Pub Date : 2020-12-01DOI: 10.1080/23288604.2019.1625498
Joseph Wong, A. Macikunas, Aylin Manduric, Joy Dawkins, Simran Dhunna
ABSTRACT Thailand is the first country in the Asia-Pacific region to be validated by the World Health Organization as having eliminated mother-to-child transmission (MTCT) of HIV. The Thai government made health—and specifically addressing the HIV/AIDS crisis—a political priority. The Thailand experience, from the emergence of the HIV/AIDS epidemic in the 1980s through the present, provides an important case study of successful MTCT elimination. To eliminate MTCT requires that health interventions reach those who are hardest to reach: the poorest of the poor, geographically distant and rural, and marginalized. This policy report highlights key factors for successfully reaching the hard to reach in Thailand, including the importance of national public policy as well as investments in health care infrastructure, such as access to antenatal care, the creation of effective monitoring and surveillance systems, and strengthening local health capacity. Increased availability and affordability of antiretroviral therapies was also critical to Thailand’s success in addressing MTCT. The Thailand case offers important policy lessons for achieving universal health. This policy report draws on secondary research and key informant interviews in Thailand to highlight factors for success in eliminating MTCT of HIV.
{"title":"Reaching the Hard to Reach in Thailand: Eliminating Mother-To-Child HIV Transmission","authors":"Joseph Wong, A. Macikunas, Aylin Manduric, Joy Dawkins, Simran Dhunna","doi":"10.1080/23288604.2019.1625498","DOIUrl":"https://doi.org/10.1080/23288604.2019.1625498","url":null,"abstract":"ABSTRACT Thailand is the first country in the Asia-Pacific region to be validated by the World Health Organization as having eliminated mother-to-child transmission (MTCT) of HIV. The Thai government made health—and specifically addressing the HIV/AIDS crisis—a political priority. The Thailand experience, from the emergence of the HIV/AIDS epidemic in the 1980s through the present, provides an important case study of successful MTCT elimination. To eliminate MTCT requires that health interventions reach those who are hardest to reach: the poorest of the poor, geographically distant and rural, and marginalized. This policy report highlights key factors for successfully reaching the hard to reach in Thailand, including the importance of national public policy as well as investments in health care infrastructure, such as access to antenatal care, the creation of effective monitoring and surveillance systems, and strengthening local health capacity. Increased availability and affordability of antiretroviral therapies was also critical to Thailand’s success in addressing MTCT. The Thailand case offers important policy lessons for achieving universal health. This policy report draws on secondary research and key informant interviews in Thailand to highlight factors for success in eliminating MTCT of HIV.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"27 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83463527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.1080/23288604.2019.1619065
Nguyen Hoang Giang, T. Oanh, Khuong Anh Tuan, Phan Hong Van, R. Jayasuriya
ABSTRACT The rising burden of Non-Communicable Diseases (NCDs) in developing countries has caused high out-of-pocket (OOP) health spending leading to many households suffering Catastrophic Health Expenditure (CHE). This study examined the association between health insurance (HI) on health-care utilization and the burden of OOP expenditure among people with reported NCDs and on their households in Vietnam. The study draws on a cross-sectional household survey of accessibility and utilization of health services in Vietnam. Data were obtained from three provinces to represent urban, rural and mountainous areas of the country. The study used a sample of 2,038 individuals with reported NCD aged over 18 years from 1,642 households having at least one person with reported NCD. The results show that people with reported NCD who had HI were twice as likely to use outpatient care compared with those without HI. Having more than one member with reported NCD resulted in double the odds of a household suffering CHE. Households in the three lowest wealth quintiles were more likely to encounter CHE and financial distress than economically better-off households. HI did not provide a protective effect to households, as there was no significant association between the HI status of household members with reported NCD and CHE or financial distress. Seeking care at higher-level facilities was significantly associated with CHE. This study highlights the need for evidence to design future HI-based interventions targeting susceptible populations to narrow the gaps in health service utilization among the population and mitigate financial catastrophe associated with NCDs. Abbreviations: NCD: Noncommunicable diseases; UHC: Universal Health Coverage; HI: Health insurance; CHE: Catastrophic health expenditure; OOP: Out of Pocket
