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

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

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

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

Bank Commitments to Communicable Diseases Have Expanded

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

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

Health Sector Development Needs to Complement Disease Control ,000 1,500 2,000 2, US$ Millions Total Lending: Investment and Adjustment Investment Lending Only

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

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

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

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

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