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Publications

 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.

 

Dennis de Tray, R4D Principle, in a new working paper addresses both capacity building as the bedrock of international development assistance and areas where it can be improved. He argues that the international community’s record on this front is not what it should be and offers strategic insight into how they can do better. He also argues that this problem is most serious in poor, weak and capacity constrained countries.

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.

This report is the result of a collective work carried out by the Writing Committee commissioned
by the Task Force on Innovative Financing for Education created by the Leading Group on
Innovative Financing for Development in March 2010.

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.




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.

In this paper, R4D Managing Director Nicholas Burnett and Oxford University Visiting Research Fellow Desmond Bermingham draw upon their extensive knowledge of education and on R4D’s work on innovative finance in other areas to examine how innovative financing can be applied to mobilize funds for education.

From the Ground Up argues that the international community’s efforts to improve public expenditure and budget execution decisions would be more effective if done in collaboration with local independent monitoring organizations.

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.

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.

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.

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

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

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 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 book, published as part of the Transparency and Accountability Program, a research project of the Brookings Institution and Results for Development, highlights the need for an analytical framework to utilize in reforms for improving governance.

Presentations

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.

Journal Articles

"The Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries," is one of the first efforts to look systematically at the expected economic benefits (returns) to large scale investment in AIDS treatment.

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

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"

This article by Managing Director Nicholas Burnett appears in the March 2010 Issue of Global magazine. It discusses the impact of the global economic crisis on achieving inclusive education and addresses areas of opportunity to ensure the realization of "Education for All."

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.

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

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.

Working Papers

In this R4D working paper entitled, "Education Resource Mobilization and Use in Developing Countries: Scope for Efficiency Gains through more Strategic Use of Education Aid," R4D expert Birger Fredriksen discusses options for enhancing the allocative efficiency of education aid by using it more strategically to increase its impact on national and global education outcomes.

This article was written for the International Working Group on Education and discusses the importance of innovative financing for education, particularly in low-income countries.

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 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.

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.

The paper develops an analytical framework applied to India, Uganda, and Afghanistan for conceptualizing the governance/stewardship function within health systems and the role of government in the context of an expanded role for private service provision and financing.

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 paper aims to identify themes emerging from practice within, and recent efforts to improve, public financial management (PFM) systems in Africa. Given the themes identified, it also seeks to suggest a perspective on the role non-governmental civil society organizations (CSO) could play in strengthening PFM in the future.

This working paper is based on a review of a sample of Country Procurement Assessment Reports undertaken in twenty-three Sub-Saharan countries. The paper analyzes the procurement systems and seeks to find ways to improve the quality of public expenditures.

Starting with the evidence of weak links between public spending and human development outcomes, this discussion paper takes an extensive look at the theoretical and empirical literature relating public resources allocation and measures of governance, transparency, and accountability.

Independent Monitoring Organizations (IMOs)- policy research and advocacy organizations that pursue transparency and accountability issues- can be key players in improving the collection and expenditure of government revenues. This paper analyzes areas where many IMOs' work could be improved and explores programs that aim to improve IMOs.

Recently there has been a surge of activity among Civil Society Organizations in India.  This paper analyzes this development, including impact, shortcomings and challenges Indian organizations face in the years to come.

This paper reviews recent measures to improve fiscal transparency in Nigeria, highlights the role played by civil society organizations (CSOs), and identifies strategies which CSOs and government officials in various African countries may adopt in order to promote more constructive and transparent dialogue on fiscal management issues.

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.

The objective of this paper is to review about 20 Public Expenditure Tracking Surveys (PETS) and related literature produced since the mid-1990s to identify common problems and lessons learned to improve the quality of public spending in the social sectors via civil society oversight and involvement.

This paper reviews roughly 60 Public Expenditure Reviews (PERs) conducted by the World Bank in virtually all regions of the world, and defines common problems and proposed solutions to improve the impact, quality, and equity of public spending.

This book seeks out, areas in which governments could focus to improve the quality public expenditures. It seeks to identify cross-cutting strengths and weaknesses of public financial management and procurement systems and the characteristics of, and lessons learned from reform 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.

Tools

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.

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.

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