{"title":"Is Health Insurance Associated with Health Service Utilization and Economic Burden of Non-Communicable Diseases on Households in Vietnam?","authors":"Nguyen Hoang Giang, T. Oanh, Khuong Anh Tuan, Phan Hong Van, R. Jayasuriya","doi":"10.1080/23288604.2019.1619065","DOIUrl":"https://doi.org/10.1080/23288604.2019.1619065","url":null,"abstract":"ABSTRACT The rising burden of Non-Communicable Diseases (NCDs) in developing countries has caused high out-of-pocket (OOP) health spending leading to many households suffering Catastrophic Health Expenditure (CHE). This study examined the association between health insurance (HI) on health-care utilization and the burden of OOP expenditure among people with reported NCDs and on their households in Vietnam. The study draws on a cross-sectional household survey of accessibility and utilization of health services in Vietnam. Data were obtained from three provinces to represent urban, rural and mountainous areas of the country. The study used a sample of 2,038 individuals with reported NCD aged over 18 years from 1,642 households having at least one person with reported NCD. The results show that people with reported NCD who had HI were twice as likely to use outpatient care compared with those without HI. Having more than one member with reported NCD resulted in double the odds of a household suffering CHE. Households in the three lowest wealth quintiles were more likely to encounter CHE and financial distress than economically better-off households. HI did not provide a protective effect to households, as there was no significant association between the HI status of household members with reported NCD and CHE or financial distress. Seeking care at higher-level facilities was significantly associated with CHE. This study highlights the need for evidence to design future HI-based interventions targeting susceptible populations to narrow the gaps in health service utilization among the population and mitigate financial catastrophe associated with NCDs. Abbreviations: NCD: Noncommunicable diseases; UHC: Universal Health Coverage; HI: Health insurance; CHE: Catastrophic health expenditure; OOP: Out of Pocket","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"35 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86275627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1655358
P. Abeykoon
Health care is considered a basic human right in Sri Lanka, and, reflecting this priority, the government dedicates government tax revenues to ensure equitable access to all people in the country, regardless of whether they are a citizen. In particular, Sri Lanka has recognized the inherent market failures associated with financing health promotion and prevention related services, and has therefore prioritized investments in those areas. In building off of the conceptual foundation and definition of common goods for health (CGH), this commentary provides an in-depth look at the successes and challenges in the financing and provision of CGH in Sri Lanka. This reflection is particularly timely given the country’s current plans to transform primary health care to meet the growing demands placed on the system by non-communicable diseases (NCDs) and emerging and re-emerging diseases.
{"title":"Financing Common Goods for Health: Sri Lanka","authors":"P. Abeykoon","doi":"10.1080/23288604.2019.1655358","DOIUrl":"https://doi.org/10.1080/23288604.2019.1655358","url":null,"abstract":"Health care is considered a basic human right in Sri Lanka, and, reflecting this priority, the government dedicates government tax revenues to ensure equitable access to all people in the country, regardless of whether they are a citizen. In particular, Sri Lanka has recognized the inherent market failures associated with financing health promotion and prevention related services, and has therefore prioritized investments in those areas. In building off of the conceptual foundation and definition of common goods for health (CGH), this commentary provides an in-depth look at the successes and challenges in the financing and provision of CGH in Sri Lanka. This reflection is particularly timely given the country’s current plans to transform primary health care to meet the growing demands placed on the system by non-communicable diseases (NCDs) and emerging and re-emerging diseases.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"5 1","pages":"397 - 401"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78837100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1655982
W. Savedoff
