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Health aid projects have both expanded and constrained the capacity of health facilities to deliver malaria services to under-five children in Malawi.
BMJ Global Health. 2018 Dec 1; 3(6):e001051.Objective: This article examines the potential pathways health aid may use to influence the availability of malaria services at a facility level and the utilisation of malaria services for children under five in Malawi. Methods: This work is grounded in a health services research theoretical model and combines a subnational census of health services available at Malawi health facilities with individual-level data on health service utilisation and the Government of Malawi’s official source of data about health aid allocation at a child-level (n=2171). Logistic and multinomial logistic models were used to assess the relationship between health aid, malaria service readiness and malaria service utilisation. Models were adjusted for predisposing, enabling and need factors and accounted for the complex relationship using a mediation approach. Results: The evidence presented suggests that health aid translates into increased diagnostic capacity, but not overall or training readiness. Results indicate that increasing aid projects in a region boost its facilities’ diagnostic readiness, increasing each facility’s relative likelihood of having a medium level of diagnostic readiness by 12% (relative risk (RR)=1.118; 95% CI 1.060 to 1.179) and its likelihood of having a high level of readiness by 23% (RR=1.230; 95% CI 1.161 to 1.303), but decreasing its readiness to provide training by 8% (RR=0.925; 95% CI 0.879 to 0.974). Conclusion: The results of this research highlight the fact that health aid is working to increase malaria diagnostic capacity at a facility level, but that increasing facility readiness to implement the diagnostic tests has been neglected.
Commitments to the Every Woman Every Child Global Strategy for Women's Children's and Adolescents' Health (2016-2030): Commitments in support of adolescent and young adult health and well-being, 2015-2017.
Geneva, Switzerland, The Partnership for Maternal, Newborn & Child Health, 2018. 11 p.Health and well-being of adolescents and young adults is one of the priorities of the EWEC Global Strategy which calls for accelerated action to more effectively meet their health needs. Adolescent health is central to the EWEC Global Strategy and to achieving the Sustainable Development Goals (SDGs). This deep dive compliments the 2018 report by the Partnership for Maternal, Newborn & Child Health on commitments to the EWEC Global Strategy by analyzing commitments made in support of adolescents and young adults aged 10-24 years.
Global Health, Science and Practice. 2018 Mar 21; 6(1):8-16.Add to my documents.
Lancet. 2017 Mar 18; 389(10074):1088-1089.Add to my documents.
[New York, New York], Guttmacher Institute, 2018 Apr. 2 p.The United States -- through its Agency for International Development (USAID) -- has long been a global leader in enabling women’s access to contraceptive services in the world’s poorest countries. Empowering women with control over their own fertility yields benefits for them, their children and their families. It means fewer unintended -- and often high-risk -- pregnancies and fewer abortions, which in poor countries are often performed under unsafe conditions. Better birth spacing also makes for healthier mothers, babies and families, and pays far-reaching dividends at the family, society and country levels.
Appropriateness and timeliness of care-seeking for complications of pregnancy and childbirth in rural Ethiopia: a case study of the Maternal and Newborn Health in Ethiopia Partnership.
Journal of Health, Population, and Nutrition. 2017 Dec 21; 36(Suppl 1):50.BACKGROUND: In 2014, USAID and University Research Co., LLC, initiated a new project under the broader Translating Research into Action portfolio of projects. This new project was entitled Systematic Documentation of Illness Recognition and Appropriate Care Seeking for Maternal and Newborn Complications. This project used a common protocol involving descriptive mixed-methods case studies of community projects in six low- and middle-income countries, including Ethiopia. In this paper, we present the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) case study. METHODS: Methods included secondary analysis of data from MaNHEP's 2010 baseline and 2012 end line surveys, health program inventory and facility mapping to contextualize care-seeking, and illness narratives to identify factors influencing illness recognition and care-seeking. Analyses used descriptive statistics, bivariate tests, multivariate logistic regression, and thematic content analysis. RESULTS: Maternal illness awareness increased between 2010 and 2012 for major obstetric complications. In 2012, 45% of women who experienced a major complication sought biomedical care. Factors associated with care-seeking were MaNHEP CMNH Family Meetings, health facility birth, birth with a skilled provider, or health extension worker. Between 2012 and 2014, the Ministry of Health introduced nationwide initiatives including performance review, ambulance service, increased posting of midwives, pregnant women's conferences, user-friendly services, and maternal death surveillance. By 2014, most facilities were able to provide emergency obstetric and newborn care. Yet in 2014, biomedical care-seeking for perceived maternal illness occurred more often compared with care-seeking for newborn illness-a difference notable in cases in which the mother or newborn died. Most families sought care within 1 day of illness recognition. Facilitating factors were health extension worker advice and ability to refer upward, and health facility proximity; impeding factors were time of day, weather, road conditions, distance, poor cell phone connectivity (to call for an ambulance), lack of transportation or money for transport, perceived spiritual or physical vulnerability of the mother and newborn and associated culturally determined postnatal restrictions on the mother or newborn's movement outside of the home, and preference for traditional care. Some families sought care despite disrespectful, poor quality care. CONCLUSIONS: Improvements in illness recognition and care-seeking observed during MaNHEP have been reinforced since that time and appear to be successful. There is still need for a concerted effort focusing on reducing identified barriers, improve quality of care and provider counseling, and contextualize messaging behavior change communications and provider counseling.
