Global Health Funding Research Articles

New Machine, Old Cough: Technology and Tuberculosis in Patna.

In 2013, a new technology, GeneXpert, was introduced in India, which, in addition to testing for TB, could also diagnose whether the detected strain was drug resistant. By detecting the bacterium more effectively than other available tests and simultaneously testing for resistance, GeneXpert promised to reduce the delay in diagnosis and hence ineffective treatments. The new test was introduced to multiple cities via a coalition that included global health funding bodies, the government of India, the World Health Organization, and non-governmental organizations. Despite the concerted effort of the coalition, among formal providers (those trained in biomedicine) in the private sector, the new technology was not adopted as quickly as had been hoped. Examining formal providers' initial responses to the technology's introduction in the city of Patna reveals how the adoption of new technology can be influenced by the particularities of the local medical market such as the availability of diagnostic tests, presence of informal providers, and reputation of formal providers. While protocols and operations might seem standardized across implementation plans, the work that is required to ensure success must take into account the particular role that the market plays from site to site.

Assembling Pharma Resources to Tackle Diseases of Underserved Populations

Tropical diseases that disproportionally affect the world's poorest people have traditionally been neglected from research efforts toward the discovery and development of new and effective therapies. Over the past two decades, major global health funders have made efforts to bring together various research institutions to work together in these disease areas offering little or no commercial return. This work describes the genesis and growth of an informal program devoted to contributing to new therapies for neglected tropical diseases within the environment of a major biopharmaceutical company (AbbVie).

Global Health Education and Mediatization of Care in Costa Rica

ABSTRACT Costa Rica has become a destination for global health education courses, while funding for global health has increased dramatically over the past thirty years. An examination of one Costa Rican group’s efforts to market humanitarian discourses, focusing on website design, provides a window into the workings of global health education and details the sometimes-uncomfortable position of non-US health professionals in educational programming. This contributes to theorizations of the intersection of mediatization and care, and suggests links between the legitimation of global health as a discipline, on the one hand, and the reproduction of inequities, on the other.

Funding sources for research: A research primer for low- and middle-income countries.

Research is a fundamental component of the development of quality emergency care systems. Developing qualified professionals and programs to conduct emergency care research is essential to understanding epidemiology in low resource settings. This leads to evaluating research outcomes, developing clinical practice guidelines and program implementation. This paper aims to introduce the reader to opportunities for research funding at various stages of one's career. We will discuss concepts necessary to obtain funding for research, a crucial step towards initiating a research program. The chapter further describes competitive funding mechanisms including governmental agencies, foundations and private industry along with organisations that offer funding for global health and emergency care research. We describe categories of grants specific to a stage of an investigator's career, developing a team for a proposal and the grant application process.

Sustainable development for global mental health: a typology and systematic evidence mapping of external actors in low-income and middle-income countries

IntroductionMental disorders account for a substantial burden of disease and costs in low-income and middle-income countries (LMICs), but attract few resources. With LMIC governments often under economic pressure, an understanding...

Sustainability of 'mHealth' interventions in sub- Saharan Africa: a stakeholder analysis of an electronic community case management project in Malawi.

The global health community and funding agencies are currently engaged in ensuring that worthwhile research-based programmes are sustainable. Despite its importance, few studies have analysed the sustainability of global health interventions. In this paper, we aim to explore barriers and facilitators for the wider implementation and sustainability of a mobile health (mHealth) intervention (Supporting LIFE Community Case Management programme) in Malawi, Africa. Between January and March 2017, a qualitative approach was used to carry out and analyse 13 in-depth semi-structured interviews with key stakeholders across all levels of healthcare provision in Malawi to explore their perceptions with regards to the implementation and sustainability of the mHealth programme. Data were analysed thematically by two reviewers. Overall, our analysis found that the programme was successful in achieving its goals. However, there are many challenges to the wider implementation and sustainability of this programme, including the absence of monetary resources, limited visibility outside the healthcare sector, the lack of integration with community-based and nationwide programmes, services and information and communication technologies, and the limited local capacity in relation to the maintenance, further development, and management. Future developments should be aligned with the strategic goals and interests of the Ministry of Health and engage with national and international stakeholders to develop shared goals and strategies for nationwide scale-up. These developments should also focus on building local capacity by educating trainers and ensuring that training methods and guidelines are appropriately accredited based on national policies. Our findings provide a framework for a variety of stakeholders who are engaged in sustaining mHealth programmes in resource-poor settings and can be used to develop an evidence-based policy for the utilization of technology for healthcare delivery across developing countries.