CONTENTS References The world, and we human beings who live in it, would be better off if we were to invest more resources and attention in producing common goods for health (CGH), such as antipollution and safety regulations, epidemiological surveillance that facilitates rapid response to infectious outbreaks, and taxes levied on harmful products like carbon emissions and tobacco. The logical reasons and the highly favorable benefit-cost ratios that should compel countries to allocate more public resources for such things are laid out clearly in the articles in this special issue of Health Systems & Reform. The papers also explain why logic and evidence are not adequate to convince people and their leaders to dedicate sufficient resources and attention to CGH. As the papers show, before societies will fund CGH, they need to solve a range of collective action problems. The papers argue that societies underinvest in CGH for behavioral reasons, such as underestimating risk and shortterm thinking; as well as economic reasons, such as externalities and free-riding (which create incentives for people to act without regard to the full social costs and benefits of their decisions). With all of these factors conspiring against the production of CGH, it is a wonder that they are produced at all. In this commentary, I argue that we need to be clear-eyed about the history and motivations that led societies to invest in the CGH that we take for granted today. Studying the past may help us identify the political strategies that could create, expand and sustain CGH in the future. So why do societies ever produce CGH? The answer is essentially historical and political, not conceptual and technical. Bump and colleagues address the proximate political factors that explain public investments in CGH. In addition to those insights, I contend that historical analysis demonstrates that broader political factors related to collective identity and power are fundamental, with significant implications for the strategies required to realize investments in CGH. In particular, I argue that investing in CGH requires that:
如果我们把更多的资源和注意力投入到生产促进健康的共同产品(common goods for health, CGH)上，例如防治污染和安全法规、便于对传染病爆发作出快速反应的流行病学监测以及对碳排放和烟草等有害产品征税，世界以及生活在其中的我们人类就会变得更好。《卫生系统与改革》这期特刊的文章清楚地阐述了合乎逻辑的原因和高度有利的收益成本比，它们应该迫使各国为这些事情分配更多的公共资源。论文还解释了为什么逻辑和证据不足以说服人们及其领导人投入足够的资源和关注CGH。正如论文所显示的那样，在社会为CGH提供资金之前，他们需要解决一系列集体行动问题。这些论文认为，社会对CGH投资不足是由于行为原因，如低估风险和短视思维;以及经济上的原因，比如外部性和搭便车(这会激励人们不考虑其决定的全部社会成本和利益而采取行动)。所有这些因素都不利于CGH的产生，它们的产生是一个奇迹。在这篇评论中，我认为我们需要清楚地了解导致社会投资于我们今天认为理所当然的CGH的历史和动机。研究过去可以帮助我们确定能够在未来创造、扩大和维持CGH的政治战略。那么，为什么社会会产生CGH呢?答案基本上是历史和政治上的，而不是概念和技术上的。Bump和他的同事探讨了解释公共投资于CGH的直接政治因素。除了这些见解之外，我认为历史分析表明，与集体身份和权力相关的更广泛的政治因素是基本的，对实现CGH投资所需的战略具有重大影响。特别是，我认为投资CGH需要:
{"title":"Why Do Societies Ever Produce Common Goods for Health?","authors":"W. Savedoff","doi":"10.1080/23288604.2019.1655982","DOIUrl":"https://doi.org/10.1080/23288604.2019.1655982","url":null,"abstract":"CONTENTS References The world, and we human beings who live in it, would be better off if we were to invest more resources and attention in producing common goods for health (CGH), such as antipollution and safety regulations, epidemiological surveillance that facilitates rapid response to infectious outbreaks, and taxes levied on harmful products like carbon emissions and tobacco. The logical reasons and the highly favorable benefit-cost ratios that should compel countries to allocate more public resources for such things are laid out clearly in the articles in this special issue of Health Systems & Reform. The papers also explain why logic and evidence are not adequate to convince people and their leaders to dedicate sufficient resources and attention to CGH. As the papers show, before societies will fund CGH, they need to solve a range of collective action problems. The papers argue that societies underinvest in CGH for behavioral reasons, such as underestimating risk and shortterm thinking; as well as economic reasons, such as externalities and free-riding (which create incentives for people to act without regard to the full social costs and benefits of their decisions). With all of these factors conspiring against the production of CGH, it is a wonder that they are produced at all. In this commentary, I argue that we need to be clear-eyed about the history and motivations that led societies to invest in the CGH that we take for granted today. Studying the past may help us identify the political strategies that could create, expand and sustain CGH in the future. So why do societies ever produce CGH? The answer is essentially historical and political, not conceptual and technical. Bump and colleagues address the proximate political factors that explain public investments in CGH. In addition to those insights, I contend that historical analysis demonstrates that broader political factors related to collective identity and power are fundamental, with significant implications for the strategies required to realize investments in CGH. In particular, I argue that investing in CGH requires that:","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"89 1","pages":"402 - 405"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83849783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1660756
