R4D Health

Global Health

R4D leverages extensive networks and expertise to improve health and achieve equity in health outcomes for all people around the world. Whether it's assessing policies that can support research and development on new drugs and vaccines, exploring innovations in healthcare and connecting innovators to each other or to investors, supporting the growing global movement for universal health coverage, or producing on-demand research and forecasting to help countries and global institutions plan their healthcare futures, R4D’s global health work unlocks new possibilities for global health actors worldwide.

Featured Global Health Resources

The Center for Health Market Innovations (CHMI) launched The Primary Care Innovator’s Handbook: Voices from Leaders in the Field. The Handbook is an attempt to share knowledge between innovators in an open and informal way, and to encourage more conversations of this style among the community of innovators working to improve primary care.

Highlights: Findings From 2014 identifies healthcare programs, policies, and practices, documents and analyzes promising practices, and spotlights programs with potential for scale up and adaptation within and across borders. Read about more than 70 programs working to make quality healthcare delivered by innovators affordable and accessible to the world's poor.

Global Health Resources

In a collection of articles that cover a broad range of media outlets, Vinod Thomas, Gina Lagomarsino, Andrew Steer and Ngozi Okonjo-Iweala, discuss central issues at the heart of economic growth.

A report published jointly by R4D, Gavi and the WHO in the journal Health Policy and Planning, presents findings from a pilot experience in 2012 helping a number of countries graduate from Gavi assistance. The pilot showed that graduating countries are highly heterogeneous in their capacity to assume responsibility for their immunization programmes. Although all possess certain strengths, each country displayed weaknesses in some of the following areas: budgeting for vaccine purchase, national procurement practices, performance of national regulatory agencies, and technical capacity for vaccine planning and advocacy. The 2012 pilot experience further demonstrated the value of transition planning processes and tools. 

A comprehensive new set of health metrics is now widely available for use by healthcare delivery organizations and their funders and investors. The product of a working partnership between the Center for Health Market Innovations (CHMI), and the IRIS initiative of the Global Impact Investing Network (GIIN), the metrics provide both investors and investees with standardized definitions for common measures of performance.

Authored by a team from the Results for Development Institute (R4D), the study titled, “Funding AIDS Programs in the Era of Shared Responsibility” breaks new ground in thinking about how much these heavily impacted countries, from Nigeria to South Africa, can pay for AIDS, and what this means for the Global Fund, PEPFAR, and other outside funding agencies. It also comes at a time when the debate on country “graduation” from donor support for AIDS and health is heating up.

ICSF and the Toronto Health Organization Performance Evaluation (T-HOPE) team at the University of Toronto published a groundbreaking report on ways to scale up primary care in low and middle-income countries. R4D's Center for Health Market Innovations acted as an expert advisor on the report which explores a range of innovative programs and uncovers successful strategies to scale up affordable, quality primary care models in the developing world.

In this report, R4D with generous support from the William and Flora Hewlett Foundation, outlines three options to support stronger monitoring and accountability (M&A), particularly social accountability, around Family Planning 2020 and family planning more broadly.

Much evidence has been generated over the past decade about the essential interventions that must be delivered along the continuum of care to save the lives of mothers and children. To inform policy options, this report summarizes available evidence on delivery platforms that are rapidly scalable which have been shown to be effective in increasing coverage of services and can save lives.

Significant headway towards achievement of the Millennium Development Goals (MDGs) and Education for All (EFA) goals has been made since their inception in 2000. However, progress has been uneven across sectors and regions, and serious questions have arisen.

In this paper, we describe these trends as a “health financing transition” to provide a conceptual framework for understanding shorter term analyses of health markets and public policy. We review the literature to show that health spending growth is a consequence of rising income and expanding medical technologies, while declining shares of out-of-pocket spending are a consequence of political movements and social change.

This research reviews reforms in four developing countries over the past 15 years: Colombia, Ghana, Vietnam, and the Philippines. The research examines the changes that took place in the four countries in absolute and relative spending levels for public, private, and total health spending, along with changes in health insurance coverage.

