Combat Malaria Globally.” (Conversely, an opt-out stance would be to support AMFm unless no compelling evidence is presented.) This very specific and strict provision makes the AMFm’s continued survival all but impossible without an explicit endorsement by US Global Malaria Coordinator (currently Rear Admiral Tim Ziemer) who leads the US President’s Malaria Initiative (PMI) housed in the US Agency for International Development (USAID).
The Global Health Initiative was launched by the Obama Administration in 2009 as a new way for the United States to do business in global health. Three years later – suffering from a lack of mandate – the GHI was dissolved and in its place a new new way to do business in global health was announced: the Office of Global Health Diplomacy, led by an Ambassador responsible for “champion[ing] the priorities and policies of the GHI in the diplomatic arena.” The announcement sparked frustration in the global health community, and I questioned if it may be short-sighted to put so much control of US global health leadership into the hands of the State Department.
One year ago, the United Nations held a high-level meeting on non-communicable disease (NCD) prevention and control that culminated in a General Assembly Resolution 66/2 to adopt a 13-page “political declaration” to “address the prevention and control of non-communicable diseases worldwide.” The event presented a united front against NCDs and its flashiness garnered lots of media attention. But one year later, where has the attention and commitment to NCDs gone?
UNITAID: maybe you’ve heard of it, or maybe not. Launched in 2006, UNITAID has lived in the shadow of its older and bigger global-health siblings (the Global Fund, GAVI, and PEPFAR, to name a few). Perhaps due to its relative obscurity and late entry to a crowded global-health field, UNITAID has proactively worked to differentiate itself through a focus on commodities, market shaping, novel funding sources, and innovation. To wit, UNITAID’s stated mission is “to contribute to scale up access to treatment for HIV/AIDS, malaria and tuberculosis for the people in developing countries by leveraging price reductions of quality drugs and diagnostics, which currently are unaffordable for most developing countries, and to accelerate the pace at which they are made available.”
The newly released new child mortality data by UNICEF has findings that are encouraging yet still worrisome: the world has made progress in reducing child deaths globally; yet each day some 19,000 children die every day largely from preventable causes. USAID highlighted this new publication to remind the world of its “Child Survival Call to Action: Ending Preventable Child Deaths,” co-hosted by USAID, India, Ethiopia, and others on June 14 and 15. Before we completely forget what happened in mid-June, we revisit the event and its desired goals by taking a closer look at the event’s “Roadmap”. Bottom line: The Child Survival Call to Action does not bring much new money or knowledge, but it brings some laudable political attention and a promising emphasis on delivery and accountability. But without more systematic attention from countries and donors, the new child survival agenda risks being another same-old global-health flavor-of-the-month, potentially crowded out by competing priorities in global health.
There’s an AIDS spending cliff in Ethiopia and the government is already in free fall. Next year, Ethiopia will experience a 79% reduction in US HIV financing from PEPFAR. The announcement of these cuts came with an explanation that PEPFAR was “free(ing) up resources by reducing programs in lower HIV prevalence countries” (see blog). Further, Global Fund monies have gone almost completely undisbursed in 2012. These cuts in spending might be warranted due to epidemiological trends and improved efficiency, or might cripple progress as health programs dependent on external donors are cut back. The truth is, with the current poor status of basic information on beneficiaries and costs, it’s difficult to judge whether these cuts are good or bad.
In this austere budget climate, generating “value for money” (VFM) is a top concern for global health funding agencies and their donors, who want the biggest bang for their buck in terms of lives saved and diseases controlled. To this end, CGD has convened a working group to help shape the VFM agenda for global health funding agencies, with a particular focus on the Global Fund to Fight AIDS, Tuberculosis and Malaria. Leading these efforts is my guest this week, Amanda Glassman, a senior fellow and director of the global health policy program at the Center for Global Development.