The global health landscape is undergoing a set of rapid and profound transitions that threaten to stall or even derail progress in global health improvement. The 4Ds project analyzes four of these major, inter-linked transitions—shifts in diseases, demography, development assistance for health (DAH), and domestic health financing.
Many middle-income countries (MICs) are transitioning away from health aid and towards full county ownership of their health programs. Both aid donors and MICs must take steps to ensure that these programs are sustained and do not face disruptions when donors exit. However, many global health donors have only recently begun to consider formalized exit strategies and plans. Even when this planning has happened, there is little publicly available information on the governance of transitions.
This project addresses 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, and other global functions of donor aid for health. Our research examines (a) how much funding is needed to adequately support such global functions, (b) innovative mechanisms to help close the financing gap, and (c) the institutional arrangements that are needed to move these financing solutions forward.
In our previous work, we explained that the “middle-income dilemma” in global health is that “although most of the poor now live in pockets of poverty in middle-income countries [MICs] and face high mortality rates, these countries are regarded as too rich to qualify for aid.” A crucial question facing donors is what role they can still play in supporting MICs after these countries have transitioned away from receiving external assistance.
Achieving the health-related Sustainable Development Goals (SDGs) will require significant increases in financial resources from many different sources, including domestic resource mobilization (DRM). In this pilot project, we are partnering with the Duke Center for International Development to examine the role of DRM for health in India (in Assam, Karnataka, and Uttar Pradesh) and Ethiopia. The project takes a “holistic” public financial management (PFM) approach—one that integrates analysis of taxation, allocation, efficiency, and insurance —and applies it to mobilizing domestic resources for health.
This project, funded by a pilot grant from the Duke Global Health Institute, is a one year study that analyzes decision-making processes that underlie a country’s preparation for and response to donor transitions. We are partnering on this project with the University of Ghana and the Institute for Health Policy, Sri Lanka. The study uses a mixed-methods approach, focusing on Ghana and Sri Lanka, to (a) explore the perspectives and experiences of in-country stakeholders with donor transition, (b) document responses to the losses arising from transition (including loss of external financing and technical assistance), and (c) address the “why” behind the chosen response strategies adopted.
In March 2018, the government of India approved a publicly funded health insurance scheme that is officially called the Prime Minister (or Pradhan Mantri) Jan Arogya Yojana (PM-JAY), also known as Ayushman Bharat (and known colloquially as “Modicare” after Indian Prime Minister Narendra Modi). With funding from a Duke Global Health Institute pilot grant, the Center for Policy Impact in Global Health is conducting a mixed method study.
This project is studying the health and financial benefits of public investments in reproductive, maternal, newborn, adolescent, and child health (RMNACH).
In 2018, a research team from Duke University and Policy Cures Research, in collaboration with TDR, the Special Programme for Research and Training in Tropical Diseases, published the first analysis of the pipeline of products for poverty-related neglected tropical diseases (PRNTDs) using a financial modelling tool called Portfolio-to-Impact (P2I). The analysis summarized the pipeline of candidate products for PRNTDs and estimated (a) the costs to move these candidates through the pipeline, (b) the likely launches, and (c) the additional costs to launch critical “missing” products. In a new project, the Center is partnering with Policy Cures Research to update both the pipeline portfolio review and the cost modeling.
The Portfolio-To-Impact (P2I) model is a recently developed product portfolio tool that enables users to estimate the funding needs to move a portfolio of candidate health products such as vaccines and drugs along the product development path from late stage preclinical to phase III clinical trials, as well as potential product launches over time. In this project, we are partnering with the European Vaccine Initiative to use the P2I tool to analyze EVI’s portfolio, which includes vaccine candidates for various diseases of poverty and emerging infectious diseases at different stages of development.