The purpose of this paper is to examine variations in the efficiency with which pooled funds are used to secure coverage, in the form of access to needed health services. 

The main goal of this study is to contribute to the UHC debate by providing robust empirical evidence on the causal link from national levels of health system coverage to population outcomes.

This paper examines the histories of attaining universal health coverage in four countries – Sweden, Japan, Chile and Malaysia. It shows that domestic pressures for universalizing access to health care are extremely varied, widespread, and persistent.

This paper analyzes how total health spending and its components (public vs. private, out of pocket vs. prepaid or insured) depend on income (level, composition and distribution), demographic factors, government revenues and other causes.

Results for Development Institute published a study in the May 1 issue of the Bulletin of the World Health Organization demonstrating that information technology is being increasingly employed to solve some of the world's biggest health systems challenges. 

The Center for Global Health R&D Policy Assessment released its latest assessment, “Patent Pools: Assessing Their Value-Added for Global Health Innovation and Access,” which explores the role of joint intellectual property management in global health innovation and access to medicines.  

This report uses the tax credit proposal HR 3156 in order to assess the value of a neglected disease R&D tax credit more broadly. After describing the design and estimated costs of the credit, its strengths and weaknesses are examined, drawing lessons from ongoing R&D tax credits.

The Center’s assessment of pooled funding for global health R&D, which was led by technical consultants Cheri Grace and Mark Pearson, addresses these two critical questions of more and “better” money: Can a pooled fund help improve funding flows to global health R&D projects? Could it bring new funders to the table?

This landscaping report points out how open source models in health depart from their IT predecessors and lays out practical steps for moving the global health community toward a knowledge commons for neglected disease R&D.

A country’s capacity to effectively implement policies and programs has long been recognized as crucial for its progress. This paper discusses shared program design elements for capacity building across R4D's portfolio that have shown promise so far and have been well received by the beneficiary countries and groups.

Lack of assistance has already led some Lower Middle Income Countries (LMICs) to fall behind in requiring children to be vaccinated from vaccine-preventable diseases. This study analyzes the challenges LMICs face as they consider the adoption of new vaccines and identifies practical interventions to address issues uncovered.


The Center for Global Health R&D Policy Assessment’s report “Prizes for Global Health Technologies” addresses how prizes may be used to spur medical innovation for neglected diseases and  drive investment in the development of drugs, vaccines, and diagnostics needed in poor countries.

In the aftermath of the Great Recession, donor countries continue to face years of protracted growth and budgetary constraints. Affinity MacroFinance and Results for Development have researched an alternative source of financing for development—emerging market pension funds.

How can Cambodia best fight its HIV/AIDS epidemic? This report examines the long-term costs and epidemiological projections of HIV/AIDS in Cambodia.

South Africa is facing a mounting financial challenge in its fight against the growing HIV/AIDS epidemic. With 5.7 million people currently infected with the HIV virus and an additional half million adults and children becoming newly infected each year, South Africa stands at a critical crossroads.

This paper, developed in partnership with the United Nations Foundation mHealth Alliance, provides an outline of key economic and financial questions to pursue in informing in-country eHealth policy and strategy investments.

In a review in The Lancet, authors from the financing group of the aids2031 project address critical questions about HIV/AIDS, taking a long-term view of financial requirements under different possible scenarios as the pandemic unfolds over the next two decades up to 2031

This report, produced in partnership with the Engelberg Center for Health Care Reform at the Brookings Institution, explores lessons learned for the stewardship of mixed health system based on health care experiences in the United States.  

Earlier this year, a group of South Africa's forfront HIV experts met to share ideas on how to best reduce the epidemic. This Global Health Magazine article, coauthored by Managing Director Robert Hecht, discusses the main points of that meeting.

This book recommends a series of actions that can move the world toward a better future in dealing with AIDS, while using financial resources in a more efficient and affordable manner.

Results for Development Managing Director Robert Hecht responds to the New York Times front page article, "At Front Lines, Global War On AIDS Is Falling Apart"

In this report Hecht, Palriwala and Rao discuss the history of U.S. involvement in innovative financing for global health and potential opportunities and barriers for increased participation and leadership in this field.

