Author Archives: CGDev

Realizing the Vision of Swasth Bharat through Fiscal Federalism in India

This is a joint post with Anit Mukherjee. Related Research Intergovernmental Fiscal Transfers for Health: Overview Framework and Lessons Learned Working Group on Fiscal Transfers for Health In his early days as India’s new prime minister, Narendra Modi has shown remarkable leadership in all sectors, including health, for which he’s articulated his vision to create a Swasth Bharat, a Healthy India.

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All Technology Leapfrogging Is Not the Same (Why Phones ≠ Energy)

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In the debates over how best to bring electricity to the billion-plus poor people who live every day without it, a common refrain is that we can replicate the telecommunications leapfrog with energy too. It’s an attractive notion. Instead of building telephone landlines, billions of poor people jumped right to mobile phones. Why not just do the same with electricity and, instead of building a grid and big dirty power plants, just go right to off-grid solar? Yet “the supposed analogy between cell phones and distributed solar is misplaced” argues UC Berkeley’s Catherine Wolfram because of (1) cost, (2) benefits of centralized networks, (3) actual development goals, and (4) quality.

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After Ebola: Five Lessons for Outbreak Response

The Obama Administration has requested $6.18 billion in emergency funding to fight and contain Ebola. The ask is now in the hands of Congress, but given that Ebola incidence seems to be on the decline in many (not all) districts in West Africa, some leaders are losing steam on the response. But sustained support to fight the current Ebola outbreak is still essential

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Most Money for Health Is Subnational, But What Will Donors Do About It?

In the big federal countries where global disease burden is concentrated, most public money for health isn’t ultimately spent by the national ministry of health, the traditional counterpart for global health funders and technical agencies. Instead, most money is programmed and spent subnationally (see figure 1).

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Shaping the Market for Global Health Data

This is a joint post with Prashant Yadav, University of Michigan The most valuable currency in global health programs today is accurate and reliable data, but such data—abundant in rich countries—does not exist for most low-income and lower-middle-income countries. And without data on past consumption and unmet needs, program planners and global financiers cannot budget appropriately, pharmaceutical and vaccine companies cannot plan investments, and it is harder to understand how programs are performing and how patients’ needs are changing over time. In OECD countries like the United States, Japan, and those of the European Union, organizations such as IMS Health collect data from a wide array of data sources throughout the health-care delivery chain

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Selecting WHO’s Next Africa Regional Director: An Interview with Candidate Dr. Jean Marie…

In November the World Health Organization will select its next regional director for Africa. As we wrote in a previous blog, this position is not posted publicly and is without an independent mechanism in place to recommend, interview, and evaluate the best qualified candidates.

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Selecting WHO’s Next Africa Regional Director: An Interview with Candidate Dr. Matshidiso…

In November, the World Health Organization will select its next regional director for Africa. As we wrote in a previous blog, this position is not posted publicly and has no independent mechanism in place to recommend, interview, and evaluate the best qualified candidates. We invited each candidate to use the Center’s platform to discuss his or her vision for the future of the WHO Regional Office for Africa (WHO AFRO), how he or she sees current challenges, and why he or she is best suited for the position.

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Letter from Liberia: Ebola Is Not a Failure of Aid or Governance

Like others, we’ve written lots about Ebola over the past weeks: the insufficient funding and effort to the response in West Africa, the importance of well-qualified leadership at WHO, the role of health systems in disease response, the futility of travel bans, among others.  It’s rare that global health issues are so continuously in the public debate. Yet Ebola has also led to heroic overstatement as well

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How Much Is Actually Being Spent on Ebola?

How much is actually being spent on Ebola by donor governments, organizations, and private individuals? The short answer is that we don’t really know.

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What Can Donors Learn from HIV in Responding to Ebola?

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This is a joint post with Alan Whiteside, CIGI Chair in Global Health Policy, BSIA and Professor Emeritus, University of KwaZulu-Natal. Since the first case of Ebola appeared last year, the virus has infected nearly 10,000 people.  The epidemic is concentrated in Liberia, Sierra Leone, and Guinea — post-conflict countries with incredibly weak health systems. It stands to have severe health, social, and economic consequences and is arguably the most pressing challenge to global health security the world has faced in decades

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Six Reasons an Ebola Travel Ban Makes Us No Safer — and No Sense

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Momentum seems to be building on Capitol Hill for some kind of West African travel ban as an anti-Ebola measure. It sounds like a simple solution. But here’s why a travel ban is pointless—or could even make us less safe.   Zero direct flights. There are no direct flights between the US and the three affected countries.

