Global Health Financing Research Articles

2008 economic crisis impact on perinatal and infant mortality in Southern European countries

Abstract Introduction The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession’s impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems’ response to protecting the health of the most vulnerable groups. Objectives To assess time trends and international disparities in perinatal mortality rates (PMR) and infant mortality rates (IMR), following the Great Recession, and their association with socioeconomic indicators in Portugal, Greece, Italy and Spain. Methods Associations were assessed through generalised linear models for all four countries. A Poisson joinpoint regression model was applied to explore PMR and IMR trend changes between 2000 and 2018. Country disparities were analysed using mixed-effects multilevel models. Results IMR and PMR have decreased overall in the four selected countries between 2000 and 2018. Still, whereas in Spain, Italy and Portugal the decreasing pace was attenuated after 2009, in Greece a positive trend was found after the 2008 crisis. IMR and PMR were significantly associated with socioeconomic indicators in all four countries. National disparities in the evolution of IMR and PMR were significantly associated with most socioeconomic indicators between 2000 and 2018. Conclusions Our results confirm the impact of the Great Recession on PMR and IMR trends in all four countries, taking recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility and stagnation of IMR and PMR into account. The association with socioeconomic indicators stresses the need to strengthen social protection and healthcare systems to better protect the population’s health from the earliest days. Key messages • Mortality patterns refer to the internal variability of the crisis’ effect and to persistent spatial regional inequalities appealing to the need for attention in policymaking. • The relevance of considering the political economy of global health finance and macroeconomic volatility as a major influence on the association of mortality rates with socioeconomic indicators.

Leveraging global investments forpolio eradication to strengthen health systems' resilience through transition.

Since the launch of the Global Polio Eradication Initiative in 1988, more than US$20 billion has been invested globally in polio eradication. The World Health Organization and its partners are currently supporting Member States to transition the functions used to eradicate polio to strengthen their health systems. This study analyses global polio activities through the lens of health systems and the Common Goods for Health (CGH). Polio activities include key health system functions such as surveillance and response systems and immunization, which are essential to maintaining resilient health systems. They also support essential functions such as policy development, planning, training and capacity building, which are often underfunded in many countries. To improve overall resilience, it is critical to continue to integrate these functions into local health systems so that the capacity built through the polio eradication programme can be used for broader public health purposes. It is vital that this integration process be tailored to each country's unique health system context, rather than using a one-size-fits-all approach. While integration of all polio activities into local health systems is ideal, the transition to domestic financing may be coordinated with other global health financing mechanisms. This would reduce funding fragmentation and transaction costs, and allow for a focus on health system functions as a whole rather than just disease-specific efforts. The transition to domestic financing of polio activities could be staggered, prioritizing the transition to domestic funding for activities with limited global externalities, while seeking longer-term external funding for those that are global CGH.

Challenges in international health financing and implications for the new pandemic fund

BackgroundThe failures of the international COVID-19 response highlighted key gaps in pandemic preparedness and response (PPR). The G20 and WHO have called for additional funding of $10.5 billion per year to adequately strengthen the global PPR architecture. In response to these calls, in 2022 the World Bank announced the launch of a new Financial Intermediary Fund (The Pandemic Fund) to catalyse this additional funding. However, there is considerable unclarity regarding the governance makeup and financial modalities of the Pandemic Fund, and divergence of opinion about whether the Fund has been successfully designed to respond to key challenges in global health financing.Methods/ResultsThe article outlines eight challenges associated with global health financing instruments and development aid for health within the global health literature. These include misaligned aid allocation; accountability; multistakeholder representation and participation; country ownership; donor coherency and fragmentation; transparency; power dynamics, and; anti-corruption. Using available information about the Pandemic Fund, the article positions the Pandemic Fund against these challenges to determine in what ways the financing instrument recognizes, addresses, partially addresses, or ignores them. The assessment argues that although the Pandemic Fund has adopted a few measures to recognise and address some of the challenges, overall, the Pandemic Fund has unclear policies in response to most of the challenges while leaving many unaddressed.ConclusionIt remains unclear how the Pandemic Fund is explicitly addressing challenges widely recognized in the global health financing literature. Moreover, there is evidence that the Pandemic Fund might be exacerbating these global financing challenges, thus raising questions about its potential efficacy, suitability, and chances of success. In response, this article offers four sets of policy recommendations for how the Pandemic Fund and the PPR financing architecture might respond more effectively to the identified challenges.

