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Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders
Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at:

Equitable Access Initiative – 2016
42 pages :: PDF –
The convening partners of the Equitable Access Initiative include: the World Health Organization; the World Bank; Gavi, The Vaccine Alliance; UNAIDS; UNICEF; UNDP; UNFPA; UNITAID; and the Global Fund, with support from the Bill & Melinda Gates Foundation and the Wellcome Trust.

Executive Summary [Excerpts]
Key Findings
The analyses find that policymaking should not rely on a single variable to inform complex health financing polices on the eligibility for and the prioritisation of investments. It is proposed that policymakers consider a more comprehensive framework for decision making that accounts for countries’ position on a health development continuum, based on the analysis of countries’ needs, fiscal capacity and policies. 5

For instance, eligibility policies should not only consider the level of wealth in a society, as measured by GNI per capita, but account for health need relative to income as well as mitigate the effects of discrete thresholds that render a country ineligible for support once it passes a certain GNI per capita level. Further, in order to prioritize investments, a government’s resources and policies to meet this health need should be taken into account. Finally, the analyses highlight the need to account for equity considerations, particularly within country inequity, suggesting that context-specific analyses are relevant when assessing the level and type of support to be provided.

Based on the analyses and findings of the EAI analytical work, a conceptual framework to guide policymaking in external financing for health is proposed that accounts for the following considerations:

:: To inform complex external health financing decisions such as eligibility and the prioritisation of investments with a multi-criteria framework that takes into account income levels and health needs, in addition to domestic capacity and policies, where relevant.
:: To inform eligibility policies by health need relative to income, and to design complimentary policies that allow for a planned gradual transition, in order to mitigate the risk of a country losing gains in health when external financing decreases rapidly in spite of significant health needs and/or limited fiscal space.2
:: To consider domestic fiscal capacity characteristics when prioritising investments and to develop policies that favour improved health outcomes and increased domestic finance.

Long-term actions
:: To consider greater investments in data collection systems towards developing a more nuanced, comprehensive framework that captures sub-national equity considerations, including the needs of key populations and vulnerable groups, through better quality and more reliable data that support the inclusion of relevant indicators.


Health Governance Capacity: Enhancing Private Sector Investment in Global Health
The Brookings Private Sector Global Health R&D Project
Darrell M. West, John Villasenor, and Jake Schneider
March 2017 :: 28 pages

Executive Summary [Excerpt]
…In this report, we examine the quality of healthcare governance in a set of low- and middle-income countries. In particular, we look at management capacity, regulatory processes, health infrastructure, and policy conditions in sub-Saharan Africa and Asia. We argue that good governance is a foundational condition for global health investment and that it conditions the
overall environment in which both public and private sector health investment takes place. This report is the first in a series of planned publications under the Brookings Private Sector Global Health R&D Project, which was launched in fall 2016. Subsequent reports will examine funding levels, rate of return on investment, and the financial benefits of global health R&D.

To explore governance, we compile data on 25 aspects of health governance in 18 different countries. As we explain later in this report, we chose these indicators based on the research literature that outlines the measures associated with investment decisions. In particular, we focus on measures that reflect key aspects related to health management, policies, regulations,
infrastructure and financing, and health systems. The countries assessed are Bangladesh, China, Democratic Republic of Congo, Ethiopia, Ghana, India, Indonesia, Kenya, Liberia, Mozambique, Nigeria, Pakistan, Philippines, Sierra Leone, South Africa, Tanzania, Uganda, and Vietnam. These places were chosen based on geographic diversity, opportunities to improve health outcomes, and having a large population.

Among the important findings of our analysis are the following:
1. Factors which can help low- and middle-income countries attract greater private investment in healthcare R&D are improving transparency, strengthening management capacity, lowering
tariffs on incoming medical products to the extent that is fiscally possible, expediting regulatory
reviews of new drugs, building effective health infrastructure, and increasing appropriately-targeted and efficient public spending on healthcare.

2. Of the countries in the study, Vietnam, South Africa, China, and Ghana rank the highest on
aspects of overall health governance that we believe have the greatest potential to help attract
private sector investment in health R&D.

3. Several countries have components of good governance that show promise in creating an
attractive investment environment. For example, South Africa and Uganda have a notably effective approach to health regulations, while South Africa and China have invested significantly in health infrastructure and Vietnam has worked hard to build its health system.

4. Ghana and Liberia do well on health leadership and management capacity, while Tanzania does well on several of its health policies.

5. Nigeria, Pakistan, the Democratic Republic of Congo, and Bangladesh perform less well on key health governance metrics.

More broadly, countries require enabling policy, regulatory, and administrative mechanisms in order to encourage positive health outcomes in general and global health R&D investments in particular. If there is a strengthened capacity to make effective use of resources, governments, businesses, and non-governmental organizations will be better able to absorb new investments relevant to global health goals. Private investors will be more likely to make global health R&D investments if it is clear that the resulting vaccines, drugs, and diagnostics will pass regulatory, policy, and legal muster, and produce positive health outcomes…