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Who Pollutes Most? Surprises in a New US Database – Kevin Ummel

Pollution has no respect for party lines. In the US, Republican and Democratic districts may differ in many ways but when comes to the carbon emissions heating our planet the differences are much smaller than you might expect. This is one of the most surprising and important findings in a remarkable new working paper from CGD visiting senior associate Kevin Ummel. I’m so excited about this paper I took a short break from my new job at the World Resources Institute to discuss with Kevin the far-reaching implications of his work for the design and politics of US carbon pollution fees.  

Kevin’s paper, Who Pollutes? A Household-Level Database of America’s Greenhouse Gas Footprint, is a slender 23 pages that sits on the brawny shoulders of a fresh approach to available data and an muscular number crunching exercise to estimate the greenhouse gas emissions of households all across America.

Kevin tells me that he set out to study the consumption habits of American households based on the recognition that “every kilogram of human-caused emissions can be traced to a consumptive choice on the part of an individual, a household, or in some cases, a government.”

Kevin used data from two massive surveys (the Consumer Expenditure Survey and the American Community Survey) to determine what American households buy with their money. He then combined this survey data with data from the environmental sciences to “translate how people spend their money into an estimate of how much [carbon] pollution they are producing.”

One surprise: the high degree of what Kevin calls “pollution inequality”—the top 10 percent of US polluters are responsible for 25 percent of the country’s carbon footprint, while the least-polluting 40 percent of Americans account for just 20 percent.

Who pollutes most? Low-density, affluent suburbs, where the lifestyle includes big homes, big cars, long commutes and plenty of international air travel. Many of these people also recycle and opt for local produce to reduce their carbon footprint! (Sound like anybody you know?)

High-density cities have the lowest household carbon footprint—especially the poorer neighborhoods that tend to vote for Democrats. More surprisingly, less affluent rural communities that tend to vote Republican also have small carbon footprints.

The new data show that these geographical distinctions are much starker than the differences between the carbon footprints of Republican and Democratic districts, which tend to be “very, very small,” Kevin says. 

All this is very good news for the growing number of policy experts and ordinary Americans who see a revenue-carbon pollution fee as the best way to reduce emissions and spark a prosperity-enhancing, poverty-reducing, green technology revolution.

“If the US were to put a carbon tax in place, it’s not the case right off the bat that the members of one party would be disadvantaged relative to the other,” Kevin says.

“The difference in political rhetoric is far greater than the difference in environmental reality,” he adds. “The rhetoric should be: Why are we taxing things we want more of, like income, instead of things we want less of, like pollution?”

It’s the politics, of course. But Kevin doesn’t put all the blame on politicians. Research, he says, can do much more to give policy makers and politicians the tools they need to design a carbon-fee-and-rebate approach that will appeal to voters across the political spectrum.

I heartily agree! I urge you to skim Kevin’s full paper to learn more about his analytical approach and the surprising findings about who pollutes (skip to the Discussion if you are more policy wonk than data nerd). Then, to discover how this could unfold in the political world, read my newly published CGD essay: The Sudden Rise of Carbon Taxes, 2010-2030, a future history. 

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UHC in Latin America: Learning from the Past, Planning for the Future

Last week I participated in the launch of a new Lancet series on universal health coverage (UHC) in Latin America, which aims to showcase and contextualize how the UHC experience has played out to date in the region.  And there is a lot to showcase: convergence –as advocated by Larry Summers and colleagues in the Global Health 2035 report – is almost complete in the region, with infant mortality and under-5 mortality similar across many countries with economies of very different sizes. Still, in spite of large increases in public spending, within-country inequalities are still pronounced and out-of-pocket spending remains stubbornly high[1], even in public health success stories like Brazil. Participants at the event highlighted obstacles to faster progress in these areas, including the fragmentation of risk pools and payment arrangements. Further, citizens’ perceived satisfaction with health systems has remained flat over time, and new pressures associated with growing economies and expectations are increasingly in play.

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Getting Hospitals Right: Dispatches from Our Cape Town Consultation Session

The Ebola epidemic has made the entire world aware of the importance of hospitals within a health system and the dearth of hospitals altogether in the hardest-hit counties in West Africa.  CGD’s Hospitals for Health working group is exploring ways the global community can foster more safe and efficient hospitals in low- and middle-income countries without crowding out investments in primary care.  We recently hosted a public consultation session at the Third Global Symposium on Health Systems Research in Cape Town, South Africa, to discuss our draft report and get feedback on its proposal for a Global Hospitals Collaborative.   Our distinguished panel featured CEO of Discovery Health, South Africa Jonathan Broomberg, plus Hospitals for Health working group members Jerry La Forgia (World Bank) and Maureen Lewis (Georgetown University).

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