Evolving Power Dynamics in Global Health: From Biomedical Hegemony to Market Dynamics in Global Health Financing; A Response to the Recent Commentaries.

Evolving Power Dynamics in Global Health: From Biomedical Hegemony to Market Dynamics in Global Health Financing; A Response to the Recent Commentaries.

Evolving market-shaping strategies to boost access to essential medical products in developing countries with HIV self-testing as a case study

The COVID-19 pandemic has exacerbated health inequities among countries in the Global South with limited access to essential medical products, leading to a higher infection and mortality rate, especially among vulnerable populations. Despite tremendous progress in global health financing, the estimated annual financing gap in developing countries is projected to reach US$371 billion per year by 2030. Therefore, developing market-shaping strategies is of great importance in ensuring adequate supply, affordable prices, and equitable access to essential medical products in low-and middle-income countries. We propose a strategic and appropriate market-shaping intervention framework for governments, international organizations, and NGOs to maximize access to essential medical products in developing countries. In the health field, we believe that market shaping strategy could be defined as a set of purposeful activities that market forces may intervene with to advance the development, production, supply, and distribution of global goods for health, making essential medical products more affordable, accessible, innovative, sustainable and quality assured. We argue that when designing a market-shaping strategy, policy or decision-makers must take full advantage of the key drivers to keep the market dynamic, interactive, and constantly evolving to meet the unmet medical needs. In addition, different forms of market-shaping interventions are determined by objectives and specific issues to be addressed. More comprehensive market shaping strategies, including the strategic use of market expansion, market disruption, market maintenance, and market contraction alone or together, deserve to be explored and key stakeholders are also expected to join forces to make the intervention more efficient and productive.

The Dynamics of Power Flow From the Global Health Financing Comment on "Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process".

This article agrees with Lassa et al that biomedical paradigms and medical professionals are a dominating force within the policy dynamics of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and that there needs to be greater community involvement in how global health initiatives (GHIs) are adopted, designed, implemented and evaluated. However, we argue that many of the conditions identified are entrenched and perpetuated by how GHIs are financed and the financing modalities employed in Development Aid for Health (DAH), particularly in low resource settings. As a result, the dynamics of power not only flow from traditionally entrenched epistemic authorities but are disproportionally sustained by global health financing modalities that favour particular GHIs over others. As we argue, these DAH modalities can exert forms of power with problematic effects on policy-making.

Does the Current Global Health Agenda Lack Vision?

<h3>Key Messages</h3> Despite the successes of the VISION 2020 global initiative, large economic and societal consequences still exist across the life span from vision impairment and blindness, which have not yet been addressed by the global health community. There remains a lack of reliable global data on vision health, especially in the case of childhood blindness and vision impairment. Historically, vision has been poorly represented in global health budgeting and finance, which objectively reflects its lack of prioritization on the overall global health agenda. We need greater investment in cost-effective strategies to prevent and treat a rapidly increasing global burden of ocular disease because of an aging and changing population.

Global Financing for Health Policy and Systems Research: A Review of Funding Opportunities.

Health Policy and Systems Research is a neglected area in global health financing. Despite repeated calls for greater investment, it seems that there has been little growth. We analysed trends in reported funding and activity between 2015 and 2021 using a novel real-time source of global health data, the Devex.com database, the world's largest source of funding opportunities related to international development. We performed a systematic search of Devex.com database for HPSR-related terms with a focus on low- and middle-income countries. We included programs, tenders & grants, and contract awards, covering all call statuses (open, closed or forecast). Such funding opportunities were included if they related specifically to HPSR funding or had an HPSR component; pure biomedical funding was excluded. Our findings reveal relative neglect of HPSR, as only approximately 2% of all global health funding calls included a discernible HPSR component. Increases in funding opportunities until 2019 2020. Most identified projects represented small scale opportunities-commonly for consultancies or technical assistance. To the extent that new data were generated, this was either tied to a specific large intervention or was narrow in scope to meet a specific challenge-with many examples informing policy responses to the Covid-19 pandemic. Nearly half of advertised funding opportunities were multi-country, usually addressing global policy priorities like health systems strengthening or development of coordinated public health policies at a regional level. The Covid-19 pandemic has shown why investing in HPSR is more important than ever to enable delivery of effective health interventions and avoid costly implementation failures. The evidence presented here highlights the need to scale up efforts to convince global health funders to institutionalize the inclusion of HPSR components in all funding calls.