Current HIV / AIDS Reports. 2016 Oct; 13(5):256-62.This review traces the course of the US President's Emergency Plan for AIDS Relief (PEPFAR) as a foreign aid program. It illustrates how the epidemiologic and geopolitical environments of the early 2000s influenced PEPFAR's early directions and contributed to its successes. In addition to scaling up infrastructure and care delivery platforms, PEPFAR led to large increases in the number of people receiving antiretroviral therapy and reductions in mortality. These successes, in turn, have brought its principal challenges-its outsized budget, narrow focus, and problem of entitlement-into sharp relief. PEPFAR's recent evolution, then, has been in response to these challenges. This review suggests that PEPFAR's early formulation as an emergency response relieved it from a need to articulate clear goals, and that this freedom is now leading to new challenges as it struggles to identify priorities in the face of expectations to do more with a flat budget.
Annals of Internal Medicine. 2017 Nov 07; 167(9):618-629.Background: Resource-limited nations must consider their response to potential contractions in international support for HIV programs. Objective: To evaluate the clinical, epidemiologic, and budgetary consequences of alternative HIV program scale-back strategies in 2 recipient nations, the Republic of South Africa (RSA) and Cote d'Ivoire (CI). Design: Model-based comparison between current standard (CD4 count at presentation of 0.260 x 109 cells/L, universal antiretroviral therapy [ART] eligibility, and 5-year retention rate of 84%) and scale-back alternatives, including reduced HIV detection, no ART or delayed initiation (when CD4 count is <0.350 x 109 cells/L), reduced investment in retention, and no viral load monitoring or second-line ART. Data Sources: Published RSA- and CI-specific estimates of the HIV care continuum, ART efficacy, and HIV-related costs. Target Population: HIV-infected persons, including future incident cases. Time Horizon: 5 and 10 years. Perspective: Modified societal perspective, excluding time and productivity costs. Outcome Measures: HIV transmissions and deaths, years of life, and budgetary outlays (2015 U.S. dollars). Results of Base-Case Analysis: At 10 years, scale-back strategies increase projected HIV transmissions by 0.5% to 19.4% and deaths by 0.6% to 39.1%. Strategies can produce budgetary savings of up to 30% but no more. Compared with the current standard, nearly every scale-back strategy produces proportionally more HIV deaths (and transmissions, in RSA) than savings. When the least harmful and most efficient alternatives for achieving budget cuts of 10% to 20% are applied, every year of life lost will save roughly $900 in HIV-related outlays in RSA and $600 to $900 in CI. Results of Sensitivity Analysis: Scale-back programs, when combined, may result in clinical and budgetary synergies and offsets. Limitation: The magnitude and details of budget cuts are not yet known, nor is the degree to which other international partners might step in to restore budget shortfalls. Conclusion: Scaling back international aid to HIV programs will have severe adverse clinical consequences; for similar economic savings, certain programmatic scale-back choices result in less harm than others. Primary Funding Source: National Institutes of Health and Steve and Deborah Gorlin MGH Research Scholars Award.
