Farley R Cleghorn MD MPH SVP amp Chief Technical Officer Australasian Aid and International Development Policy Workshop Canberra February 13 amp 14 2014 Outline Public Goods Theory ID: 777445
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Slide1
Provision of Appropriate Regional Public Health Goods in the Pacific after 2015
Farley R. Cleghorn MD, MPH SVP & Chief Technical Officer
Australasian
Aid and International Development Policy
Workshop,
Canberra, February 13 & 14, 2014
Slide2Outline
Public Goods TheoryTaxonomy of public goods
Public health goods
Regional public health goods
Examples and Evidence: Regional Public Health Goods
Institutional, operational and financial arrangements of RPHGs
Evaluation of RPHGs
Regional Public Health Goods in the Pacific
Priority health areas
Current RPHG arrangements
Roadmap
for RPHG
Implementation
in
Oceania/Pacific
Institutional steps
Financing and role for donors
Conclusions
Slide33 components of public goods:Non-rivalry of benefits
Non-excludability of benefit recipientsTechnology of public supply aggregationA regional public good (RPG) provides benefits to two or more nations in a well defined
region
Effective in addressing
transboundary
challenges Language, geography, technology and culture are some factors that may influence non-rivalry and non-excludability of RPGsRPGs serve as a crucial function of South South Cooperation
What
A
re Public Goods?
Slide4Public Health Goods
Class of good
Properties
Examples
Pure
Non-rival and non-excludable benefits
Discovering a cure to a disease, curbing harmful pollutants, basic research, best practices
Impurely public
Partially non-rival and/or partially non-excludable benefitsSurveillance, curbing an epidemicClubExcludable benefits, partially rivalRenowned hospitalsJoint ProductsMultiple outputs that vary in degree of publicnessImmunization, teaching hospitalsPrivateRival and excludable benefitsDiagnostic tests, medicines
After Sandler 2001 & Ferroni 2002
Slide5Why are RPHGs needed?Regionalism is growing trend
Abundance of health goods could be improved through increased regional cooperation (policy, research, etc.)RPHGs often neglected by donor community
Challenges in provision:
Free riding
Collective action problem & group size
Limited capacity of countries to benefitCrowding-outLack of sustainable financingRegional Public Health Goods
Slide6What regional public health goods are needed in the Pacific
?How can regional public health goods be provided and funded in the Pacific?Research Questions
Slide7Outline
Public Goods TheoryTaxonomy of public goodsPublic health goods
Regional public health goods
Examples and Evidence: Regional Public Health Goods
Institutional, operational and financial arrangements of RPHGs
Evaluation of RPHGsRegional Public Health Goods in the PacificPriority health areasCurrent RPHG arrangements
Roadmap
for RPHG
Implementation in Oceania/PacificInstitutional stepsFinancing and role for donorsConclusions
Slide8Ideally, existing regional institutions coordinate its member nations to supply
RPHGsSpillover range of RPHGs should not extend beyond or fall short of the political jurisdictionRegional banks, trade blocs, NGOs, etc. (examples: IDB, CARICOM, PAHO)Regional organization elements:
Secretariat
Steering committee
Membership
PartnershipInstitutional Arrangements
Slide9Institutional Arrangements, cont.
Type of arrangement
Examples
Networks
Asia-Pacific Regional Network for Early Childhood (ARNEC)
Public-private partnerships
Onchocerciasis
Control Partnership
Global multilateralsUNDP’s Regional South-South UnitsCharitable foundations or NGOsThe Asia Foundation’s Pacific Islands Disaster Risk Management Program Nation-based organizationsNIH Medical Education Partnership Initiative
Slide10Operating structure
HeadquartersLegal basisBinding (treaty, multilateral agreement) vs. non-binding (voluntary)Criteria for leadership, membership and partnershipE
lected vs. rotating leadership, term limits, membership quotas, extent of involvement of organizations/countries outside region
D
ecision-making
Standards for reaching consensus (voting power)Frequency and location of meetingsResource allocationBudgets, sources of financing, annual reports
Operational Arrangements
Slide11Financing Arrangements
Financing Mechanism
Example
Public sources (national & international)
PAHO,
AusAID, USAID, UNICEFPrivate sourcesBill and Melinda Gates Foundation, Coca Cola, Rockefeller Foundation
Payment by users and beneficiaries
Caribbean Epidemiology Centre (CAREC)
PartnershipsOnchocerciasis Control Partnership
Slide12Important Role of Regional Development
BanksRDBs can convene countries, generate and transfer knowledge, assist negotiations, and transfer funding Types of financing: Grants, technical assistance, loans
Financing Recipient:
Wealthiest country, poorest country, or regional
body
Example: IDB Initiative for the Promotion of Regional Public Goods provides $10 million in grants for various RPGsChallenges:RPHGs do not benefit donor countries, which can discourage investmentMost aid is traditionally bilateral (country ownership)Regional consensus on cost-sharing is difficult
Financing Arrangements, cont.