Living with HIV as Donor Aid Declines in Tanzania

ABSTRACTFluctuations in global health funding can significantly impact the lives of people who depend on donor-funded programs for life-long care. In this article, I examine shifting HIV policies that expanded antiretroviral therapy (ART) while reducing “care” services meant to improve ART access and adherence. I describe how these changes were experienced by HIV+ women accessing ART at a hospital in Tanzania in 2011–2012, highlighting their increasing precarity and uncertainty for care amidst donor instability and eroding program services. This research suggests that stable funding in support of long-term care services is important to help HIV+ people maintain life-long ART.

Health system reconstitution syndrome: an often misunderstood phenomenon in global health practice

The beginning of the 21st century was marked by the new definition and framework of health systems strengthening (HSS). The global movement to improve access to high-quality care garnered new resources to design and implement comprehensive HSS programs. In this effort, billions of dollars flowed from novel mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and several bilateral funders. However, poor health outcomes, particularly in low-income countries, raise questions about the effectiveness of HSS program implementation. While several evaluation projects focus on the ultimate impact of HSS programs, little is known about the short- and mid-term reactions occurring throughout the active implementation of HSS interventions. Using the well-documented WHO framework of six HSS building blocks, we describe the evolution and phases of health system reconstitution syndrome (HSRS), including: (1) quiescent phase, (2) reactive phase, (3) restorative phase and (4) stability phase. We also discuss the implications of HSRS on global health funding, implementation, policy and research. Recognizing signs of HSRS could improve the rigour of HSS program design and minimize premature decisions regarding the progress of HSS interventions.

International Decision Support Initiative: Bellagio and beyond

What would the world look like if the international Decision Support Initiative, iDSI, were successful? This was the core issue we explored at an event at the Rockefeller Bellagio Center in Italy on 10-12 September 2014. The event brought together 25 like-minded individuals from various organisations across the globe, ranging global health funders and development agencies, practitioners of priority-setting, as well as universities and consultancies with an important stake in global health. We share a common vision: if iDSI were successful, we would see countries making the right choices for better health. Our mission is thus guiding decision makers to effective and efficient resource allocation strategies for improving people’s health.

Effectiveness of health systems strengthening interventions in Africa: a systematic review

World Health Organization devoted World Health Report of 2000 to health systems performance. Since then, many international development partners and national governments have been funding health systems strengthening (HSS) interventions. Interventions that are included in this review are those that were carried out in single or multiple African countries. Among other criteria, such interventions had to directly target at least one of six HSs building blocks. Eighteen relevant evaluations were critically appraised for quality from 200 potentially relevant evaluations. No intervention concurrently strengthened all the six HSs building blocks and none improved all four overall outcomes of HSS. HSS intervention in Africa deserves more attention by policy makers, global health funders, and public health professionals in Africa. This systematic review reveals shortcomings of HSS interventions in Africa and makes four evidence-based recommendations to guide and improve future HSS interventions in Africa to enable them have impacts on all intermediate and overall HSS outcomes indicators.

Health security policy and politics: contemporary and future dilemmas

Global health issues are once again high on the international agenda. In New York, we have seen the United Nations hold several high-level meetings on topics extending from eliminating tuberculosis to promoting universal health cover to tackling health crises. Half a world away in Europe, governments expanded the World Health Organization’s (WHO) remit to assume a more operational role in responding to health emergencies. New intergovernmental entities such as the Joint External Evaluation (JEE) Alliance and the Coalition for Epidemic Preparedness Innovations (CEPI) have been created, tasked with duties ranging from health system strengthening to providing innovative funding mechanisms for the development of new pharmaceuticals. Where individual governments have reduced funding for global health and instituted foreign aid policies that (once again) restrict access to basic services like family planning, other governments have responded by announcing their willingness to fill the leadership and financial void left by those departing the field. This has occurred even as yet other governments have demonstrated their blatant disregard for long-held international norms such as those prohibiting the use of chemical weapons. In short, as the second decade of the twenty-first century nears its end, global health politics are as fraught and politically charged as ever.

