The Effectiveness of Global Health Partnerships

1. The Effectiveness of Global Health Partnerships Findings and Lessons from a World Bank Evaluationof Global Health Programs Uma Lele April 14, 2005

2. Health Challenges Are in Need of Comprehensive Solutions • Declining health indicators in Africa and South Asia • MDG targets are a stretch • Malaria, TB, and HIV/AIDS on the rise • Crisis in Africa • High aid dependence • Unpredictable and uncoordinated aid flows • Persistent domestic budgetary shortfalls • Lack of human and institutional capacity • Conflict, poor governance, and corruption compound challenges

3. Advocacy Leads to Increasing Partnerships and Health Expenditure • Communicable disease control a global public good par excellence • Partnerships a way to scale up treatment rapidly • Dissatisfaction with performance of traditional international organizations • Collective action the only way to address the health crisis • Hence aid to health grows faster than overall aid • Growing role of private philanthropy • Substantial institutional innovation in health – the GFATM, public private partnerships But can increased expenditures and institutional innovation alone meet the growing challenge?

4. Age of Health Programs Evaluated Size of Health Programs Evaluated Scope of Health Program Review Programs, well-funded on a long-term, consistent and predictable basis would be more effective than the current myriad, small, under-funded programs

5. Bank Commitments to Communicable Diseases Have Expanded

6. GFATM Commits the Most Funds to the Most Countries for HIV/AIDS, TB and Malaria

7. ...But Implementation Has High Transaction Costs • Differing approval, oversight, and disbursement procedures among donor agencies • Duplication of institutional arrangements between donor agencies and governments • High and unmet demand for technical assistance: WHO, UNAIDS, and others cannot meet them with their limited resources

8. Total Lending: 2,500 Investment and Adjustment 2,000 1,500 US$ Millions 1,000 Investment Lending Only 500 0 1990 1992 1994 1996 1998 2000 2002 2004 Health Sector Development Needs to Complement Disease Control

9. Research Has Limited Funding and No Global Strategy • TDR: large impact and growing mandate • But research funding is stagnating • Global Forum for Health Research: Donor response too small • Global public-private health partnerships: $200 million annually on drug and vaccine research • At least $1 billion a year needed for drug development • Applied and adaptive research, and surveillance too are under-funded

10. Prospects for Private Funding of Drug and Vaccine Development Are Limited • High costs of research • Lack of viable markets in developing countries • Long gestation lags: 10 to 15 years for vaccine and drug development • High risks, element of serendipity Is the proposed International Financing Facility a possibility for long-term funding?

11. Stop TB’s DOTS Strategy: A Lesson in Donor Coordination • The successful implementation of DOTS in China and India – a model for coordination • Technically sound program • Integrated across partners • Applied and operations research • Global Drug Facility: providing timely access to drugs • Country-level investment finance • Quality technical assistance, training, and monitoring and evaluation results • Scope to develop shared frameworks for HIV/AIDS and malaria

12. GAVI’s Child Immunization Needs Sustained External Assistance • Vaccine Fund has committed $1 billion to 71 developing countries • Immunized 30 million children • Prevented more than 670,000 deaths from common childhood diseases • Promotes performance-based management • Promotes markets for new vaccines • But sustaining it will require continued external financing

13. Lessons • Promote high-priority programs • Provide consistent, long-term funding • Increase public investment in health research • Increase coherence of disease-specific programs • Increase support to develop health system capacity • Strengthen linkages between global health programs and country assistance strategies