Seattle, Washington, IHME, 2015. 136 p.Financing Global Health 2014 is the sixth edition of this annually produced report on global health financing. As in previous years, this report captures trends in development assistance for health (DAH) and government health expenditure (GHE). Health financing is one of IHME’s core research areas, and the aim of the series is to provide much-needed information to global health stakeholders. Updated GHE and DAH estimates allow decision-makers to pinpoint funding gaps and investment opportunities vital to improving population health. This year, IHME made a number of improvements to the data collection and methods implemented to produce Financing Global Health estimates. Both govern¬ment health expenditure and development assistance for health estimates were updated and enhanced in 2013. Development assistance for health: To develop DAH estimates, IHME collects data from organizations that provided funding for health projects in developing countries from 1990 through 2014. These data include annual reports, publicly available budgets, tax returns, and other information obtained through corre¬spondence. Conversations with global health partners allow IHME to validate these data. Data are then processed into a form usable for analysis. In cases where 2013 and 2014 data are not available, IHME uses statistical methods that rely on previous trends in spending and budget data to produce preliminary estimates. Government health expenditure: IHME uses data produced by the World Health Organization (WHO) to provide estimates of GHE as a source of funding. Using DAH estimates, IHME employs the WHO’s GHE data to approximate how much governments spend on health-related activities out of their own treasur¬ies as well as how these expenditures vary over time.
Seattle, Washington, IHME, 2016. 128 p.Financing Global Health 2015 depicts the development assistance for health (DAH) disbursed to maintain and improve health in low- and middle-income countries over the last 26 years. This report takes a deep dive into the sources, intermediary channels, recipients, health focus areas, and program areas that characterize these international funding flows. The 2015 report provides conclusive evidence of a plateau in DAH. With an ongoing migrant crisis in Europe, incomplete recovery from the financial crisis, and other global issues, aid budgets are increasingly constrained by tough trade-offs among important priorities. For this reason, the continued provision of more than $36 billion in DAH – more than 25% of all official development assistance (ODA) – is an encouraging sign that commitment to global health remains strong. A number of key contributions helped to maintain DAH in 2015. Of note, DAH from the World Bank climbed substantially, bolstering the DAH total with a major expansion in funding for health. Increases in DAH from other important funders, including the Bill & Melinda Gates Foundation, the United States, and the United Kingdom, were also vital to sustaining DAH levels. Contributions from many other development assistance partners dropped. The focus and magnitude of these changes are explored in depth throughout the report. Methodological improvements to this year’s report make it easier than ever to understand the global health activities supported by DAH. The report unveils detailed estimates of programmatic investments in HIV/AIDS. These new program area estimates complement updated breakdowns of DAH for non-communicable diseases (NCDs), maternal health, and child health. Better tracking of NGO funding flows also characterizes this year’s estimates. Funding for Ebola, broken down by sources, intermediaries, and recipients of DAH, sheds light on the international response to the epidemic that struck West Africa in 2014 and 2015. The report is divided into three main chapters. The first chapter, Overview of development assistance for health, examines DAH on the whole in 2015. This includes an assessment of the year-over-year and long-term trends in interna¬tional funding from the main organizations active in global health. A summary of DAH flows to health focus areas and recipient regions is also provided. The next chapter, Health focus areas, delves into each of the eight health focus areas: HIV/AIDS, malaria, tuberculosis (TB), maternal health, newborn and child health, NCDs, other infectious diseases (including Ebola), and health sector support and sector-wide approaches (HSS/SWAps). We also explore the program areas that underpin select health focus areas, furnishing a view of the interventions and other activities that make up global health. Finally, in the third chapter, Government health expenditure as a source, updated estimates of government health expenditure as a source (GHE-S) expose changes in domestic health funding in developing countries over more than two decades.
All women, all rights, sex workers included: U.S. foreign assistance and the sexual and reproductive health and rights of female sex workers.