European Union citizens\u2019 views on development assistance for developing countries, during the recent migrant crisis in Europe

BackgroundDevelopment assistance from governments of high income countries represents the vast majority of international funding for global health. Recent stagnation of this important source of funding may affect attainment of major global health goals. The financial crisis is widely accredited as denting governments’ outlay for development aid, as well as citizen’s support for aid. Europe has also recently experienced record levels of migration; the so called ‘European migration crisis’. This study aims to analyse trends in public attitudes towards development aid in European Union (EU) countries, in the context of the European migrant crisis.MethodsEurobarometer survey data from 2011 (prior to the migrant crisis) and 2015 (at the peak of the crisis) was analysed for 27 EU countries. The outcome variables related to people’s levels of support to three statements around the importance of supporting people in developing countries, increasing countries’ commitments to aid and willingness to pay extra for products from developing countries. EU Member States were categorised as ‘arrival’ or ‘destination’ countries in view of migration routes and numbers of asylum applications per 100,000 population, respectively. Multiple linear regression analysis was performed, adjusting for countries’ economic status (gross domestic product per capita).ResultsIn general, support for development aid has increased from 2011 to 2015, but was largely unaffected by migration status when applying the regression model. In 2015, the belief that development assistance is ‘very important’ was significantly higher in countries where migrants first arrived compared to other EU Member States, with a trend towards this association also apparent in 2011.ConclusionsThe positive trends in public support for development aid are encouraging in an age where economic hardships at home, as well as the tone of national political discourses and rising right wing populism appear to suggest otherwise.

Global health enabling systems

This think piece argues for the importance of administrative and bureaucratic labor –‘mundane’ things – in maintaining US-African global health research partnerships and the power relations within them. The daily work of accounting, compliance, and risk management undertaken by global health ‘enabling systems’ created by US universities contrasts with global health’s heroic self-image and conjures up negative imaginaries of intransigent African bureaucracies, crumbling communication infrastructure, and corruption. These negative imaginaries help to authorize forms of US fiscal and administrative control that may contradict global health’s ethic of partnership and its related goal of ‘building capacity’ in low-income partner nations, as well as feed ‘creative accounting’ practices by both partner entities. Critiquing these inequalities may seem risky in an era of ‘America First’ and threatened cuts to global health funding. In fact, advocating for equity in global health partnerships and prioritizing the building of African institutional capacity are only made more urgent by the current political climate.

Neglected Tropical Diseases and Equity in the Post-2015 Health Agenda

The Millennium Development Goals’ focus on just three infectious diseases (HIV/AIDS, malaria, and belatedly, tuberculosis) configured the global health funding landscape for 15 years. neglected tropical diseases (NTDs), a group of 17 or so diseases that disproportionately afflict the world’s ‘bottom billion’, are a symbol of global health inequities, in terms of prioritisation, research attention, and treatment. This article traces efforts to include NTDs in the Sustainable Development Goal (SDG) agenda and, having achieved that goal, lobby for an influential position in the post-2015 aid agenda. The SDGs herald a shift to a more expansive approach and there is a risk that NTDs will once again be left behind, lost in a panoply of new goals and targets. There is, however, an opportunity for NTDs to lever their ‘neglect’ and be recast as a tool of accountability, acting as both a target for and proxy indicator of health equity for the SDGs.

How well are aid agencies evaluating programs? An assessment of the quality of global health evaluations

ABSTRACTEvaluations are key to learning and accountability. We assessed the methodological quality of 37 randomly selected programme evaluations from 5 major global health funders. Two researchers rated each evaluation for relevance, validity, and reliability and met to resolve discrepancies. Most evaluations asked questions relevant to the health programme, but less than 40 per cent of impact evaluations and less than 10 per cent of performance evaluations used relevant data, followed accepted social science methods for sampling, or had high analytical validity and reliability. There is a need to improve the methodological quality of programme evaluations.

Turning the gaze: challenges of involving biomedical researchers in community engagement with research in Patan, Nepal

Global health funding bodies are increasingly promoting and offering specific funding support for public and community engagement activities, in addition to research and programme funding. In the context of this growing commitment to engagement work, we need to find ways to better support contextually appropriate and meaningful exchanges between researchers and community members. I argue that, rather than focusing solely on how to involve communities in engagement with global health research, we should also pay attention to the quality and depth of the involvement of researchers themselves. This is an often overlooked dimension of community engagement in both practice and the literature. In this paper, I present three contextual factors, which created logistical and attitudinal obstacles for researchers’ involvement in meaningful engagement in a global health research unit in Nepal. These comprised implicit and explicit messages from funders, institutional and disciplinary hierarchies and educational experiences. Lessons were drawn from an exploration of the successes and failures of two participatory arts projects connected to the research unit in 2015 and 2016. Both projects intended to foster mutual understanding between researchers and members of their research population. As an engagement practitioner and ethnographic researcher, I documented the processes.

A New Golden Age? Proposal for an Innovative Global Health Funding Mechanism for Middle-Income Countries.

