How do major health donors prepare for country exits?

Policy Blog
This blog was first published in Brookings Future Development Blog. The authors, Kaci Kennedy McDade, Osondu Ogbuoji, Marco Schäferhoff, and Gavin Yamey have authored a review “Health aid in transition: a review of the Global Fund to Fight AIDS, Tuberculosis, and Malaria." Many development donors use country income levels—typically gross national income per capita—to ensure that their support for health systems in the developing world goes to countries with the greatest need. As a result, donors often reduce support when countries graduate from low- to middle-income status. While this graduation reflects advancement in economic development and is cause for celebration, transitions away from donor assistance for health typically bring significant challenges for middle-income countries. The evidence also appears to indicate that countries that are expected to graduate from multilateral health assistance…
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The “4 Ds” that Threaten Middle-Income Countries

Policy Blog
This blog was first published in Global Health NOW June 26, 2019. The authors, Shashika Bandara, Kaci Kennedy McDade, Hanna Huffstetler, and Wenhui Mao are major contributors to the 4Ds project at the Center.   In the last 2 decades, more than 30 countries moved from low-income to middle-income status, a billion people were lifted out of poverty, and there were major reductions in maternal and child mortality globally. Despite this progress, middle-income countries, where over 70% of the world’s population now live, are facing unprecedented challenges. The progress they’ve made is threatened. In particular, 4 key phenomena—which we call the 4Ds of global health transition—are rapidly reshaping the nature of health in MICs: Disease: The global burden of disease is shifting away from infections toward non-communicable diseases and injuries. In many…
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Measuring the gap between ability and effort in domestic revenue mobilization

Latest News from the Center, Policy Blog
This blog was first published in Brookings Future Development Blog. The authors, Ipchita Bharali and Indermit Gill have authored a policy brief and a report "Enhancing domestic revenues: constraints and opportunities" available for download here. Developing countries should expect foreign aid to fall during the transition from low to middle income, and end soon after. In low-income countries, the share of foreign aid is about 2.5 percent of GDP. This drops to 0.8 percent in lower-middle-income economies; by upper-middle-income levels, it is a negligible 0.2 percent. For both givers and receivers of foreign assistance, one of the main concerns is that foreign aid weakens the incentives to build domestic revenue administration capacity and make sensible tax policy choices. The stakes can be high. Even a pre-announced and gradual reduction of foreign…
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A Roadmap for Ending the Moral Catastrophe of TB

Latest News from the Center, Policy Blog
This Op-Ed was first published in GLOBAL HEALTH NOW of Johns Hopkins Bloomberg School of Public Health. The Op-Ed focuses on the release of the report by the Lancet Commission on Tuberculosis, the challenges and opportunities ahead to end TB. The good news is that tuberculosis deaths are declining steadily. The bad news is that we are wildly off track to meet the bold targets set for controlling the world’s #1 lethal infectious disease. The Sustainable Development Goals call for a 90% reduction in TB deaths by 2030. And the WHO’s End TB strategy calls for a 90% reduction in TB incidence by 2035. Yet at current rates of decline, a 90% reduction in TB incidence probably will not be achieved in in India until 2124 or in Uganda until 2134, for example. Such…
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Is trade with India changing Africa’s health care landscape?

Latest News from the Center, Policy Blog, Stories from Africa Seminar Series
This blog was first published in Brookings Future Development Blog and is part of an ongoing series of blogs based on the Stories from Africa Seminar Series that concluded in November 2018 at Duke University. Two of the authors, Siddharth Dixit and Chinmoy Kumar, along with Indermit Gill, have authored a related recent paper "Are Economic Relations with India Helping Africa?" available for download here. African countries face numerous challenges in health services, from severe shortages of health care professionals to weak leadership and governance to limited infrastructure and resources to self-imposed policy barriers. In recent years, trade in the health sector has provided some solutions, such as eHealth (the use of information and communication technologies for health) and mHealth (the use of mobile devices for health). But there is still a long way to go…
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Stories from Africa: Closing Africa’s health financing gap

Latest News from the Center, Policy Blog, Stories from Africa Seminar Series
This blog was first published in Brookings Future Development Blog and is part of an ongoing series of blogs based on the Stories from Africa Seminar Series that concluded in November 2018 at Duke University. The Sustainable Development Goal (SDG) health targets are extremely ambitious. They call for ending the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases, and preventable deaths of newborns and children below 5 years of age by 2030. Achieving these targets will require large sums of money. Karin Stenberg and colleagues estimate that among 67 low-income countries (LICs) and middle-income countries (MICs)—representing 95 percent of the population of all LICs and MICs—the annual financing gap to reach the SDG health targets is more than $370 billion. About half of these countries are in sub-Saharan Africa, where the…
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Stories from Africa: Achieving Health Gains on the Way to Universal Health Coverage

Latest News from the Center, Policy Blog, Stories from Africa Seminar Series
This blog was first published in Brookings Future Development Blog and is part of an ongoing series of blogs based on the Stories from Africa Seminar Series that concluded in November 2018 at Duke University. Health leaders and policymakers around the world have a shared interest and commitment to achieve universal health coverage (UHC) by 2030. Health systems are responding to increased demand due to population growth, aging populations with complex conditions, or prior commitments to achieve UHC. Despite health gains in the last 20 years, problems are particularly acute in Sub-Saharan Africa. As economies grow to middle-income levels, they have to tackle communicable diseases while more people are living with non-communicable diseases like diabetes and hypertension. The burden of disease may be higher in low-income economies, but the complexity of…
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 Reducing out-of-pocket payments for health in order to achieve universal health coverage in Mongolia

Policy Blog
Healthcare costs are among the largest barriers to accessing health services and achieving universal health coverage (UHC) in Mongolia. In 2014, 0.7% or 5,681 households in Mongolia experienced catastrophic health expenditures due to out-of-pocket (OOP) expenses, spending more than 40% of their household subsistence income on health care.1 In this blog, I discuss the origins and impacts of these OOP payments, potential policy solutions and their likely impacts, and the challenges that Mongolia is likely to face in tackling OOP expenses in the future. How Mongolia’s health system has evolved since 1990 Since the early 1990s, when Mongolia transitioned to a market economy, the Mongolian health system has undergone a number of healthcare financing reforms, gradually moving away from the centralized, state-controlled “Semashko-style” model. In 1993, Social Health Insurance (SHI)…
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Indonesia’s pursuit of universal health coverage: challenges in selecting high-value healthcare and preventing waste

Policy Blog
This was an invited guest blog written by colleagues in Thailand’s Health Intervention and Technology Assessment Program. Health care technologies, including medicines, vaccines, and devices, contribute towards improved health outcomes but are also drivers of the rising costs of healthcare. Therefore, in the interest of sustainability it is essential to assess the value of these technologies on a regular basis. Indonesia, the fourth most populous country in the world, has a prime example of an evolving health system that is facing rising health care costs. This challenge, along with Indonesia’s transition from official development assistance for health and a budget deficit facing the country’s social insurance administration organization (called BPJS), which administers the national health insurance program, have made health technology assessment (HTA) a critically important tool. HTA can help…
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