Putting your money where your mouth is: Geographic targeting of World Bank projects to the bottom 40 percent.

The adoption of the shared prosperity goal by the World Bank in 2013 and Sustainable Development Goal 10, on inequality, by the United Nations in 2015 should strengthen the focus of development interventions and cooperation on the income growth of the bottom 40 percent of the income distribution. This paper contributes to the incipient literature on within-country allocations of development institutions and assesses the geographic targeting of World Bank projects to the bottom 40 percent. Bivariate correlations between the allocation of project funding approved over 2005-14 and the geographical distribution of the bottom 40 as measured by survey income or consumption data are complemented by regressions with population and other potential factors affecting the within-country allocations as controls. The correlation analysis shows that, of the 58 countries in the sample, 41 exhibit a positive correlation between the shares of the bottom 40 and World Bank funding, and, in almost half of these, the correlation is above 0.5. Slightly more than a quarter of the countries, mostly in Sub-Saharan Africa, exhibit a negative correlation. The regression analysis shows that, once one controls for population, the correlation between the bottom 40 and World Bank funding switches sign and becomes significant and negative on average. This is entirely driven by Sub-Saharan Africa and not observed in the other regions. Hence, the significant and positive correlation in the estimations without controlling for population suggests that World Bank project funding is concentrated in administrative areas in which more people live (including the bottom 40) rather than in poorer administrative areas. Furthermore, capital cities receive disproportionally high shares of World Bank funding on average.

Effect of currency exchange rate fluctuations on Aid Effectiveness in the Health Sector in Zambia.

Development assistance for health (DAH) remains a significant and important source of health financing in many low and lower middle-income countries. However, this assistance has not been fully effective. This study explores the effect of currency exchange rate fluctuations on volatility of DAH in Zambia using a mixed methods approach. Data covering the period 1997-2008 were collected from various financial and programmatic reports, while six key informant interviews were conducted to validate and translate findings from the quantitative analysis. Results show fluctuations in the volume of funds disbursed to the Ministry of Health by donors due to changes in the exchange rates between non-US$ currencies and the US$, ranging from -11.1% to +13.4% during the period 1997-2008. The overall effect was a loss of US$ 13.4 million over the period 1997-2008 which is equivalent to an annual average loss of US$ 1.1 million per annum. There were also fluctuations in the US$ amount that was converted to the Zambian Kwacha to fund districts ranging from -22% to +22% over the same period. The monthly average loss that was incurred was US$ 302 214 per month, but large gains and losses were observed when individual months were analysed. Information from key informants suggest that currency exchange rate losses contribute to reductions in the health workforce, quantity and quality of health services, while currency exchange rate gains can contribute to reduced absorption capacity and/or low utilization of financial resources. The study concludes that fluctuations in currency exchange rates contribute to volatility in DAH, reduces financial stability and leads to unpredictability of DAH which ultimately affects health service delivery. For DAH to be effective, governments and donors should increase awareness and work systematically to mitigate currency exchange risks.

Sector-wide or disease-specific? Implications of trends in development assistance for health for the SDG era.

The record of the Millennium Development Goals broadly reflects the trade-offs of disease-specific financing: substantial progress in particular areas, facilitated by time-bound targets that are easy to measure and communicate, which shifted attention and resources away from other areas, masked inequalities and exacerbated fragmentation. In many ways, the Sustainable Development Goals reflect a profound shift towards a more holistic, system-wide approach. To inform responses to this shift, this article builds upon existing work on aggregate trends in donor financing, bringing together what have largely been disparate analyses of sector-wide and disease-specific financing approaches. Looking across the last 26 years, the article examines how international donors have allocated development assistance for health (DAH) between these two approaches and how attempts to bridge them have fared in practice. Since 1990, DAH has overwhelmingly favoured disease-specific earmarks over health sector support, with the latter peaking in 1998. Attempts to integrate system strengthening elements into disease-specific funding mechanisms have varied by disease, and more integrated funding platforms have failed to gain traction. Health sector support largely remains an unfulfilled promise: proportionately low amounts (albeit absolute increases) which have been inconsistently allocated, and the overall approach inconsistently applied in practice. Thus, the expansive orientation of the Sustainable Development Goals runs counter to trends over the last several decades. Financing proposals and efforts to adapt global health institutions must acknowledge and account for the persistent challenges in the financing and implementation of integrated, cross-sector policies. National and subnational experimentation may offer alternatives within and beyond the health sector.

Crafting AIDS policy in Brazil and Russia: State-civil societal ties, institutionalised morals, and foreign policy aspiration.

During the 1990s, Brazil and Russia diverged in their policy response to AIDS. This is puzzling considering that both nations were globally integrated emerging economies transitioning to democracy. This article examines to what extent international pressures and partnerships with multilateral donors motivated these governments to increase and sustain federal spending and policy reforms. Contrary to this literature, the cases of Brazil and Russia suggest that these external factors were not important in achieving these outcomes. Furthermore, it is argued that Brazil's policy response was eventually stronger than Russia's and that it had more to do with domestic political and social factors: specifically, AIDS officials' efforts to cultivate a strong partnership with NGOs, the absence of officials' moral discriminatory outlook towards the AIDS community, and the government's interest in using policy reform as a means to bolster its international reputation in health.