Commodities of Care: The Business of HIV Testing in China by Elsa L. Fan

Reviewed by: Commodities of Care: The Business of HIV Testing in China by Elsa L. Fan Aaron Su Elsa L. Fan. Commodities of Care: The Business of HIV Testing in China. Minneapolis: University of Minnesota Press, 2021. 216 pp. When strategies to streamline global health resources result in narrow, magic-bullet testing solutions, what meaningful interventions and social relations are enacted or foreclosed? Resonating with contemporary debates around the limits of technical solutions for COVID-19, Elsa L. Fan's Commodities of Care explores the scaling up of HIV testing in China stimulated by global health donors through programs of performance-driven financing. From the production of the category "men who have sex with men" (MSM) to the retraction of programs that offer lasting support beyond the positive test itself, Commodities of Care deftly illustrates how new trends in global health financing simultaneously usher in new subject positions, experiences of disease, and definitions of care. In so doing, the book offers a lucid glimpse into the stories and meanings of HIV for MSM in China while never losing sight of the political economy that makes these experiences possible. Commodities of Care is the result of Fan's comparative ethnographic work across several HIV organizations in a southern Chinese city. These community-based local centers, such as Bright Love, administer sexual health services as well as events and outreach programs, yet their funding structures are ambivalently tied to heterogeneous global health donors. Some, like the Health Fund and the Global Fund, have recently pushed for performance-based financing schemes that determine payments based on quantitative measures of HIV tests administered, positive test outcomes, and other related outputs, thereby reducing care to the transactional process of "selling blood (mai xue)" (3), as one of Fan's interlocutors [End Page 715] describes it. Analyzing the consequences of this shift—e.g., the purposeful proliferation of repeated and fraudulent tests for financial gain (40), the reduction of the HIV-positive population to solely MSM (17), and the "instrumentalization of community-based organizations as technical service delivery agents rather than stewards of social change" (116)—the author illuminates the transformative effects that "audit cultures" (Strathern 2000) can wield in the making of local and global health. Having worked in the development and philanthropy industries during these "ideological shifts" (19), Fan is uniquely positioned to tell the history of global health's financial streamlining at the turn of the millennium alongside the emergence of new players like the Gates Foundation. In the introduction and Chapter 1, she ethnographically analyzes how the world of HIV testing as a singular global health solution par excellence comes together in the Chinese context. Intricately describing the promotion of performance-based financing over peer-to-peer education (26) as well as the rise of statistics like the quality-adjusted life year and disability-adjusted life year in global health discourses (36), Fan traces how these shifts appear in the narrations and material practices of her interlocutors. For example, she digs into rumors of organizations splitting performance incentives with non-MSM migrant laborers, whom they recruit to get tested for the sake of their tally. She thus reveals the concrete, local consequences of approaches like evidence-based medicine (EBM) and their dominance in public health. In Chapter 2, Fan draws on Ian Hacking's (1986) concept of "making up people"–the production of new subject positions through categories and counting practices–to show how global health's enumeration strategies led to the "making up" of MSM in China. She charts the varied negotiations over the concept of MSM in China to understand organizations' concerns about recruiting testers, noting that many MSM were perhaps in publicly heterosexual relationships. Addressing this problem of a "hidden population" and insisting that Chinese MSM could not merely be drawn out and defined in the conventional terms of identity politics, Fan illuminates how practices of self-affirmation (ziworentong) "instill in these men an acceptance of their same-sex desires and a recognition of their HIV risk as part and parcel of desires" (77). The result of this affirmation, Fan reminds us, is not just the production of new personhoods but also the manufacturing of "commodities of care" in...