Washington, D.C., Center for Health and Gender Equity [CHANGE], 2016. 54 p.Female sex workers (FSWs) experience significant unmet sexual and reproductive health and rights (SRHR) needs related to family planning, safe pregnancy, gender-based violence (GBV), and HIV. FSWs continue to be framed by the international community largely in terms of their HIV risk as though it represents the full depth and breadth of their health needs. While rights-based HIV prevention, treatment, and care for FSWs is essential, the international community must acknowledge that FSWs are women with a range of SRHR needs and the same right to comprehensive, non-discriminatory healthcare services as women in the general population.* In recent years, emerging research and collaborative guidelines on programs for sex workers such as the Sex Worker Implementation Tool (SWIT)1 have increased knowledge about evidence-based best practices to effectively address the HIV epidemic in FSWs, as well as promote their broader SRHR needs. The global movement for the decriminalization of sex work is also gaining momentum with growing recognition that promoting FSWs’ fundamental human rights is necessary to end the HIV epidemic, including the rights to associate and organize, the right to equal protection of the law, the right to be free from violence, the rights to privacy and freedom from arbitrary interference, the right to health, and the right to work and free choice of employment.2 The United States (U.S.) has also gradually intensified its global health programming and funding specific to FSWs. Some of its most recent projects suggest an encouraging shift toward recognition of the necessity of a human rights approach to FSWs and other key populations.† Despite these areas of progress, significant challenges remain. Insufficient attention and resources are directed at the structural drivers of FSWs’ HIV risk and poor SRHR outcomes, including criminalization, stigma, discrimination, and endemic violence. Moreover, the health and rights of FSWs are highly politicized, with resulting negative consequences for donor policies and programs. The first section of this report aims to provide an overview of best practices around the SRHR of FSWs, including those related to HIV/AIDS, family planning, sexual health, maternal health, and gender-based violence, as well as highlight some of the most urgent knowledge gaps that should be addressed moving forward. The second section of this report assesses how U.S. foreign assistance can better conform with best practices to support the SRHR of FSWs, including both specific policies and more general programmatic approaches. The report is based on a review of peer-reviewed articles, collaborative guidance and recommendations, and grey literature which examined the SRHR needs of FSWs. CHANGE also conducted semi-structured, not-for-attribution interviews with key informants, including U.S. officials, country-based implementers, researchers, sex workers, and sex worker advocates, service providers, and representatives from multilateral organizations. Based on our review and these interviews, we identify priority areas where U.S. foreign assistance should be better harmonized with best practices and fundamental human rights principles in order to more effectively promote the health and rights of FSWs. In a global context where sex work is almost universally criminalized and gross human rights abuses against sex workers are widespread, changes to U.S. foreign assistance are only one piece of what must be a larger collective response. However, the U.S. is well-positioned as both a funder of research and an international donor to promote a global health agenda that addresses FSWs’ broader SRHR needs and priorities, along with an inclusionary, rights-based, community-empowerment paradigm.
Washington, D.C., Center for Global Development, 2017 Jun. 27 p. (Center for Global Development Policy Paper 106)There is a global shortage of health workers. Demand for nurses outstrips supply as systemic underinvestment in training meets ballooning needs due to aging in rich countries and population growth in poor ones. A Global Skills Partnership combines training funded by donors with pre-agreed arrangements for qualified graduates to work temporarily overseas, usually in the donor country. This paper shows through one hypothetical example how a GSP for a specific sector (nursing) financed by a specific donor (the UK) delivering training in a specific country (Malawi) addresses critical nursing shortages in both countries. The Partnership would help the NHS meet urgent needs in the UK. It would increase the number of health workers to fill vacancies in Malawi, so it will not cause ‘brain drain.’ And it would dramatically raise nurses’ incomes and augment their skills, boosting both Malawi’s economy and the quality of its healthcare. A conservative benefit-cost calculation shows the scheme would provide very large financial benefits and represents extremely competitive value for money for UK Aid.
New institutional formation in the intersection of Tanzanian decentralization and HIV/AIDS interventions.
Journal of Eastern African Studies. 2017 Oct 2; 11(4):692-713.Assessments of sub-Saharan African decentralization processes often overlook change experienced and facilitated by technical institutions operating in recipient countries on behalf of major donor interventions. This change affects public service delivery at different government levels and the decentralization-oriented exchanges between those levels. This article examines these institutions as well as the change they experience and facilitate. It does so from the perspective of program implementing units (PIUs) contracted by donors to support technical public service delivery. The selected PIU cases are those contracted by the Tanzanian operations of the American President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR Tanzania played an instrumental role in the national health sector’s HIV/AIDS policy shift from a focus on prevention of and care for those with the virus to the adoption and implementation of a national treatment policy. Complicating treatment in Tanzania were expectations for homogenous national distribution of HIV/AIDS requiring extensive, consistent service support at every point of care. The government’s decentralization strategy introduced the PIUs as core HIV/AIDS service institutions. The PIUs’ resulting position in decentralization structures facilitated their own institutional change as well as change in relevant decentralization stakeholders’ exchanges that altered the government’s decentralization-by-devolution strategy.
Bethesda, Maryland, HFG, 2017 Sep. 6 p. (USAID Cooperative Agreement No. AID-OAA-A-12-00080)This policy brief presents family planning expenditure data from Burkina Faso, estimated using the System of Health Accounts (SHA 2011) methodology, together with a new guide on family planning. The brief describes how these data can help answer key policy and planning questions related to family planning, and presents some related recommendations.