A. Yazbeck, A. Soucat
Abstract This paper presents the rationale and motivation for countries and the global development community to tackle a critical set of functions in the health sector that appear to be under-prioritized and underfunded. The recent eruptions of Ebola outbreaks in Africa and other communicable diseases like Zika and SARS elsewhere led scientific and medical commissions to call for global action. The calls for action motivated the World Health Organization (WHO) to respond by defining a new construct within the health sector: Common Good for Health (CGH). While the starting point for developing the CGH construct was the re-emergence of communicable diseases, it extends to additional outcomes resulting from failures to act and finance within and outside the health sector. This paper summarizes global evidence on failures to address CGHs effectively, identifies potential reasons for the public and private sectors’ failures to respond, and lays out the first phase of the WHO program as represented by the papers in this special issue of Health Systems & Reform.
{"title":"When Both Markets and Governments Fail Health","authors":"A. Yazbeck, A. Soucat","doi":"10.1080/23288604.2019.1660756","DOIUrl":"https://doi.org/10.1080/23288604.2019.1660756","url":null,"abstract":"Abstract This paper presents the rationale and motivation for countries and the global development community to tackle a critical set of functions in the health sector that appear to be under-prioritized and underfunded. The recent eruptions of Ebola outbreaks in Africa and other communicable diseases like Zika and SARS elsewhere led scientific and medical commissions to call for global action. The calls for action motivated the World Health Organization (WHO) to respond by defining a new construct within the health sector: Common Good for Health (CGH). While the starting point for developing the CGH construct was the re-emergence of communicable diseases, it extends to additional outcomes resulting from failures to act and finance within and outside the health sector. This paper summarizes global evidence on failures to address CGHs effectively, identifies potential reasons for the public and private sectors’ failures to respond, and lays out the first phase of the WHO program as represented by the papers in this special issue of Health Systems & Reform.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"78 1","pages":"268 - 279"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84286879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1652461
Ajay Shah, Sanhita Sapatnekar, Harleen Kaur, Shubho R. Roy
On average, higher per capita GDP is correlated with improved health outcomes. In parallel, improved population health also seems to foster higher GDP. Yet health and growth need not increase proportionately with one another, nor is this relationship universal. Patnaik highlights potential externalities resulting from growth that could negate efforts to improve population health: development itself can both increase and decrease certain health risks depending on how the process is planned, implemented and regulated.
Over the last 35 years, India’s GDP grew annually at 6.3% (doubling every 11 years or so) but population-based health indicators did not improve proportionally. Instead, new health risks emerged while old ones remained unresolved. Decades of rapid urbanization led to unsafe buildings, unplanned cities, bad drainage and sewage, dysfunctional garbage disposal systems, polluted air and water, among other issues. For example, with the construction of roads catering to high-speed traffic, accompanied by inadequate design of road safety systems, road accident fatalities have surged since 1999. Today, India’s disease burden is evolving into two streams. The first is the persistent poverty-related health agenda (e.g., malnutrition or high infant and maternal mortality). The second relates to growth that does not consider new health risks emerging from it (e.g., air pollution resulting from rapid urbanization or infrastructure built on areas prone to natural disasters). In both areas, the key policy response involves population-based government financed interventions that generate large societal health benefits, i.e., Common Goods for Health (CGH). Moving forward, CGH is therefore at the center of Indian health policy. In this commentary, we draw on India’s experience to decompose the overall CGH agenda and identify common obstacles that countries may face in financing such goods.
