Many low-and lower-middle-income countries currently procure a large portion of their health commodities—drugs, devices, diagnostics, and vector control tools—through centralized, donor-managed procurement mechanisms, and often at subsidized prices or as donations. Over the next several decades, however, the landscape of global health procurement will change dramatically as countries grow richer and lose aid eligibility; disease burdens shift; and technological breakthroughs change the portfolio of commodity needs. To consider how the global health community can ensure the medium- to long-term relevance, efficiency, quality, affordability, and security of global health procurement, the Center for Global Development (CGD) launched the Working Group on the Future of Global Health Procurement in July 2017. A final report is expected in spring 2019. Throughout this process, CGD will engage key global health stakeholders—country representatives, procurement agents, funders, and industry partners—to reflect the range of views on these issues and encourage the adoption of proposed recommendations.
In recent decades, the world has made great strides toward improving global access to lifesaving health commodities, including medicines, diagnostics, medical devices, and vector control tools.* This increase in access has in large part resulted from the investments of international health partnerships such as UNICEF, UNFPA, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and bilateral aid programs such as PEPFAR, DFID, and USAID. To deliver these lifesaving global health commodities to where they are needed most, these funders have also set up centralized procurement mechanisms to purchase drugs, diagnostics, devices, and vector control tools from manufacturers, and to subsequently make them available to countries at subsidized prices or as donations.
Over the next decade, however, most low-income countries will become middle-income countries that are ineligible for aid under current rules, spend more domestic public monies on health, and self-procure most needed health commodities. At the same time, demographic and epidemiological changes will affect the size and composition of demand for health care and related products; infectious diseases will diminish in importance while non-communicable diseases increase. Other factors—such as growing drug resistance, the pace of economic growth and its impact on public spending, the trend towards increasing decentralization of procurement and service delivery, and the continual development of new technologies in the context of rising expectations for more comprehensive health benefits—will also put new pressures on global health procurement. In this context, policymakers should be prepared to take preemptive action to ensure the medium- to long-term relevance, efficiency, quality, affordability, and security of global health procurement. This Working Group considers how global health procurement mechanisms can adapt to this changing landscape.
Working group meetings were held on July 25, 2017 in Washington, DC; February 6-7, 2018 near Geneva, Switzerland; July 19-20, 2018 in London, England; and November 29, 2018 in Washington, DC. The group benefitted from research partnerships with AfRx Consulting, the Clinton Health Access Initiative (CHAI), the Toulouse School of Economics (TSE), and the Office of Health Economics; bilateral consultations with representatives from the pharmaceutical industry; a private roundtable with private-sector procurement specialists co-hosted with the Bill & Melinda Gates Foundation; a technical workshop with leading industrial organization economists, including Nobel laureate Jean Tirole; and several CGD-led analyses. The full set of background research and analysis is available here. The final report is available here.
*Note: This working group does not consider vaccines.
Working Group Members
Michael Anderson, MedAccess
Amie Batson, formerly PATH
Sarah Garner, World Health Organization (WHO)
Christa Cepuch, Médecins Sans Frontières (MSF)
Clinton de Souza, Imperial Logistics
Todd Dickens, PATH
James Droop, UK Department for International Development
Akthem Fourati, UNICEF
Eduardo González-Pier, formerly Ministry of Health, Mexico, and Center for Global Development (CGD)
Martha Gyansa-Lutterodt, Ministry of Health, Government of Ghana
Lisa A. Hare, U.S. President’s Malaria Initiative/U.S. Agency for International Development (USAID)
Beverly Lorraine Ho, Department of Health, The Philippines
Christine Jackson, Crown Agents Ltd.
Mariatou Tala Jallow, Global Fund to Fight AIDS, Tuberculosis and Malaria
Biljana Kozlovic, Ministry of Health, Serbia
Wesley Kreft, i+ solutions
Melissa Malhame, Independent Advisor and formerly Gavi, the Vaccine Alliance
Susan Nazzaro, Bill & Melinda Gates Foundation
Aurélia Nguyen, Gavi, the Vaccine Alliance
Ed Rose, formerly NHS England
Rajeev Sadanandan, Government of Kerala, India
Eugene Schneller, W. P. Carey School of Business, Arizona State University
Andreas Seiter, World Bank
Paul Stannard, Population Services International
Netnapis Suchonwanich, Health Intervention and Technology Assessment Program, Thailand
Gregory Vistnes, William Davidson Institute, University of Michigan
Brenda Waning, Global Drug Facility
Tommy Wilkinson, University of Cape Town, South Africa
Janeen Madan Keller