What happens to health financing during the middle-income transition?

Policy Blog
This blog was first published in Brookings Future Development Blog. The authors are Ipchita Bharali and Indermit Gill. As countries move from low to middle income, they experience big shifts in the composition of public and private spending on health. One reason for the change in financing is the eligibility criteria for concessional development assistance: Foreign aid starts to decrease after countries move into middle income. This is evident from a snapshot of health expenditures across the income spectrum, used to proxy what happens to a country as its per capita income increases. Figure 1 charts health expenditures by source for countries organized from lowest to highest GDP per capita in year 2015; charts for 2000, 2005, and 2010 look similar. The black vertical lines mark the gross national income (GNI)…
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My Experience as a Global Health Policy Fellow

Policy Blog
My Experience as a Global Health Policy Fellow I have recently finished a two-month global health policy fellowship at the Center for Policy Impact in Global Health (CPIGH). This fellowship program is aimed at mid-career health professionals from CPIGH’s partner countries. As a researcher with the Health Policy Research Group, University of Nigeria, my main research interests are health services; health systems governance and accountability; analysis of health policies, plans and strategies; and getting research evidence into policy and practice. And so, when I discovered that my application for the fellowship at CPIGH was successful, I looked forward to opportunities to deepen my capacity in the field of global health policy and systems, which I hoped would help me to make a more impactful contribution to global heath. Working as…
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The 5 problems China must tackle now to achieve the 2030 health SDGs

Policy Blog
This blog was first published in Brookings Future Development Blog. The authors are Shu Chen, Wenhui Mao, and Shenglan Tang. China made impressive gains during the Millennium Development Goal (MDG) era. According to the Report on China’s Implementation of the Millennium Development Goals (2000-2015), China’s achievements included the following: “The number of medical technicians and staff per thousand people rose from 3.63 people in 2000 to 5.40 people in 2014, and the number of beds per thousand in medical and health institutions increased from 2.38 in 2000 to 4.77 in 2014. … The under-five child mortality rate dropped from 61.0% in 1991 to 12.0% in 2013; the gap between urban and rural areas in child mortality rate was narrowed from 1:3.4 to 1:2.4; the maternal mortality rate dropped from 88.8 per…
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What donors can learn from the Global Polio Eradication Initiative’s transition

Policy Blog
Our Policy Associate, Kaci Kennedy McDade, attended the 2019 World Health Summit in Berlin. This blog is her reflection on the Summit. At the World Health Summit last month, I attended a session on finishing the last mile of polio eradication. At the session, panelists described the remarkable gains that have been made over the last three decades. For example, since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, poliovirus cases have decreased by over 99% and polio remains endemic in only three countries (Afghanistan, Nigeria, and Pakistan). Although we have not yet achieved global polio eradication, a key topic of the discussion that may have surprised some attendees was transition. By transition, I mean the phase-out and withdrawal of polio-focused support. While some participants may have…
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Financing Global Public Goods for Health: How Can We Make the Case?

Policy Blog
On September 19, 2019, our Center Director Gavin Yamey gave a video presentation at the 5th Annual Public Policy Conference in the Philippines. The conference was called “Navigating the New Globalization: Local Actions for Global Challenges.” Dr. Yamey’s presentation was on financing global public goods for health.  The blog below is an updated version of his talk. I am delighted to have the opportunity to talk to you today about financing of what we at the Center for Policy Impact in Global Health call “global functions,” and what the World Health Organization (WHO) is calling global common goods for health. The work that I will be presenting today is part of a new program of work led by the WHO on Financing Common Goods for Health, published in a special…
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What makes a successful international global health or development commission?

Policy Blog
Our Center Director Gavin Yamey is chairing the Advisory Board for the new Lancet Commission on Hearing Loss.  Yesterday, at the first meeting of the Commission, hosted by Duke University, he gave a 10-minute talk on what makes a successful international global health or development commission. Below we post his talk. Last year, I led the writing of a peer-reviewed paper published in the journal Health Policy & Planning called “How to Convene an International Health or Development Commission: Ten Key Steps.” The authors were all involved in Global Health 2035: A World Converging in a Generation, aka the Lancet Commission on Investing in Health (the CIH). Three of us—myself, Larry Summers, and Dean Jamison—were commissioners and one of us, Jessica Brinton, was from the Bill & Melinda Gates Foundation,…
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How do global health academics “reach the people”?

Latest News from the Center, Policy Blog
Today, at the Triangle Global Health Consortium annual conference, our Center Director Gavin Yamey was a panelist on a panel called “Reach the People: How to Communicate Global Health Issues and Solutions.” Below, we post his 10-minute panel presentation. In the next 10 minutes, I’m going to try and answer the question: How does a global health academic like me “reach the people”? I’m taking a bit of liberty in thinking about who “the people” are.  I direct a global health policy center at Duke, and for us our key engagement is with a broad array of policymakers – global health funders, foundations, ministries of health and finance, NGOs, and so on. We want our analytic work to influence the conversations, the debates, the dialogue among these global health actors.…
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Donor approaches to health aid transitions: Gavi and PEPFAR

Policy Blog
Many former low-income countries are developing their economies and becoming capable of self financing their health systems. External donors are responding to this shift in varied ways: some have developed exit strategies based on reaching pre-determined milestones while others have shifted programmatic areas of focus and funding levels to respond to a country’s context specific needs. As countries continue to develop their capacity to become more self-reliant, how will donors respond in turn? Will these donor responses enable countries to sustainably continue to advance? Could such responses, if not properly prepared for, slow or even reverse progress? To understand and build the knowledge base around this phenomenon, known as transitions from health aid, we are publishing a series on how seven major global health funders are approaching transition. The seven…
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Are the multilaterals ready to act on pandemic prevention and other global public goods?

Policy Blog
This blog was first published in Brookings Future Development Blog. The authors, Kaci Kennedy McDade and Gavin Yamey have authored a working paper “Aligning multilateral support for global public goods for health under the Global Action Plan" Later this month, leaders from across the world will gather in New York for the United Nations General Assembly. During the U.N. High-level Political Forum, the Global Action Plan for healthy lives and well-being for all will launch. Announced at the 2018 World Health Summit, the Global Action Plan is a historic commitment by 12 major multilateral health and development organizations to join forces to help achieve the Sustainable Development Goals (SDGs). Specifically, signatories to the Global Action Plan agreed to align their efforts, accelerate progress in key areas, and enhance accountability across common…
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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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