{"title":"Financing Common Goods for Health: A Public Administration Perspective from India","authors":"Ajay Shah, Sanhita Sapatnekar, Harleen Kaur, Shubho R. Roy","doi":"10.1080/23288604.2019.1652461","DOIUrl":"https://doi.org/10.1080/23288604.2019.1652461","url":null,"abstract":"On average, higher per capita GDP is correlated with improved health outcomes. In parallel, improved population health also seems to foster higher GDP. Yet health and growth need not increase proportionately with one another, nor is this relationship universal. Patnaik highlights potential externalities resulting from growth that could negate efforts to improve population health: development itself can both increase and decrease certain health risks depending on how the process is planned, implemented and regulated.<br><br>Over the last 35 years, India’s GDP grew annually at 6.3% (doubling every 11 years or so) but population-based health indicators did not improve proportionally. Instead, new health risks emerged while old ones remained unresolved. Decades of rapid urbanization led to unsafe buildings, unplanned cities, bad drainage and sewage, dysfunctional garbage disposal systems, polluted air and water, among other issues. For example, with the construction of roads catering to high-speed traffic, accompanied by inadequate design of road safety systems, road accident fatalities have surged since 1999. Today, India’s disease burden is evolving into two streams. The first is the persistent poverty-related health agenda (e.g., malnutrition or high infant and maternal mortality). The second relates to growth that does not consider new health risks emerging from it (e.g., air pollution resulting from rapid urbanization or infrastructure built on areas prone to natural disasters). In both areas, the key policy response involves population-based government financed interventions that generate large societal health benefits, i.e., Common Goods for Health (CGH). Moving forward, CGH is therefore at the center of Indian health policy. In this commentary, we draw on India’s experience to decompose the overall CGH agenda and identify common obstacles that countries may face in financing such goods.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"36 1","pages":"391 - 396"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81327355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1649949
Alexandra J Earle, Susan P Sparkes
Honorable Cllr. Tolbert Nyenswah was interviewed as part of the Financing Common Goods for Health (CGH) special issue based on his first-hand experience in managing Liberia’s Ebola virus disease (EVD) outbreak in 2014. Through this interview insights are gained into how a national government and its citizens collectively responded to such a public health crisis and what actions have been taken since in the call for more investments in CGH.
{"title":"Financing Common Goods for Health in Liberia post-Ebola: Interview with Honorable Cllr. Tolbert Nyenswah","authors":"Alexandra J Earle, Susan P Sparkes","doi":"10.1080/23288604.2019.1649949","DOIUrl":"https://doi.org/10.1080/23288604.2019.1649949","url":null,"abstract":"Honorable Cllr. Tolbert Nyenswah was interviewed as part of the Financing Common Goods for Health (CGH) special issue based on his first-hand experience in managing Liberia’s Ebola virus disease (EVD) outbreak in 2014. Through this interview insights are gained into how a national government and its citizens collectively responded to such a public health crisis and what actions have been taken since in the call for more investments in CGH.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"1 1","pages":"387 - 390"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91058497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1663646
M. Schäferhoff, P. Chodavadia, Sebastian Martinez, Kaci Kennedy McDade, Sara Fewer, S. Silva, D. Jamison, G. Yamey
Abstract West Africa’s Ebola epidemic of 2014–2016 exposed, among other problems, the under-funding of transnational global health activities known as global common goods for health (CGH), global functions such as pandemic preparedness and research and development (R&D) for neglected diseases. To mobilize sustainable funding for global CGH, it is critical first to understand existing financing flowing to different types of global CGH. In this study, we estimate trends in international spending for global CGH in 2013, 2015, and 2017, encompassing the era before and after the Ebola epidemic. We use a measure of international funding that combines official development assistance (ODA) for health with additional international spending on R&D for diseases of poverty, a measure called ODA+. We classify ODA+ into funding for three global functions—provision of global public goods, management of cross-border externalities, and fostering of global health leadership and stewardship—and country-specific aid. International funding for global functions increased between 2013 and 2015 by $1.4 billion to a total of $7.3 billion in 2015. It then declined to $7.0 billion in 2017, accounting for 24% of all ODA+ in 2017. These findings provide empirical evidence of the reactive nature of international funders for global CGH. While international funders increased funding for global functions in response to the Ebola outbreak, they failed to sustain that funding. To meet future global health challenges proactively, international funders should allocate more funding for global functions.