The secretariat of the Health Financing Task Force at the Results for Development Institute prepared this paper for the 25th meeting of the UNAIDS Programme Coordinating Board to evaluate the impact of the global financial crisis on HIV/AIDS programs in developing countries.

This paper examines potential long-term costs and financing options for the global AIDS response under four different scenarios and provides policy recommendations based on projected epidemiological and financial impacts.

Given finite donor funding and the likelihood of future scarcity, the GAVI Alliance requested an analysis of possible parameters to allow for effective and fair allocation and prioritization of resources. In a paper presented to the Board in November 2009, a set of principles to help guide this tough decision-making process was proposed.

As part of the Board's request to study and revise its existing eligibility criteria, certain countries currently receiving GAVI aid are expected to become ineligible. For this reason, proper and fair graduation procedures need to be established to ensure a smooth and sustainable transition to self-financing.

The GAVI Alliance Board requested its country eligibility policy be reviewed and revised during 2009. The results of the study can be found in this paper.

The Global Alliance for Vaccines and Immunization (GAVI) spent 2009 reviewing its policy to determine whether or not a country is eligible to receive aid. Here is the presentation made to the GAVI Board in November 2009 of findings from the eight-month study. It includes information on proposed indicators and their thresholds, as well as recommended procedures for assisting countries that graduate from GAVI support.

This article is based on the synthesis report Public Stewardship of Private Providers in Mixed Health Systems

The Woodrow Wilson International Center for Scholars’ Global Health Initiative (GHI) worked with consultants in Ghana, Senegal, and Uganda to assess technical skills within these countries’ ministries of finance and ministries of health, as well as the communication between the ministries in order to improve implementation of systems and increase budget allocations for the health sector.   

This paper incorporates results from several of the aids2031 working groups to examine the costs and financial implications of changing the current approach to fighting HIV/AIDS.  It examines four different scenarios: Current Trends, Rapid Scale-up, Hard Choices for Prevention and Structural Change.

This paper assesses the costs of antiretroviral drug (ARV) procurement and identifies policies that could help to lower costs, improve efficiency, and thereby ensure sustainable long-term access to ARVs by low and middle income countries.

This paper presents recent findings regarding costs and cost-effectiveness of AIDS prevention, treatment and care interventions, which can be used to inform a long-term strategic response to the epidemic.

This is an excerpt from the synthesis report on "Public Stewardship of Private Providers in Mixed Health Systems".

This report estimates Liberia’s resource requirements for scaling up the country’s workforce plans.

This report estimates the Philippine resource requirements for scaling up the country’s workforce plans.

This report estimates Uganda’s resource requirements for scaling up the country’s workforce plans.

This report estimates Mozambique’s resource requirements for scaling up the country’s workforce plans.

This report estimates Ethiopia’s resource requirements for scaling up the country’s workforce plans.

This report estimates Ghana’s resource requirements for scaling up the country’s workforce plans.

A case study focusing on the implementation of the World Bank's Strategy and Action Plan Self-Assessment Tool (SAT) in Honduras.

This background paper examines costing practices, cost-effectiveness data and prioritization processes in national HIV/AIDS strategic plans.

This paper discusses the possible role of the philanthropic sector in funding the fight against HIV/AIDS over the next 10 to 20 years.

How could HIV and AIDS resources be allocated to achieve the greatest possible impact? This paper begins with a theoretical discussion of this issue, describing the key elements of an “evidence-based allocation strategy.”

Donor assistance for AIDS is a primary source of funding in developing countries. The economic crisis and subsequent reduction in donor funding has shown the inherent vulnerabilities of relying on these funds. This paper examines future of donor assistance and policy options that can be put in place now to reduce these vulnerabilities.

In this paper we explore the importance of how funding for AIDS has helped to strengthen health systems in the past and the role it can play in the next 25 years in improving the delivery of interventions while simultaneously helping to improve overall system performance.

