Provision of Appropriate Regional Public Health Goods in the Pacific after 2015 - PowerPoint Presentation

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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

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Outline

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

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3 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?

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Public 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

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Why 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

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What regional public health goods are needed in the Pacific

?How can regional public health goods be provided and funded in the Pacific?Research Questions

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Outline

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

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Ideally, 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

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Institutional 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

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Operating 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

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Financing 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

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Important 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.

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Evaluating 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

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Outline

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

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Isolation (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

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WHO 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

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InstitutionalSecretariat 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

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Disease 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

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Outline

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

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Institutional 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

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Disease 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

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Increase 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

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Outline

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

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RPHGs 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

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For more

information,

please

contact:

fcleghorn@futuresgroup.com

ADutta@futuresgroup.com

ian.wanyeki@mail.mcgill.ca