Commitment and innovation on the road to people-centred PHC financing

Commitment and innovation on the road to people-centred PHC financing

Prevention of surgical site infection in low-resource settings

WHO defines universal health coverage (UHC) as “access to needed essential health services, without financial hardship”. 1 WHOUniversal Health Coverage. https://www.who.int/healthsystems/universal_health_coverage/en/Date: 2021 Date accessed: May 4, 2021 Google Scholar UHC requires about US$100 per head for an essential package of 218 interventions, and approximately $50 per head for a basic package of 108 of the highest priority interventions. 2 Schäferhoff M Martinez S Ogbuoji O Sabin ML Yamey G Trends in global health financing. BMJ. 2019; 365l2185 Crossref PubMed Scopus (12) Google Scholar Yet, estimates in 2016 suggested that only nine of the 49 low-income and middle-income countries (LMICs) could afford the essential package, and that 16 countries could afford the 108 highest priority interventions of the basic package. 2 Schäferhoff M Martinez S Ogbuoji O Sabin ML Yamey G Trends in global health financing. BMJ. 2019; 365l2185 Crossref PubMed Scopus (12) Google Scholar At an average government spend on health in low-income countries of only $9 per head in 2018 (1·2% of Gross National Product), literally every cent counts. 3 WHOGlobal spending on health: weathering the storm. WHO, Geneva2020 Google Scholar Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trialThis trial did not show benefit from 2% alcoholic chlorhexidine skin preparation compared with povidone–iodine, or with triclosan-coated sutures compared with non-coated sutures, in preventing SSI in clean-contaminated or contaminated or dirty surgical wounds. Both interventions are more expensive than alternatives, and these findings do not support recommendations for routine use. Full-Text PDF Open Access

Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050

SummaryBackgroundThe rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020.MethodsWe estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050.FindingsIn 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5–0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0–25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448–1591) per person in 2050, although spending across countries is expected to remain varied.InterpretationGlobal health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all.FundingBill & Melinda Gates Foundation.

Global-scale action in health: a common language is a critical starting point to bolster global health financing.

Global-scale action in health: a common language is a critical starting point to bolster global health financing.

Structural changes of global health financing in the context of coronavirus pandemic

Structural changes of global health financing in the context of coronavirus pandemic

Examining the governance and structure of the global health financing system using network analyses

Abstract Background Development assistance for health (DAH) has been a vital in achieving the improvements in health since the year 2000. This was facilitated through the distribution of financial and in-kind resources, valued at over $37 billion in 2017, from a group of global health and development entities to low- and middle-income countries. The resources from these organisations originated from a variety of sources, including national treasuries, philanthropic foundations, and private corporations. The allocation of these resources are also governance arrangements, in many cases with disease and intervention priorities determined outside the recipient localities. Methods The structure of global health financing was investigated using network analyses of DAH actors in the context of disease/health area-specific funding. The dataset utilised in the analyses, assembled by the Institute of Health Metrics and Evaluation, consisted of 27 years of annual estimates (1990-2017) of DAH flows tracked from sources through channels to 177 recipient countries, disaggregated by health area. Results The number and diversity of organisations involved in global health financing saw a rapid expansion since 1990. The most prominent structural changes were the recession of large multi-laterals and the emergence of non-OECD and private entities. Amongst these, unofficial partnerships were detected. This study identified several weaknesses in the global health financing system pertaining to specific diseases as well as child and maternal health. Conclusions To provide sustainable, efficient, and effective health intervention implementation in DAH-recipient countries, it is important to understand the structure of the global health funding system. These results will be used to develop potential future financing scenarios, and to understand the impact of the global health financing structural characteristics on the improvement of targeted health outcomes in developing countries. Key messages Global health financing has undergone substantial structural changes since 1990, with multi-laterals scaling back proportionally and the emergence new types of entities. The governance and delivery arrangements within global health are linked to the financial arrangements, potentially causing structural weaknesses that threaten the sustainability of the system.

Global-scale action in health: a common language is a critical starting point to bolster global health financing.

Global-scale action in health: a common language is a critical starting point to bolster global health financing.

Understanding health spending for SDG 3

The present Article and previous publications from the Global Burden of Disease Health Financing Collaborator Network clearly indicate the diminishing importance of development assistance for health (DAH) for financing services at the country level, even for disease areas commonly perceived as highly dependent on DAH 1,3,4 The projections to 2030 indicate that DAH will continue to be important in some low-income countries at the end of the SDG period, but this finding is more a consequence of the lack of growth in domestic spending than an effect of increasing DAH Vlad Sokhin/Panos Pictures In the present Article, the authors also present funding estimates for specifically relevant areas for SDG3—ie, HIV/AIDS, tuberculosis, malaria, and universal health coverage 1 Although these estimates might be useful for a global dialogue around how SDGs are prioritised in DAH, the approach is less relevant for increased understanding of, and improved decision making in, the health sector of countries included in the study [ ]the Article does not take a health systems approach to the data