Discussion of estimates of future resource availability for AIDS, and necessary political space needed to use resources effectively. Results indicate that Sub-Saharan Africa and South Asia will continue to be dependent on external funds, while some middle income countries may be able to self-finance their programs in the near future.

Cost effective approaches to AIDS interventions in countries with low and concentrated epidemics. By focusing on interventions aimed at the Most at Risk groups: sex workers, MSM and IDUs, countries can reduce both cost and incidence of HIV infection.

The RRT helps countries estimate and project the cost of planned HRH employment and pre-service training as well as the affordability of these plans.

This paper outlines the functionalities and uses of the Resource Requirements Tool (RRT).

This document explains seven financing and economic issues that matter for health workforce scale-up and financing. It then states twenty-nine actions that policy-makers could take right away to address the issues, independent of any long-term HRH interventions in progress.

This paper synthesizes the human resources for health (HRH) health financing work conducted to date and sets out the topics requiring additional academic and field research. The analysis for the paper was conducted by the Secretariat  of the Financing Task Force  of the Global Health Workforce Alliance (GHWA). 

The report characterizes supply chains, analyzes the potential to invest in private sector initiatives, and makes recommendations for key stakeholders.

The report identifies and characterizes a number of contracting models that exist in the Zambian health sector.

The paper reviews various purchasing models and the advantages each offers for purchasing from the private sector.

The paper describes performance-based incentive contracting schemes implemented in developing countries.

This paper examines the literature on governments’ capacity to regulate health providers and identifies key constraints to governments' ability to implement regulatory policy, including corruption, administrative constraints, and informational constraints

The State of Andhra Pradesh in India has recently taken several innovative approaches to improve access to healthcare. This report presents the major initiatives, including health insurance and contracting arrangements for health services, and describes underlying motives, challenges, and opportunities associated with the reform.

The report discusses the challenges of introducing and scaling smaller, voluntary riskpooling programs in an attempt to constructively consider how to overcome these challenges.

The report reviewed the literature on a number of innovative service delivery models, isolating business processes that could be applied more broadly, including marketing strategies, financing strategies, and operating strategies.

This paper develops a framework for designing and implementing healthcare delivery innovations aimed at making markets work better for poor people.

The paper seeks to explain the very large differences in per capita spending on healthcare across countries and determines that almost all (more than 90%) of these differences can be explained by variation in per capita income (gross national product).

Employing qualitative and quantitative research methodologies, the report assesses the attitudes of global and national stakeholders toward the private health sector in developing countries.

The paper analyzes Demographic and Health Survey (DHS) from low and middle income countries data and reveals a wide variation in the role of informal private, formal private, and public sector actors.

This report describes 33 innovative pro-poor healthcare financing and delivery programs in South Asia and Sub-Saharan Africa that are led by or engage the private heath sector.

This report outlines the large and complex private markets for healthcare and emphasizes the importance of effective stewardship by governments of their country’s health system, especially given the reality that the private (non-state) part of the system is large and complex, with major challenges and significant opportunities.

This paper looks at the challenges China faces in implementing reforms to improve how health care is paid for and ways in which these challenges can be met.

This short article describes how well-implemented public or private health insurance programs create a platform for pooled strategic purchasing that can drive improvements in quality of care and increase availability of health services for poor people.

This proposes a results‐based contracting approach that builds on current and previous successes in leveraging private sector organizations that could potentially improve the outcomes of future malaria prevention programs.

Funded by the Bill & Melinda Gates Foundation as part of the Brookings Institution's two year Global Health Financing Initiative, this working paper examines the options for financing global health and proposes a framework to help guide aid decisions.

The questionnaire is designed to help MLI staff and the designated Ministry of Health leadership team identify specific focal areas for development as part of a specialized technical assistance and leadership support package.

This fictional case study was created by Results for Development on the topic of community-based health insurance as a way to explore approaches to problem-solving and decision-making within Ministries of Health.

In 2008, Bitran y Asociados developed a case study for the Ministerial Leadership Initiative about the politics of the AUGE health reform in Chile. The case outlines the efforts undertaken by policymakers to secure political approval of an ambitious reform seeking to grant explicit health guarantees to the country’s entire population.