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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.
Looming budget cuts for FY2012 and recent reports about the decline in AIDS funding from the USG in FY2010 relative to FY2009 have triggered the classic Washington, D.C. tug-of-war; global health and development advocates are pushing to maintain funding levels, if not to increase them, and the U.S. Congress is looking for ways to increase oversight and management of taxpayer dollars. Advocates are rightly pointing out what would happen if we don’t have the money and Congress is rightly signaling that the party is over. What’s new? Nothing.
The latest effort to address aid coordination problems and health system issues – the Health System Funding Platform (the Platform) – is evolving slowly and beginning to recreate the same traps it was supposed to solve. In a paper released this month, Bill Savedoff and I show how the natural tendency for aid agencies to fall back on measuring and paying for inputs is likely to undermine the Platform’s goals. Linking funding to results is the most promising way for the donors to achieve the aims they initially set for the initiative.
At the IAS conference, protestors turned out to oppose one reform under consideration at the Global Fund for AIDS, Tuberculosis, and Malaria: allocating funding ex ante instead of having countries propose the amount they would like to receive. Mohga Kamal-Yanni of Oxfam writes:
A new pay-for-performance approach to spur the 35 states of India to perform better in the health sector was recently announced. For the first time, central government funding to individual states under the country's 'flagship' health program, the National Rural Health Mission (NRHM), will depend on the state's performance. According to a Times of India news article, states that fail to perform on certain areas – primarily a more equitable distribution of doctors and nurses – will have their NRHM budget reduced, while states demonstrating performance on other areas, such as providing free generic drugs at public facilities, can earn additional outlays.