The U.S. Government's Global Health Policy Architecture: Structure, Programs and Funding

Provides an overview of the history, scope, and role of U.S. engagement in global health, including funding; statutes, authorities, and policies; agencies involved; major initiatives; and countries with U.S. bilateral programs and funding

Cambodia’s patient zero: The political economy of foreign aid and avian influenza

What happens when a developing country with poor health infrastructure and even poorer animal health surveillance is thought to be a potential source for the next emerging infectious disease? This is the story of Cambodia and Avian Influenza. This paper undertakes a review of the relevant literature and analyzes the results of detailed semi-structured interviews of individuals highly engaged in Avian Influenza work in Cambodia. First, the political economy context is detailed with particular attention to aid dependency, tourism and the role of the livestock sector. The role of politics and the bureaucracy in this context is explored. Three competing policy narratives emerge: first, kill the birds, but don’t compensate as it’s too difficult and costly; second, behaviour modification change is the answer; and third, whatever happened to poverty and livelihoods? Finally, the political economy of the policy process in Cambodia is described, including actors, networks and interests. The paper finds that in the context of avian influenza, donors are too often motivated by concerns other than protecting livelihoods, just as traditional aid activities are often dominated by the need to tie aid to donor countries, avian influenza activities have been overtly focused on detecting and preventing pandemic as a threat to the donor countries themselves. As of 2008, donors have committed $35 million to Cambodia, placing it seventh among the top 10 recipients of avian influenza funding globally, fourth in terms of per case and per death from A/H5N1, and second in terms of per capita and per outbreak funding. However, ultimate responsibility for the success or failure of policies in Cambodia must rest with those in charge. Poor governance and pervasive institutional failure have plagued the response in Cambodia. Effective disease response and effective governance must go hand-in-hand. A rushed, emergency oriented response to avian influenza may have undermined already weak governance capacity in Cambodia, fuelling patronage networks and encouraging rent seeking. Whether such funds have increased the ability of Cambodia—and the world—to prevent a future pandemic remains uncertain.Highly Pathogenic Avian Influenza, Cambodia, Political Economy

Disease Surveillance Networks Initiative Asia: Final Evaluation

The DSN Initiative was launched in 2007 under the new strategy of the Rockefeller Foundation. The initiative intends:[1] To improve human resources for disease surveillance in developing countries, thus bolstering national capacity to monitor, report, and respond to outbreaks;[2] To support regional networks to promote collaboration in disease surveillance and response across countries; and[3] To build bridges between regional and global monitoring effortsThe purpose of the DSN evaluation in the Mekong region was twofold:[1]To inform the work and strategy of the Foundation, its grantees, and the broader field of disease surveillance, based on the experience of DSN investments in the Mekong region. More specifically, the evaluation will inform future directions and strategies for current areas of DSN Initiative work, particularly in Asia, and will highlight potential new areas of work and strategy; and[2] To provide accountability to the Rockefeller Foundation's board, staff, and stakeholders for the DSN funds spent in the Mekong region

Ready or Not? Protecting the Public's Health From Diseases, Disasters, and Bioterrorism, 2008

Examines ten indicators to assess progress in state readiness to respond to bioterrorism and other public health emergencies. Evaluates the federal government's and hospitals' preparedness. Makes suggestions for funding, restructuring, and other reforms

Ready or Not? Protecting the Public's Health From Diseases, Disasters, and Bioterrorism, 2009

Based on ten indicators, assesses progress in the readiness of states, federal government, and hospitals to respond to public health emergencies, with a focus on the H1N1 flu. Outlines improvements and concerns in funding, accountability, and other areas

Out-of-pocket payments for health care services in Bulgaria: financial burden and barrier to access.

BACKGROUND: In recent years, Bulgaria has increasingly relied on out-of-pocket payments as one of the main sources of health care financing. However, it is largely unknown whether the official patient charges, combined with informal payments, are affordable for the population. Our study aimed to explore the scale of out-of-pocket payments for health care services and their affordability. METHODS: Data were collected in two nationally representative surveys, conducted in Bulgaria in 2010 and 2011, using face-to-face interviews based on a standardized questionnaire. To select respondents, a multi-stage random probability method was used. The questionnaire included questions on the out-of-pocket payments for health care services used by the respondent during the preceding 12 months. RESULTS: In total, 75.7% (2010) and 84.0% (2011) of outpatient service users reported to have paid out-of-pocket, with 12.6% (2010) and 9.7% (2011) of users reporting informal payments. Of those who had used inpatient services, 66.5% (2010) and 63.1% (2011) reported to have made out-of-pocket payments, with 31.8% (2010) and 18.3% (2011) reporting to have paid informally. We found large inability to pay indicated by the need to borrow money and/or forego services. Regression analysis showed that the inability to pay is especially pronounced among those with poor health status and chronic diseases and those on low household incomes. CONCLUSION: The high level of both formal and informal out-of-pocket payments for health care services in Bulgaria poses a considerable burden for households and undermines access to health services for poorer parts of the population

Reimagining WHO: Leadership and Action for a New Director-General

Three candidates to be the next WHO Director-General remain: Tedros Adhanom Ghebreyesus, David Nabarro, and Sania Nishtar. The World Health Assembly’s ultimate choice will lead an Organization facing daunting internal and external challenges, from its own funding shortfalls to antimicrobial resistance and immense health inequities. The new Director-General must transform WHO into a 21st century institution guided by the right to health. Topping the incoming Director-General’s agenda will be a host of growing threats—risks to global health security, antimicrobial resistance, non-communicable diseases, and climate change—but also the transformative potential of the Sustainable Development Goals, including their universal health coverage target. Throughout, the next Director-General should emphasize equality, including through national health equity strategies and, more boldly still, advancing the Framework Convention on Global Health. Success in these areas will require a reinvigorated WHO, with sustainable financing, greater multi-sector engagement, enhanced accountability and transparency, and strengthened normative leadership. WHO must also evolves its governance to become far more welcoming of civil society and communities. To build the political support for these transformative changes, the Director-General will need to focus first on gaining political support. This entails improving accountability and transparency to gain member state trust, and enabling meaningful civil society participation in WHO’s governance and standing up for the right to health to gain civil society support. Ultimately, in the face of a global environment marked by heightened nationalism and xenophobia, member states must empower the next Director-General to enable WHO to be a bulwark for health and human rights, serving as an inspiring contra-example to today’s destructive politics, demonstrating that the community of nations are indeed stronger together