Slide13Evaluating RPHGs
Evaluation
of…
Conclusions
Group
drug procurement-Lower prices and cost savings for MOH, strengthened quality control, new market opportunities
-Lack of political will
&
payment into revolving fund, poor procurement management or insufficient cost savings have led to some schemes failingRegional disease surveillance-MECIDS and MBDS have introduced and spread new communications and laboratory technologiesRegional health meetings in the Pacific-Effective forums for information sharing, but the proliferation of meetings has added to workloads-Other critiques: mixed mandates, duplication and inconsistent attendanceODA earmarked for international public goods-No significant crowding-out of aid in poor countries due to the provision of GPGs through ODA
Slide14Outline
Public Goods TheoryTaxonomy of public goodsPublic health goods
Regional public health goods
Examples and Evidence: Regional Public Health Goods
Institutional, operational and financial arrangements of RPHGs
Evaluation of RPHGsRegional Public Health Goods in the PacificPriority health areasCurrent RPHG arrangements
Roadmap
for RPHG
Implementation in Oceania/PacificInstitutional stepsFinancing and role for donorsConclusions
Slide15Isolation (both geographic and knowledge sharing)
Small and dispersed populations (limits economies of scale)Limited natural resourcesRapid population growth in some countriesShortage of critical infrastructure with poor maintenanceHigh vulnerability to the impacts of climate change and natural disasters
Regional Challenges
Slide16WHO key health areas for regional cooperation:Maternal
and child healthCommunicable disease (STIs, HIV, TB, NTDs, malaria)Non-communicable diseaseEpidemics, disasters, environmental threatsUniversal access to essential health services
Examples of current RPHGs:
Collaborative regional meetings on health policy, knowledge sharing, building evidence base
Infectious disease surveillance (PPHSN)
HIV, STI and TB controlCommunicable disease preventionRegional Health Priorities
Slide17InstitutionalSecretariat of the Pacific Community (SPC)
Pacific Islands Forum Secretariat (PIF)OperationalPacific PlanFinancialTraditional aid (Australia
, France, New Zealand, U.S.)
Asian Development Bank
NGOs
, charitable foundations and networksPublic-private partnershipsPayment by users (member contribution)RPHG Arrangements in the Pacific
Slide18Disease surveillanceSustainable model for PPHSN
NCD surveillanceGroup drug procurementHarmonization of essential drug listsPooled procurement and central negotiationCapacity building/ health systems strengthening
Regional nurse training facility
Recommendations for RPHG Provision
Slide19Outline
Public Goods TheoryTaxonomy of public goodsPublic health goods
Regional public health goods
Examples and Evidence: Regional Public Health Goods
Institutional, operational and financial arrangements of RPHGs
Evaluation of RPHGsRegional Public Health Goods in the PacificPriority health areasCurrent RPHG arrangements
Roadmap
for RPHG
Implementation in Oceania/PacificInstitutional stepsFinancing and role for donorsConclusions
Slide20Institutional Steps
Disease surveillance
Turn PPHSN into a formal network (i.e., multilateral agreement)
Create a regional hub/network for NCD surveillance
Group drug procurement
Increase political will through regional meeting of MOH
Determine feasibility and costs of harmonizing drug lists and pooled procurement for interested countries
Determine who will be the “host” country for implementation
Regional nurse training facility
Form a board that represents all countries in PIF
Determine budget, enrolment capacity, and admissions criteria; hire professors/staff; model curriculum off of other accredited nurse training institutions
Identify country and facility to be used for nurse training facility
Slide21Disease surveillanceQ
uota contributions from member states (CAREC model)CAREC 2010-2011 quota contributions: 6,173,140 USDTrinidad and Tobago (host country) pays 55%Group drug procurementSPC or PIF pays using a common fund, member countries reimburse once goods are received in-country (PAHO model
)
Regional nurse training facility
Government-funded
Tuition fees only: Per student costs over 3 years (allowing for drop outs) would be F$34,000Tuition and living expenses: Per student costs would be F$50,000Fees could be charged, but repayment is delayed until student is employed and reaches a certain income benchmark (HECS model)
Financing
Slide22Increase aid flows to regional projects and bodiesADB committed to increasing regional cooperation and integration (RCI) lending operations to 30% by 2020
Need appropriate funding for type of RPHGType of financing (loans, grants, technical assistance)Recipients of aid:
Shared responsibility among member states
Weakest-link:
country with the lowest capacity and contribution
Best-shot: country with most capacity and biggest contributionRole for Donors
Slide23Outline
Public Goods TheoryTaxonomy of public goodsPublic health goods
Regional public health goods
Examples and Evidence: Regional Public Health Goods
Institutional, operational and financial arrangements of RPHGs
Evaluation of RPHGsRegional Public Health Goods in the PacificPriority health areasCurrent RPHG arrangements
Roadmap
for RPHG
Implementation in Oceania/PacificInstitutional stepsFinancing and role for donorsConclusions
Slide24RPHGs are already being provided in the Pacific, but there are inefficiencies in provision and targeting and lack of sustainable financing
RPHG Recommendations:Improve disease surveillance by using CAREC as a model for PPHSN and creating regional NCD surveillance hubTake steps toward regional drug procurement in order to lower cost of treatmentCreate a regional nurse training facility to ease human resource constraints in the region
Conclusions
Slide25For more
information,
please
contact:
fcleghorn@futuresgroup.com
ADutta@futuresgroup.com
ian.wanyeki@mail.mcgill.ca