Despite economic growth and increased global commitment to health financing in the past decades, the health needs of some of the world's most vulnerable people remain overlooked. In particular, middle‐income countries (MICs) often face the conundrum of receiving reduced development assistance for health (DAH) while still being home to most of the world's poor and the majority of the global burden. We believe that this reflects shortcomings in the global DAH system's architecture, which operate on principles that do not respond well to current realities. Hence, we propose a novel mechanism for international health financing and action that specifically addresses the newly emerged strengths and needs of MICs. The Incentives for Health (I4H) Alliance will offer MICs flexible incentives in exchange for their making and meeting health‐related commitments in their countries. Countries can set their own health targets, in alignment with the existing Sustainable Development Goals' framework, and those that achieve them will be subsequently rewarded with financial or other incentives, which are not restricted to the health sector. We believe that the I4H Alliance will promote greater MIC involvement towards global health financing both as incentive providers and recipients; encourage collaboration between Ministries of Health and Finance; and provide a needed complement to traditional DAH mechanisms. We advocate for the creation of I4H at a MICs‐oriented financing institution such as the New Development Bank. We intend I4H to spark new thinking around innovative health financing approaches to ensure that the “golden age” of global health remains ahead.

Out of Alignment? Limitations of the Global Burden of Disease in Assessing the Allocation of Global Health Aid.

The Global Burden of Disease (GBD) project quantifies the impact of different health conditions by combining information about morbidity and premature mortality within a single metric, the Disability Adjusted Life Year. One important goal for the GBD project has been to inform decisions about global health priorities. A number of recent studies have used GBD data to argue that global health funding fails to align with the GBD. We argue that these studies’ shared assumption that global health resources should ‘align’ with the burden of disease is unfounded and has troubling implications. First, since the allocation of resources involves difficult trade-offs between different, potentially competing goals, any ‘misalignment’ of allocation and disease burdens need not necessarily indicate that the allocation of funds fails to meet recipient countries’ needs or interests. Second, using alignment as a baseline implicitly makes controversial assumptions about how harms of different magnitudes affecting different numbers of individuals should be aggregated. We discuss two alternative ways in which GBD data could help inform decisions about resource allocation, neither of which gives more than a limited role to GBD data.

The Foreseeable Harms of Trump's Global Gag Rule.

As one of his first acts as President of the United States, Donald Trump signed an executive order reinstating a version of the global gag rule. Under this rule, US grantees are barred from receiving global health funding if they engage in abortion-related work: not only abortion services, but also abortion referrals and counseling or advocacy for the liberalization of abortion laws. Critics of the Trump global gag rule generally raise three classes of objections: (1) that the rule fails to accomplish its presumed objective of reducing the number of abortions; (2) that it negatively affects the health and well-being of individuals and populations in affected countries; and (3) that it interferes with governments' ability to meet their international obligations. In this commentary, we examine the scientific and policy bases for these criticisms.

Global funding trends for malaria research in sub-Saharan Africa: a systematic analysis.

SummaryBackgroundTotal domestic and international funding for malaria is inadequate to achieve WHO global targets in burden reduction by 2030. We describe the trends of investments in malaria-related research in sub-Saharan Africa and compare investment with national disease burden to identify areas of funding strength and potentially neglected populations. We also considered funding for malaria control.MethodsResearch funding data related to malaria for 1997–2013 were sourced from existing datasets, from 13 major public and philanthropic global health funders, and from funding databases. Investments (reported in US$) were considered by geographical area and compared with data on parasite prevalence and populations at risk in sub-Saharan Africa. 45 sub-Saharan African countries were ranked by amount of research funding received.FindingsWe found 333 research awards totalling US$814·4 million. Public health research covered $308·1 million (37·8%) and clinical trials covered $275·2 million (33·8%). Tanzania ($107·8 million [13·2%]), Uganda ($97·9 million [12·0%]), and Kenya ($92·9 million [11·4%]) received the highest sum of research investment and the most research awards. Malawi, Tanzania, and Uganda remained highly ranked after adjusting for national gross domestic product. Countries with a reasonably high malaria burden that received little research investment or funding for malaria control included Central African Republic (ranked 40th) and Sierra Leone (ranked 35th). Congo (Brazzaville) and Guinea had reasonably high malaria mortality, yet Congo (Brazzaville) ranked 38th and Guinea ranked 25th, thus receiving little investment.InterpretationSome countries receive reasonably large investments in malaria-related research (Tanzania, Kenya, Uganda), whereas others receive little or no investments (Sierra Leone, Central African Republic). Research investments are typically highest in countries where funding for malaria control is also high. Investment strategies should consider more equitable research and operational investments across countries to include currently neglected and susceptible populations.FundingRoyal Society of Tropical Medicine and Hygiene and Bill & Melinda Gates Foundation.