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Independent research & practical ideas for global prosperity
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Independent research & practical ideas for global prosperity
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 Posts:June 19, 2009Give the Global Fund a Gold Star for Their Hard-Hitting Evaluation…Now Comes the Hard PartBy April HardingIn 2002, the Global Fund (GF) was established to be a “new and improved” model for health aid. Founding head, Richard Feachem coined the pithy phrase “Raise it. Spend it. Prove it.” to capture their raison d’etre. A hard-hitting evaluation of their first five years has just been published. It gives them: an A – for “raising it”; a B – for “spending it”; and, a D minus, for “proving it”. Much to their credit, the evaluation assessed not just the grants, but also how the Fund’s structure, and modus operandi, influences how the grant activities are identified and implemented. GF funders and board members are now in a position to make informed decisions about changes that could make the GF work better. By any measure, hard work awaits. Read More… 8 Comments »March 26, 2009Health Systems Strengthening: Whither the World Bank?By April HardingWith Ruth Levine. The High Level Taskforce on Innovative International Financing for Health Systems met week before last in London. To their great credit, they’ve posted draft reports from their two Working Groups so interested observers can see the where they’re going. Working Group 1 seeks to identify the health systems-related constraints to achieving global health goals, and presents estimates of costs of achieving priority goals (e.g. targeted reductions in maternal and child health). Working Group 2 (WG2) aims to identify new sources of funding and lay out the best options for channeling the funding to countries to improve health system performance. Further work and consultation is pending over the next three months, and then the Taskforce will provide their suggestions to the G8 for consideration at the July Summit in Italy. Read More… 2 Comments »February 11, 2009Oxfam — This Is Not How to Help the PoorBy April Harding
10 Comments »January 27, 2009Beyond Prices, Patents, and Logistics: A Deeper Look at the Challenges of Expanding Access to Life-Saving Medicines and Technologies in Developing CountriesBy April HardingChild health advocates point out that after more than 20 years, oral rehydration therapy use, which is cheap and could save millions of children, has plateaued at 38% coverage. See Bryce et al 2008 Lancet. Others draw attention to the “product pile up” – referring to the significant resources invested to develop products which could save lives and contain costs, like malaria Rapid Diagnostic Kits. But they don’t get adopted by the providers. Comment »December 9, 2008The Public versus Private Debate: Inching Toward the Middle . . .By April HardingAn exchange in the pages of PLoS Medicine underscores a promising trend in global health: a shift toward more pragmatism and less name-calling on the role of the private sector in developing country health systems. Comment »February 1, 2008The Economist (!) Succumbs to the “Siren Song” of Universal Bednet GiveawaysBy April HardingWith dismay, I read today this piece in The Economist – which adds their important voice to the chorus calling for bednet programs based on universal First, the prevailing wisdom. Two reviews, one by Roll Back Malaria, and another by the World Health Organization’s malaria department, have been conducted on how to achieve high and sustained coverage of bednets. Both concluded the same thing: to achieve and sustain bednet coverage, multiple distribution strategies involving both public and private sector distribution are more effective than public distribution The logic of free bednets, and public sector distribution is obviously seductive…and now it Comment »December 18, 2007If You Can’t Do Everything, Should You Do Anything? LA Times Article Hits, and Misses, the Mark on Global Health ProgramsBy April HardingReaders of this recent LA Times article were treated to a series of heart rending stories — which taken together suggest serious program design flaws in, mainly Gates-funded, health programs in poor countries. The article is long, and raises many issues. I think it’s worth examining some of them a bit more deeply. One important point that came through is the growing concern that massive disease programs, especially HIV/AIDS, are quite likely undermining poor countries’ health systems’ ability to respond to other health problems. This problem is rightly drawing increased attention among global health funders, including Gates. Throughout the article, though, the Gates Foundation is singled out and taken to task for low levels and stagnant indicators of “societal health.” A reader might mistakenly get the impression that Gates programs are the major determinant of health systems performance and outcomes in these countries. Anyone with passing familiarity with health systems in Africa could tell you that, like health systems everywhere, local policy decisions and actions have far more influence than any donor, or even all donors taken together. But the authors go further. They imply that the disease programs are failures simply because they haven’t improved countries’ ability to save people from other illnesses. This framing of the problem belies the basic reality of poor country health systems (indeed all health systems): resource scarcity. Since neither Gates nor anyone else can fund everything, they have to choose among the many things they could fund. It may well be that Gates could get more “value for their money” by reallocating their funds from AIDS treatment, to say, treatment of diarrheal disease or respiratory illness. But the article doesn’t acknowledge the need for trade-offs, but rather implies that if you do one thing (in this case, AIDS treatment), you should do everything. This is not a useful foundation for figuring out how to do better health development assistance. 3 Comments » |
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Today I had a flashback to the days when the global health community was divided into two bitterly opposed camps, the 
