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Health economics, Applied econometrics, Epidemiological and economic simulation modeling, Impact evaluation, AIDS.
Mead Over is a senior fellow emeritus at the Center for Global Development researching economics of efficient, effective, and cost-effective health interventions in developing countries. Much of his work since 1987, first at the World Bank and now at the CGD, is on the economics of the AIDS epidemic. After work on the economic impact of the AIDS epidemic and on cost-effective interventions, he co-authored the Bank’s first comprehensive treatment of the economics of AIDS in the book, Confronting AIDS: Public Priorities for a Global Epidemic(1997,1999). His most recent book is Achieving an AIDS Transition: Preventing Infections to Sustain Treatment (2011)in which he offers options, for donors, recipients, activists and other participants in the fight against HIV, to reverse the trend in the epidemic through better prevention. His previous publications include The Economics of Effective AIDS Treatment: Evaluating Policy Options for Thailand (2006). Other papers examine the economics of preventing and of treating malaria. In addition to ongoing work on the determinants of adherence to AIDS treatment in poor countries, he is working on optimal pricing of health care services at the periphery, on the measurement and explanation of the efficiency of health service delivery in poor countries and on optimal interventions to control a global influenza pandemic.
In addition to his numerous research projects at the Center, Over currently serves as a member of PEPFAR’s Scientific Advisory Board and as a member of the Steering Committee of the HIV/AIDS modeling consortium funded by the Bill & Melinda Gates Foundation.
Recruited to the World Bank as a Health Economist in 1986, Mead Over advanced to the position of Lead Health Economist in the Development Research Group, before leaving the World Bank to join the Center for Global Development in 2006. Each spring since 2005, he has taught a module on “Modeling the Cost-Effectiveness of Interventions against Infectious Diseases” as part of the master’s degree program in health economics for developing countries at the Centre d'Etudes et de Recherches sur le Développement International (CERDI) at the University of the Auvergne, Clermont-Ferrand, France.
"Evaluating the Impact of Organizational Reforms in Hospitals," with Naoko Watanabe, Chapter 3 in A. Preker and A.Harding (eds.) Innovations in health service delivery: The corporatization of public hospitals. World Bank, March 2003
Earlier this year, Uganda’s President signed into law an Anti-Homosexuality Act that strengthens penalties against gay people and defines some homosexual acts as crimes punishable by life in prison. If enforced to its full extent, the law is expected to endanger public health by handicapping HIV prevention and treatment efforts; already, the national police have raided and forced a US-supported HIV/AIDS treatment center to shut down.
UNAIDS recently convened a diverse group of experts to discuss how UNAIDS should go about estimating the post-2015 cost of the HIV/AIDS response. Participants opinions varied on most topics: whether estimates should assess the cost of treating all HIV infected people as soon as they are infected (the “Universal Test and Treat” option) or that of a less ambitious treatment policy; whether spending on poverty reduction and gender empowerment should be included in the cost estimates and, if so, on how to cost these “critical enablers.” But on one question, there appeared to be virtually unanimous agreement: donors and countries should increase the frequency, the granularity and the precision of HIV infection surveys.
I recently proposed that any assessment of a country’s statistical capacity be structured around the functions of government, such as those offered by the UN statistical office here. When this list is fully expanded, it includes all of the data that advanced countries like the US or Japan use to manage government and inform citizens. Most developing countries will fall below such an ambitious standard. So how should investments in improved statistical capacity be prioritized?
Last year, PEPFAR submitted guidelines which encouraged country staff to submit a proposal to conduct an “impact evaluation” (IE) as part of their annual Country Operation Plan (COP). Subsequently, they received four submissions, of which three were funded. But they also learned that many PEPFAR staff – who are mostly program implementers, or the managers of program implementers – didn’t fully understand what they were being asked to do; what does PEPFAR mean by “impact evaluations”?
Those who follow CGD will be familiar with our branded meme: “Cash on Delivery” aid, or COD. Many are enthusiastic about COD’s potential to revolutionize aid effectiveness. Yet within some global development organizations, leadership and staff alike express common concerns: is COD practical in the real world? Have you thought about this problem, or that constraint? How would this work in the context of our organization? And if we decided to move forward, how would we design a COD grant?
There’s no doubt that Treatment as Prevention (TasP) will receive continued emphasis at this year’s International Aids Conference (IAC), as advocates argue for aggressively expanding treatment from the 9 million worldwide currently on antiretrovirals (ARVs) to the 35 million people who are HIV infected. But at the TasP workshop in Vancouver last month the more challenging and novel topic was pre-exposure prophylaxis, or PrEP. A whole array of sessions on PrEP is already on the agenda for next week’s conference in Melbourne, and our bet is that PrEP will generate a lot of buzz – an approach with intriguing potential, but edgy downside possibilities.
In this paper, the authors set out to study how increased access to antiretroviral therapy affects sexual behavior in Mozambique. The researchers found that greater access to antiretroviral therapy led Mozambicans to perceive HIV/AIDS as less dangerous and to engage in more risky sexual behavior. The authors conclude that prevention programs must include educational messages about antiretroviral therapy in order to temper changing beliefs about HIV.
The Institute of Medicine, the prestigious health arm of the National Academy of Sciences, has weighed in with a massive report on the President’s Emergency Plan for AIDS Relief (PEPFAR), the multibillion dollar US effort to confront the epidemic in the developing world. The evaluation validates PEPFAR’s enormous reach during its first 10 years and identifies concrete actions that Congress and PEPFAR should take for the program to become more sustainable moving forward.
At our recent event, “How Can Finance Ministries Support a Sustainable HIV Response?” representatives from PEPFAR and the US Department of Treasury came together to discuss an innovative partnership between them and with finance ministries around the world. The partnership aims to improve the coordination and productivity of resources devoted to combatting HIV/AIDS in low- and middle-income countries, and to strengthen the long-term feasibility of these efforts.