Mental health and ending female genital mutilation and cutting: Recommendations for U.S. foreign policy and programs.
Washington, D.C., ICRW, 2017. 4 p.In 30 countries, mainly concentrated in Africa, the Middle East and Asia, at least 200 million girls and women have undergone female genital mutilation/cutting (FGM/C). The practice involves the cutting or removal of the external female genitalia or other injury to the female genital organs, and most girls are cut between the ages of 5-14. The root causes behind the practice of FGM/C are diverse and multi-dimensional, and include gender inequality, prevailing social norms and a desire to control female sexuality. It is a highly concentrated practice, with two-thirds of all women who have experienced FGM/C residing in just four countries: Egypt, Ethiopia, Nigeria and Sudan. Nonetheless, it is important to understand that FGM/C is associated with several cultural traditions but is not limited to any one region or religion. While the physiological health impacts from FGM/C have been widely documented, psychological health risks have been less well explored. As such, ICRW is exploring the mental health impacts of FGM/C and lessons we might take from the evidence for policy and programming. We know that many girls who have undergone FGM/C report that they do not know in advance that they are going to be cut, making this a highly traumatic experience. We also know that the trauma, pain and complications due to the experience can lead to both short- and long-term psychological harm, including post-traumatic stress, flashbacks, fear, anxiety and depression.v Some studies have also reported positive feelings, which we explore later in this brief as it relates to social norms. The limited evidence that exists suggests that the psychological impact of FGM/C is related to the type of FGM/C a girl experiences, complications that have arisen and the socio-cultural context of her belief system, marital relationship and support networks.vii This brief summarizes the evidence and recommendations for U.S. foreign policy.
Silence sexual and reproductive health discussions and we fuel the rise of HIV/AIDS in sub-Saharan Africa.
Reproductive Health. 2017 Oct 17; 14(1):131.In the mid 1990s, the HIV epidemic was initially impacting South Africa. Fear, stigma and denial surrounding sexual practices undermined treatment access and prevention initiatives. Significant strides have been made in reducing the HIV epidemic in South Africa and other areas in sub-Saharan Africa through effective programming and funding of prevention programs. Reinstatement of the Mexico City Policy threatens to negatively impact gains made in the HIV/AIDS community. Recognition that communication is essential to effective reproductive health and HIV/AIDS programming needs to be recognized by politicians enacting the Mexico City Policy and the possibility of viewing a rise in HIV/AIDS incidence in sub-Saharan Africa.
Studies In Family Planning. 2017 Dec; 48(4):309-322.With limited international resources for family planning, donors must decide how to allocate their funds to different countries. How can a donor for family planning decide whether countries are adequately prioritized for funding? This article proposes an ordinal ranking framework to identify under-prioritized countries by rank-ordering countries by their need for family planning and separately rank-ordering them by their development assistance for family planning. Countries for which the rank of the need for family planning is lower than the rank of its funding are deemed under-prioritized. We implement this diagnostic methodology to identify under-prioritized countries that have a higher need but lower development assistance for family planning. This approach indicates whether a country is receiving less compared to other countries with similar levels of need.
Delegated Service Authority: Institutional Evolution of PEPFAR Health-Based Program Implementing Units in Tanzania.
Global Policy. 2017; 8(3):303-312.The critical development literature examines donor interventions' institutions and institutional impact. Donor agencies examine specific intervention mechanisms to improve intervention effectiveness or conformity with given development trends. Both literatures insufficiently address the potential evolution of program implementing units (PIUs) deployed by donor agencies according to the units' respective technical capacities. This article assesses PIU evolution using specific units contracted under the United States Government's PEPFAR program in Tanzania. These units evolved in their respective operational space that exists in the interactions between three stakeholder categories: (1) the contracting agency of PEPFAR; (2) relevant Tanzanian national public institutions; and (3) local Tanzanian authorities responsible for HIV/AIDS or health service delivery. This article examines how stakeholders' delegation of authority to PIUs for technical management and/or implementation of HIV/AIDS prevention and treatment services drive the units' institutional evolution. This evolution is ongoing given iterative PIU-stakeholder interaction expanding units' services along with delegated authority. In the Tanzanian case, evolved PIUs became essential to the national health system with few institutions able to re-assume the units' services or delegated authority. They also fostered a new domestic technocracy with transnational network connections to the global public health epistemic community offering new policy platform voice and exit opportunities. © 2017 University of Durham and John Wiley & Sons, Ltd
Nature. 2017 Jun 05; 546(7657):185.Add to my documents.
