Measuring the Impact: Cross-Country Quantitative Analysis

1. Measuring the Impact: Cross-Country Quantitative Analysis

2. Previous Studies

3. Background • Debate regarding the capacity of developing countries, particularly low-income countries, to effectively spend significant new resources for health

4. Measuring absorptive capacity • Ratio of cumulative disbursements in each quarter over total grant commitment for Phase One.

5. Data and Methods • Time series and cross sectional data on disbursement, grants characteristics and country characteristics • Various estimation methods

6. Major Findings • Low-income countries, were more likely to have a higher rate of disbursement than high income countries holding everything else constant. • For a given level of income, countries with less-developed health systems were more likely to have a higher rate of grant disbursement than nations with more-developed health systems.

8. Data and Methods • Time series and cross sectional data from 1995 to 2004 on DTP3 coverage, country’s characteristics • Various estimation methods

9. Results • In countries with DTP3 coverage of 65% or less at baseline, ISS spending per surviving child had a significant positive effect on DTP3 coverage. • This effect was not present in countries with DTP3 coverage of 65–80% or 80% or more at baseline.

10. Evaluating the Impact of the Global Fund on Fighting against Tuberculosis IHEA 6th World Conference July 9, 2007 Session: Evaluating Global Health Initiatives Presenter: Chunling Lu Authors: Chunling Lu, PhD, Senior Research Associate Catherine Michaud, PhD, Senior Research Scientist Andrew Stokes, Research Assistant Christopher J.L Murray, M.D, DPhil Institute Director, Institute for Health Metrics and Evaluation and Professor of Global Health, University of Washington

11. Effects of GFATM on Malaria IHEA 6th World Conference July 9, 2007 Session: Evaluating Global Health Initiatives Presenter: Chunling Lu Authors: Catherine Michaud, PhD, Senior Research Scientist Felix Masiye, PhD, Research Fellow and Christopher J.L Murray, M.D, DPhil Institute Director, Institute for Health Metrics and Evaluation and Professor of Global Health, University of Washington

12. Measuring the Performance of Global Fund and PEPFAR Monies on the Expansion of ARV Treatment IHEA 6th World Conference July 9, 2007 Session: Evaluating Global Health Initiatives Presenter: Christopher Murray Authors: Chunling Lu, PhD, Senior Research Associate Catherine Michaud, PhD, Senior Research Scientist Felix Masiye, PhD, Research Fellow and Christopher J.L Murray, M.D, DPhil Institute Director, Institute for Health Metrics and Evaluation and Professor of Global Health, University of Washington

13. Impact of GHIs on HSS? • Impact of HSS on GHIs? Positive Synergies between GHIs and HSS

14. Impact of GHIs on HSS? Positive Synergies between GHIs and HSS

15. Measuring the impact of GHIs • Disbursements of GHIs to recipient countries

16. Global Resources for Health- by IHME

17. Global Resources for Health- by IHME • A comprehensive data on all types of resources flows for health is lacking. • A subset of global players

18. Selecting GHIs • Over 80 GHIs • Largest GHIs: GFATM, GAVI, and PEPFAR • Time-series cross-sectional disbursements data available

19. Evaluation Matrix of the Impact of GHIs on Health Systems

20. Inputs of a health system Process of a health system GHIs investments Outputs of a health system Outcomes of a health system

21. Input Measures Money value of all resources used by the health system • Government/Public health spending • Private health spending (households out-of-pocket health spending) • External sources (i.e. GHIs)

22. Process Measures • Human resources • Infrastructure and equipment • Drug supply • Operational measures • Program activities

23. Output Measures • Coverage/Effective Coverage - target diseases (HIV, Malaria, TB) - medical interventions for non-target diseases - basic medical services (i.e. immunization)

24. Outcomes Measures

25. Cross-country quantitative study- Four projects in eight months Government spending on health Coverage of immunization GHIs investments Coverage of skilled-attendance at delivery Child mortality

26. Impact on government health spending – substitution effect? • Government spending on health indicates the commitment of a government to public health. • Expanding government spending on health is critical to maintaining financing sustainability in developing countries.

27. Impact on interventions of non-target diseases or programs • Immunization • Skilled-attendance at delivery

28. Impact on population health outcomes • Child mortality

29. Time-series and Cross-sectional Data • Disbursements of GFATM, GAVI, and PEPFAR • Government Health Spending - NHA data by WHO - OECD CRS on external sources • Child mortality - IHME • Country characteristics variables

30. Missing Data Figure 1 Public Spending from 1996-2005 across 127 Countries

31. Dealing with missing data and low-quality data • Developing estimation methods • Providing uncertainty level for estimates • Test the sensitivity of findings to estimates derived from various methods

32. 2. Impact of HSS on GHIs? Positive Synergies between GHIs and HSS

33. Challenges • Outcome variables - How to differentiate the health outcomes by GHIs from that by health system • Measurements of the strength of a health system

34. Limitations of Cross-Country Quantitative Analysis Data availability  the statistical power Robustness of findings Not able to provide evidence on detailed practice in specific countries