{"title":"International Funding for Global Common Goods for Health: An Analysis Using the Creditor Reporting System and G-FINDER Databases","authors":"M. Schäferhoff, P. Chodavadia, Sebastian Martinez, Kaci Kennedy McDade, Sara Fewer, S. Silva, D. Jamison, G. Yamey","doi":"10.1080/23288604.2019.1663646","DOIUrl":"https://doi.org/10.1080/23288604.2019.1663646","url":null,"abstract":"Abstract West Africa’s Ebola epidemic of 2014–2016 exposed, among other problems, the under-funding of transnational global health activities known as global common goods for health (CGH), global functions such as pandemic preparedness and research and development (R&D) for neglected diseases. To mobilize sustainable funding for global CGH, it is critical first to understand existing financing flowing to different types of global CGH. In this study, we estimate trends in international spending for global CGH in 2013, 2015, and 2017, encompassing the era before and after the Ebola epidemic. We use a measure of international funding that combines official development assistance (ODA) for health with additional international spending on R&D for diseases of poverty, a measure called ODA+. We classify ODA+ into funding for three global functions—provision of global public goods, management of cross-border externalities, and fostering of global health leadership and stewardship—and country-specific aid. International funding for global functions increased between 2013 and 2015 by $1.4 billion to a total of $7.3 billion in 2015. It then declined to $7.0 billion in 2017, accounting for 24% of all ODA+ in 2017. These findings provide empirical evidence of the reactive nature of international funders for global CGH. While international funders increased funding for global functions in response to the Ebola outbreak, they failed to sustain that funding. To meet future global health challenges proactively, international funders should allocate more funding for global functions.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"131 1","pages":"350 - 365"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75439923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1656028
S. Gaudin, Peter C. Smith, A. Soucat, A. Yazbeck
Abstract This paper presents the economic rationale for treating Common Goods for Health (CGH) as priorities for public intervention. We use the concept of market failure as a central argument for identifying CGH and apply cost-effectiveness analysis (CEA) as a normative tool to prioritize CGH interventions in public finance decisions. We show that CGH are consistent with traditional lists of public health core functions but cannot be identified separately from non-CGH activities in such lists. We propose a public finance decision tree, adapted from existing health economics tools, to identify CGH activities within the set of cost-effective interventions for the health sector. We test the framework by applying it to the 2018 Disease Control Priority (DCP) list of interventions recommended for public funding and find that less than 10% of cost-effective interventions unconditionally qualify as CGH, while another two-thirds may or may not qualify depending on context and form. We conclude that while CEA can be used as a tool to prioritize CGH, the scarcity of such analyses for CGH interventions may be partly responsible for the lack of priority given to them. We encourage further research to address methodological and resource challenges to assessing the cost-effectiveness of CGH intervention packages, in particular those involving large investments and long-term benefits.