[Washington, D.C.], Feed the Future, 2017. 28 p.Feed the Future has shown that progress in fighting global hunger is possible. By bringing partners together to invest in agriculture and nutrition, we have helped millions of families around the world lift themselves out of hunger and poverty. Feed the Future’s 2017 Progress Snapshot reports about our results through the years and relates the stories of lives changed.
Washington, D.C., Center for Global Development, 2014 Nov. 59 p. (CGD Policy Paper 049)This paper focuses on aid effectiveness. The paper considers peer-reviewed, cross-country, econometric studies, published over the last decade in order to propose areas with policy implications related to the conditions under which aid is more likely to be effective. The paper is intended for a nontechnical audience. We discuss the nature of evidence on aid and why assessing its impact is so difficult. We attempt to make some global-level generalisations, with caveats, on when aid is most likely to work, as opposed to just whether aid works or not. We review aid’s impacts on economic growth and social development in general before focusing on conditions identified in the aid and growth literature under which aid is more likely to be effective. We suggest that there are four broad areas where the evidence reviewed shows signs of convergence that have direct relevance for policy decisions on aid effectiveness. These areas are: (i) aid levels; (ii) domestic political institutions; (iii) aid composition, and (iv) aid volatility and fragmentation.
Washington, D.C., Center for Global Development, 2015 Jan. 29 p. (CGD Policy Paper 050)This paper articulates how development assistance can promote program evaluation generally, and impact evaluation specifically, as a contribution to good governance. We argue that aid agencies are particularly well suited to fund impact evaluations, and can accelerate progress in the developing world by increasing the resources available for evaluation, particularly through a collective vehicle like the International Initiative for Impact Evaluation (3ie). Finally, we highlight the conditions that need to be in place -- and require additional efforts -- to yield the full benefits of collective investment in finding out what works.
Does results-based aid change anything? Pecuniary interests, attention, accountability and discretion in four case studies.
Washington, D.C., Center for Global Development, 2015 Feb. 61 p. (CGD Policy Paper 052)This paper studies foreign assistance programs called Results-Based Aid (RBA) in which one government disburses funds to another for achieving an outcome. At least four theories are typically advanced to explain how RBA increases program effectiveness: by appealing to governments’ pecuniary interests to shift domestic priorities, by drawing the attention of politicians and managers to results, by establishing accountability to constituents; and by giving recipients discretion to engage in local problem-solving. Using four case studies -from GAVI, the Amazon Fund, Ethiopian Secondary Education and Salud Mesoamérica -the paper analyzes program features to show which of these theories are being applied and what we can learn about the effectiveness of the RBA approach. The four case studies show that concerns with corruption, unintended consequences, short-termism, and additional costs have not materialized. The analysis demonstrates that relatively few RBA programs are being piloted and that most do not rely on the assumption that a financial incentive will lead aid recipients to shift their priorities. RBA programs are also not typically designed to work through accountability and recipient discretion. Rather, most RBA programs seem designed to draw attention to results, making them more salient to politicians and managers. As relatively cautious adaptations of conventional approaches, these initiatives are unable to test the potential benefits from greater recipient discretion and public transparency. Future experimentation may test these other theories but for now, RBA remains a work in progress.
Washington, D.C., Center for Global Development, 2015 Feb. 51 p. (Center for Global Development Working Paper 394)Since 2001, an aid consortium known as Gavi has accounted for over half of vaccination expenditure in the 75 eligible countries with an initial per capita GNI below $1,000. Regression discontinuity (RD) estimates show aid significantly displaced other immunization efforts and failed to increase vaccination rates for diseases covered by cheap, existing vaccines. For some newer and more expensive vaccines, i.e., Hib and rotavirus, we found large effects on vaccination and limited fungibility, though statistical significance is not robust. These RD estimates apply to middle-income countries near Gavi's eligibility threshold, and cannot rule out differential effects for the poorest countries.
[Washington, D.C.], Center for Global Development, 2015 Feb 9. 6 p. (Center for Global Development Briefs)Gavi, the Vaccine Alliance, pools donor funds to increase immunization rates in developing countries. Vaccines have saved millions of lives.  Results from new research at the Center for Global Development suggest Gavi could save more lives by shifting support away from lowercost vaccines provided to middleincome countries toward more underused vaccines and support to the poorest countries..