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With shifting disease burdens, growing uncertainties about the future of development assistance for health, and rising demands for more expensive and complex healthcare comes the need for a greater focus on value for money. International health funders and agencies want to know how to make resources stretch further by focusing on the highest impact interventions among the most affected populations. Whether through more efficient procurement systems and supply chains, results-based financing, or more detailed assessments of the effectiveness of health technology, CGD’s work aims to make health funding go further to save, prolong, and improve more lives.
Early this month, CGD co-hosted a conference with the Inter-American Development Bank (IDB), highlighting progress, challenges, and lessons learned from the first phase of the Salud Mesoamerica Initiative (SMI), a seven-year-old results-based funding (RBF) partnership between donors and national governments in health. Uniquely, the event brought together country governments, external funders, intermediaries, and evaluators—from different stages of the program—to discuss motivations, results, issues, and lessons learned.
As developing nations are increasingly adopting economic evaluation as a means of informing their own investment decisions, new questions emerge. The right answer to the question “which perspective?” is the one tailored to these local specifics. We conclude that there is no one-size-fits-all and that the one who pays must set or have a major say in setting the perspective.
Cost-effectiveness studies compare the costs and benefits of different interventions with the aim of improving decisions on the allocation of scarce resources for health. Or, put simply, they allow policy-makers to set priorities for health spending and consider how the next dollar available can get more health for the money.
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. We offer three recommendations to improve evaluation and inform development of DIBs in the future.
One of the things I am proudest of having done in Washington was having the idea as Chief Economist of the World Bank that the Bank should devote its annual World Development Report to making the case for improving both the quantity and quality of global health investment.
Many low- and middle-income countries aspire to universal health coverage (UHC), but for rhetoric to become reality, the health services offered must be consistent with the funds available, which may require tough tradeoffs. An explicit health benefits package—a defined list of services that are and are not subsidized—is essential in creating a sustainable UHC system.
This report of the Rethinking U.S. Foreign Assistance Program summarizes the rationale for continued U.S. investment in global health, looks into the evolution of the Global Health Initiative, and recommends a re-boot for the whole enterprise.