{"title":"Common Goods for Health: Economic Rationale and Tools for Prioritization","authors":"S. Gaudin, Peter C. Smith, A. Soucat, A. Yazbeck","doi":"10.1080/23288604.2019.1656028","DOIUrl":"https://doi.org/10.1080/23288604.2019.1656028","url":null,"abstract":"Abstract This paper presents the economic rationale for treating Common Goods for Health (CGH) as priorities for public intervention. We use the concept of market failure as a central argument for identifying CGH and apply cost-effectiveness analysis (CEA) as a normative tool to prioritize CGH interventions in public finance decisions. We show that CGH are consistent with traditional lists of public health core functions but cannot be identified separately from non-CGH activities in such lists. We propose a public finance decision tree, adapted from existing health economics tools, to identify CGH activities within the set of cost-effective interventions for the health sector. We test the framework by applying it to the 2018 Disease Control Priority (DCP) list of interventions recommended for public funding and find that less than 10% of cost-effective interventions unconditionally qualify as CGH, while another two-thirds may or may not qualify depending on context and form. We conclude that while CEA can be used as a tool to prioritize CGH, the scarcity of such analyses for CGH interventions may be partly responsible for the lack of priority given to them. We encourage further research to address methodological and resource challenges to assessing the cost-effectiveness of CGH intervention packages, in particular those involving large investments and long-term benefits.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"73 1","pages":"280 - 292"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89282414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1660104
D. Peters, Odd N Hanssen, Jose Gutierrez, J. Abrahams, T. Nyenswah
Abstract In the absence of good data on the costs and comparative benefits from investing in health emergency and disaster risk management (EDRM), governments have been reluctant to invest adequately in systems to reduce the risks and consequences of emergencies and disasters. Yet they spend heavily on their response. We describe a set of key functional areas for investment and action in health EDRM, and calculate the costs needed to establish and operate basic health EDRM services in low- and middle-income countries, focusing on management of epidemics and disasters from natural hazards. We find that health EDRM costs are affordable for most governments. They range from an additional 4.33 USD capital and 4.16 USD annual recurrent costs per capita in low-income countries to 1.35 USD capital to 1.41 USD recurrent costs in upper middle-income countries. These costs pale in comparison to the costs of not acting—the direct and indirect costs of epidemics and other emergencies from natural hazards are more than 20-fold higher. We also examine options for the institutional arrangements needed to design and implement health EDRM. We discuss the need for creating adaptive institutions, strengthening capacities of countries, communities and health systems for managing risks of emergencies, using “all-of-society” and “all-of-state institutions” approaches, and applying lessons about rules and regulations, behavioral norms, and organizational structures to better implement health EDRM. The economic and social value, and the feasibility of institutional options for implementing health EDRM systems should compel governments to invest in these common goods for health that strengthen national health security.
{"title":"Financing Common Goods for Health: Core Government Functions in Health Emergency and Disaster Risk Management","authors":"D. Peters, Odd N Hanssen, Jose Gutierrez, J. Abrahams, T. Nyenswah","doi":"10.1080/23288604.2019.1660104","DOIUrl":"https://doi.org/10.1080/23288604.2019.1660104","url":null,"abstract":"Abstract In the absence of good data on the costs and comparative benefits from investing in health emergency and disaster risk management (EDRM), governments have been reluctant to invest adequately in systems to reduce the risks and consequences of emergencies and disasters. Yet they spend heavily on their response. We describe a set of key functional areas for investment and action in health EDRM, and calculate the costs needed to establish and operate basic health EDRM services in low- and middle-income countries, focusing on management of epidemics and disasters from natural hazards. We find that health EDRM costs are affordable for most governments. They range from an additional 4.33 USD capital and 4.16 USD annual recurrent costs per capita in low-income countries to 1.35 USD capital to 1.41 USD recurrent costs in upper middle-income countries. These costs pale in comparison to the costs of not acting—the direct and indirect costs of epidemics and other emergencies from natural hazards are more than 20-fold higher. We also examine options for the institutional arrangements needed to design and implement health EDRM. We discuss the need for creating adaptive institutions, strengthening capacities of countries, communities and health systems for managing risks of emergencies, using “all-of-society” and “all-of-state institutions” approaches, and applying lessons about rules and regulations, behavioral norms, and organizational structures to better implement health EDRM. The economic and social value, and the feasibility of institutional options for implementing health EDRM systems should compel governments to invest in these common goods for health that strengthen national health security.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"25 1","pages":"307 - 321"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72867140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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