Transition of Health Financing and Cost Risk-Sharing and Risk-Pooling Models in the Health Sector: A Systematic Review (1990 - 2019)

Context: Health expenditures in the world undergo increasing growth. According to the WHO Report (2000), health financing is one of the main functions of the health system that has a significant impact on its other functions. Objectives: The aim of this study is the systematic review of the changes and shifting of health care financing models and cost burden risk-sharing mechanisms in health systems over the past three decades. Data Sources: In this systematic review, data sources of studies on health financing realm in different countries were investigated using a series of keywords, including “health financing”, “health expenditure “, “model”, “financing mechanism/arrangement”, and “cost risk-sharing” from the most important databases such as Google Scholar, Web of Science, Scopus, PubMed, and the Iranian databases, such as Magiran, IranMedx, SID, in 1990 - 2019. Study Selection: According to PRISMA Flow Diagram, with application of inclusion and exclusion criteria (time limitations, language restrictions, lack of related title abstract, full text), among 86,611 documents, 150 studies were selected. Two pairs of review author’s independently extracted data and assessed the risk of bias. Results: The systematic review of different evidence suggests that with economic growth, since 2001 to 2014, global health expenditure trend was increased from $ 3.8 trillion (in 2001) to $ 9.2 trillion (in 2014) and is estimated to reach $ 24.2 trillion (in 2040). Also, all the evidence indicates a tangible change, a 10% increase in public and pre-payments health expenditures and a 16% reduction in private expenditures, in the global health financing model in the current period up to 2040. Conclusions: The review of regional and global studies, across countries and during the time, shows that in the last three decades, health financing systems are in a transition towards pervasive (with high financial risk-sharing) public health policies in the world.

It’s politics, stupid! A political analysis of the HIV/AIDS Trust Fund in Uganda

The role of trust funds in the practice of and the policy discourse on the sustainable financing for health and HIV is growing. However, there is a paucity of political analyses on implementing trust fund arrangements. Drawing on a novel meta-framework – connecting multiple streams and advocacy coalition frameworks to policy cycle models of analysis – to politically analyse HIV financing policy design, adoption and implementation as well as insights from public finance literature, this article critically analyses the politics of the AIDS Trust Fund (ATF) in Uganda. We find that politics was the most fundamental driver for the establishment of the ATF. Whereas HIV financing is inherently both technical and political, enacting the ATF was largely a geopolitical positioning policy instrument that entailed navigating political economy challenges in managing multiple stakeholder groups’ politics. With the mandated tax revenues earmarked to capitalise the ATF covering only 0.5% of the annual resource needs, we find a very insignificant potential to contribute to financial sustainability of the national HIV response per se. As good ideas and evidence alone often do not necessarily produce desired results, we conclude that systematic and continuous political analysis can bring meaningful insights to our understanding of political economy dimensions of the ATF as an innovative financing policy instrument, thereby helping drive technically sound health financing policy proposals into practice more effectively. For Uganda, while proponents have invested a considerable amount of hope in the ATF as a source of sustainable domestic funding for the HIV response, substantial work remains to be done to address a number of questions that continue to beguile the current ATF architecture. Regarding global health financing policy, the findings suggest the need to pay attention to the position, power and interests of stakeholders as a powerful lever in health financing policy reforms.

Global health futures?

Since 2010, there has been a discernable expansion of global health financing forms using private equity, bonds, and ‘facilities’ to finance international development and humanitarian endeavors. I present the logics of the Pandemic Emergency Facility (PEF), a World Bank device that lashes together a bond, cash, and swaps to lie in reserve for an infectious disease outbreak. I explain how the PEF is emblematic of financial devices that have the potential to fund global health aid while offering investors a chance to make money. Reckoning with the pandemic bond means that we take account not only of the PEF (what does it organize and by what logics?) but also of the relationships it cultivates (what does it bind together?) and reproduces (what does it aim to multiply and what does it forsake?). I use ‘reckoning with’ as an analytic concept to help us think about measures and futures of global health in both economic and ethical registers, as well as to take account of how death data is used. Reckoning with something lets us pause to take account of where we are and where we are going, and helps us think about what we want. Is it necessary to translate the ethical obligation to help those who are suffering into financial devices that make people money, a trend we are clearly in the initial stages of? Are there conditions when the suffering of others as the source of financial speculation becomes desirable?