Development assistance for health: past trends, associations, and the future of international financial flows for health.

BACKGROUND: Disbursements of development assistance for health (DAH) have risen substantially during the past several decades. More recently, the international community's attention has turned to other international challenges, introducing uncertainty about the future of disbursements for DAH. METHODS: We collected audited budget statements, annual reports, and project-level records from the main international agencies that disbursed DAH from 1990 to the end of 2015. We standardised and combined records to provide a comprehensive set of annual disbursements. We tracked each dollar of DAH back to the source and forward to the recipient. We removed transfers between agencies to avoid double-counting and adjusted for inflation. We classified assistance into nine primary health focus areas: HIV/AIDS, tuberculosis, malaria, maternal health, newborn and child health, other infectious diseases, non-communicable diseases, Ebola, and sector-wide approaches and health system strengthening. For our statistical analysis, we grouped these health focus areas into two categories: MDG-related focus areas (HIV/AIDS, tuberculosis, malaria, child and newborn health, and maternal health) and non-MDG-related focus areas (other infectious diseases, non-communicable diseases, sector-wide approaches, and other). We used linear regression to test for structural shifts in disbursement patterns at the onset of the Millennium Development Goals (MDGs; ie, from 2000) and the global financial crisis (impact estimated to occur in 2010). We built on past trends and associations with an ensemble model to estimate DAH through the end of 2040. FINDINGS: In 2015, US$36·4 billion of DAH was disbursed, marking the fifth consecutive year of little change in the amount of resources provided by global health development partners. Between 2000 and 2009, DAH increased at 11·3% per year, whereas between 2010 and 2015, annual growth was just 1·2%. In 2015, 29·7% of DAH was for HIV/AIDS, 17·9% was for child and newborn health, and 9·8% was for maternal health. Linear regression identifies three distinct periods of growth in DAH. Between 2000 and 2009, MDG-related DAH increased by $290·4 million (95% uncertainty interval [UI] 174·3 million to 406·5 million) per year. These increases were significantly greater than were increases in non-MDG DAH during the same period (p=0·009), and were also significantly greater than increases in the previous period (p<0·0001). Between 2000 and 2009, growth in DAH was highest for HIV/AIDS, malaria, and tuberculosis. Since 2010, DAH for maternal health and newborn and child health has continued to climb, although DAH for HIV/AIDS and most other health focus areas has remained flat or decreased. Our estimates of future DAH based on past trends and associations present a wide range of potential futures, although our mean estimate of $64·1 billion (95% UI $30·4 billion to $161·8 billion) shows an increase between now and 2040, although with a large uncertainty interval. INTERPRETATION: Our results provide evidence of two substantial shifts in DAH growth during the past 26 years. DAH disbursements increased faster in the first decade of the 2000s than in the 1990s, but DAH associated with the MDGs increased the most out of all focus areas. Since 2010, limited growth has characterised DAH and we expect this pattern to persist. Despite the fact that DAH is still growing, albeit minimally, DAH is shifting among the major health focus areas, with relatively little growth for HIV/AIDS, malaria, and tuberculosis. These changes in the growth and focus of DAH will have critical effects on health services in some low-income countries. Coordination and collaboration between donors and domestic governments is more important than ever because they have a great opportunity and responsibility to ensure robust health systems and service provision for those most in need. FUNDING: Bill & Melinda Gates Foundation.

The IAEA technical cooperation programme and nuclear medicine in the developing world: objectives, trends, and contributions.

The International Atomic Energy Agency's technical cooperation (TC) programme helps Member States in the developing world with limited infrastructure and human resource capacity to harness the potential of nuclear technologies in meeting socioeconomic development challenges. As a part of its human health TC initiatives, the Agency, through the TC mechanism, has the unique role of promoting nuclear medicine applications of fellowships, scientific visits, and training courses, via technology procurement, and in the past decade has contributed nearly $54 million through 180 projects in supporting technology procurement and human resource capacity development among Member States from the developing world (low- and middle-income countries). There has been a growing demand in nuclear medicine TC, particularly in Africa and ex-Soviet Union States where limited infrastructure presently exists, based on cancer and cardiovascular disease management projects. African Member States received the greatest allocation of TC funds in the past 10 years dedicated to building new or rehabilitating obsolete nuclear medicine infrastructure through procurement support of single-photon emission computed tomography machines. Agency support in Asia and Latin America has emphasized human resource capacity building, as Member States in these regions have already acquired positron emission tomography and hybrid modalities (positron emission tomography/computed tomography and single-photon emission computed tomography/computed tomography) in their health systems. The strengthening of national nuclear medicine capacities among Member States across different regions has enabled stronger regional cooperation among developing countries who through the Agency's support and within the framework of regional cooperative agreements are sharing expertise and fostering the sustainability and productive integration of nuclear medicine within their health systems.

