For its initial program of work, the Center for Policy Impact in Global Health is focusing on innovative ways to close critical financing gaps that present obstacles to achieving the health-related Sustainable Development Goals and a “grand convergence” in global health.
Areas of Focus
The global functions of health aid: quantifying and closing the financing gaps
The Center’s first focus will be on ways to finance under-funded but crucial global public goods for health—such as developing new medicines and vaccines for poverty-related and neglected diseases (PRNDs)—and other global functions of donor aid for health.
Donor aid for health can be classified into two types—aid for global functions, which addresses transnational health challenges affecting multiple countries, and aid for country-specific functions, which tackles health problems within individual countries only. There are three groups of global functions:
- global public goods for health, such as product development for PRNDs
- management of cross-border externalities, such as pandemic preparedness and tackling antimicrobial resistance
- fostering global health leadership, such as bolstering WHO’s stewardship capacities.
The Center’s work on these global functions will address three key questions:
What is the financing gap for these functions?
Our recent research with collaborators at the University of California San Francisco, SEEK Development, Harvard University, and the Karolinska Institute, found that only one fifth of donor financing for health is directed at these global functions. But it remains unclear how much donors should be spending on these functions—there has been very little empirical work on their costs.
The Center will therefore aim to produce a set of robust and up-to-date “price tags” for several of the most important global functions, particularly product development for PRNDs. This analytic work will be guided by an international Working Group on International Collective Action for Health, chaired by Lawrence Summers from Harvard University, comprising technical experts and high level policy stakeholders.
Through which mechanisms can these financing gaps be closed?
The Center, with guidance from the Working Group, will design and develop new policy solutions to help close the financing gaps for these global functions. This work will include wide consultation with bilateral and multilateral funding agencies, development banks, and experts from the public, private, and philanthropic sectors. In spring, 2017, the Center will also host a policy dialogue with financing innovators and thinkers, with the aim of developing an initial set of policy proposals. Based on feedback from policymakers, we will then further develop the most promising of these proposals into more fully fledged solutions.
Which institutions are fit for purpose in delivering on these solutions and are new institutions needed?
This policy analysis will examine the institutional arrangements that are needed to move these financing solutions forward. It will assess which current institutions are fit for purpose in delivering on our proposed solutions and whether new funding vehicles or channels are needed.
How health aid should evolve to tackle the “middle-income dilemma”
The Center’s second focus will be on how donor support should evolve to help to address the “middle-income” dilemma in health. In our previous work, we explained that, “the dilemma is that although most of the poor now live in pockets of poverty in middle-income countries and face high mortality rates, these countries are regarded as too rich to qualify for aid.”
A contentious issue is whether health aid still has a role in supporting middle-income countries after they have graduated from receiving such aid. One way that donor support could be used to tackle the health challenges facing poor populations in these countries after graduation is through channeling this support to global functions. We will examine how aid for health should evolve in ways that could benefit these populations, especially through support for global functions.
This work will include a case study, in partnership with AidData, of one middle-income country using spatial methods to gain an understanding of where contributions of health aid are currently located in relationship to poverty and poverty-related diseases, such as malaria and tuberculosis.
Closing the domestic health financing gap in low- and middle-income countries
The Center’s third focus will be on ways to mobilize domestic resources for health in low- and middle-income countries. This work will be led by investigators in the Duke Center for International Development’s Public Finance Group. It will involve a partnership with in-country policy makers in two partner countries as well as key International Financing Institutions such as the IMF and World Bank.
In this work, a “holistic” approach to public financial management will be adopted, one that integrates four domains of analysis: taxation, allocation of funds, efficiency of spending, and health insurance. A broad analytical framework will be applied in two countries in different circumstances—one low-income and one middle-income—in order to:
- provide a general assessment of each country’s capacity for domestic resource mobilization
- develop country-specific policy solutions to help with such mobilization
- tailor policy proposals to the priority objective of increasing the level and efficiency of health expenditure.