Scoping medical tourism and international hospital accreditation growth.

PURPOSE: Uwe Reinhardt stated that medical tourism can do to the US healthcare system what the Japanese automotive industry did to American carmakers after Japanese products developed a value for money and reliability reputation. Unlike cars, however, healthcare can seldom be test-driven. Quality is difficult to assess after an intervention (posteriori), therefore, it is frequently evaluated via accreditation before an intervention (a priori). This article aims to scope the growth in international accreditation and its relationship to medical tourism markets. DESIGN/METHODOLOGY/APPROACH: Using self-reported data from Accreditation Canada, Joint Commission International (JCI) and Australian Council on Healthcare Standards (ACHS), this article examines how quickly international accreditation is increasing, where it is occurring and what providers have been accredited. FINDINGS: Since January 2000, over 350 international hospitals have been accredited; the JCI's total nearly tripling between 2007-2011. Joint Commission International staff have conducted most international accreditation (over 90 per cent). Analysing which countries and regions where the most international accreditation has occurred indicates where the most active medical tourism markets are. However, providers will not solely be providing care for medical tourists. PRACTICAL IMPLICATIONS: Accreditation will not mean that mistakes will never happen, but that accredited providers are more willing to learn from them, to varying degrees. If a provider has been accredited by a large international accreditor then patients should gain some reassurance that the care they receive is likely to be a good standard. ORIGINALITY/VALUE: The author questions whether commercializing international accreditation will improve quality, arguing that research is necessary to assess the accreditation of these growing markets.

Perspective in supportive care--practical experiences in Georgia.

Authors describe the first steps of Palliative Care development in Georgia, including policy, educational issues, drug availability and services. It is underlined the importance and effectiveness of collaboration of Governmental institutions, NGOs and international organizations and experts to create the basis for Palliative care system in the Country. Georgian experience on revealing of problems of adequate pain control gained by survey with participation of advanced patients and their family members is also discussed. All current activities in the sphere of Palliative Care as well as the future models of Palliative Care provision in the capital and regions of Georgia is shown.

The World Health Organization program for emergency surgical, obstetric, and anesthetic care: from Mongolia to the future.

This special article provides an introduction to the World Health Organization (WHO) Emergency and Essential Surgical Care (EESC) program. The program was launched by the WHO in December of 2005 to address the lack of adequate surgical capacity as a global public health issue. The overall objective is to reduce death and disability from trauma, burns, pregnancy-related complications, domestic violence, disasters, and other surgically treatable conditions. The program and materials have spread to over 35 countries and focus on providing (1) basic education and training materials; (2) enhancement of surgical infrastructure at the governmental and health facility level; and (3) resources for monitoring and evaluating surgical, obstetrical, and anesthetic capacity. Additionally, a global forum for program members was established that collaborates with ministries of health, WHO country offices, nongovernmental organizations, and academia. The results of the third biennial meeting of global EESC members in Mongolia are outlined as well as future challenges.

A Food in Health Security (FIHS) platform in the Asia-Pacific Region: the way forward.

The advent of multiple global crises, especially those of climate change, economics, energy, water, food and health evident in 2008, is of considerable moment to those who are suffering their consequences and for those with responsibility and interest in the systems affected. A coalition of parties in the Asia Pacific Region who work in the food and health systems met in August, 2009 in Taiwan and instigated a Food in Health Security (FIHS) Network which might join with other like-minded networks in and beyond the region. Sustainable health has many dimensions, among which food and nutrition is often neglected; there is a wide spectrum of nutritionally-related disorders. Malnutrition remains the global concern for agricultural research and development scientists and linkage with the health sector is key to progress. The disconnect between agricultural and health sectors negatively impacts consumer nutrition and health. Ethical and equity affect food and health systems. Food and health security is attainable only when the underlying social inequities are addressed; it is an ethical issue as reflected in the UN Universal declaration of Human Rights which includes the right to food for health and well-being. Food and health security are part of the larger security agenda and merit corresponding attention. Policy recommendations with immediacy are greater investment in combined food and health research; an Asia Pacific security agenda which emphasizes planetary, human, health and food security as relevant to traditional defence security; and community and household security measures which include maternal literacy, communication technology and entrepreneurial opportunity.

Grand challenges in global health governance.

INTRODUCTION: This review identifies an agenda for global health by highlighting the current 'grand challenges' related to governance. SOURCES: Literature from the disciplines of health policy and medicine, conference presentations and documents, and materials from international agencies (such as the World Health Organization). AREAS OF AGREEMENT: The present approach to global health governance has proven to be inadequate and major changes are necessary. AREAS OF CONTROVERSY: The source of problems behind the current global health governance challenges have not always been agreed upon, but this paper attempts to highlight the recurrent themes and topics of consensus that have emerged in recent years. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH: A solution to the 'grand challenges' in global health governance is urgently needed and serves as an area for developing research.