Category Archives: Innovative financing

Universal Health Coverage: the right path towards equity and development

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SPEED READ

– A large global coalition of more than 500 organizations from over 100 countries, has marked 12 December 2014 as the first-ever Universal Health Coverage Day, to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.

– Investing in health is a wise choice. Indeed, making universal health coverage a priority for all nations could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries.

– The Council on Health Research for Development (COHRED) proudly supports UHC Day and actively works on a number of activities at the global scale, all aimed at contributing to UHC through making the most out of the impact of research and innovation on the health and development problems of people in developing countries.

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Health is a right, not a privilege

“Health for all, everywhere”. Simple and linear as it may sound, attaining this is indeed a formidable challenge. Each year 1 billion people can’t afford a doctor, pay for medicines or access other essential care, and another 100 million fall into poverty trying to access it. In Africa and Southeast Asia, for example, nearly a third of households have to borrow money or sell assets to pay for health care.

Taking action to rapidly change this grim reality, on 12 December 2012, the United Nations unanimously endorsed Universal Health Coverage (UHC), declaring that everyone, everywhere, has the right to access the quality health services they need without facing financial hardship. Shortly after, Margaret Chan, Director General of the World Health Organization stated that, “Universal health coverage (is) the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.”

Responding to that historic call, a global coalition of more than 500 organizations from over 100 countries is now marking 12 December 2014 as the first-ever UHC Day. Spearheaded by The Rockefeller Foundation and WHO, this coalition is stepping up to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.

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Looking ahead, wisely: invest in health!

Making UHC a priority for all nations is not only a matter of justice and human rights. Rather, it could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries (LMICs). Health improvements drove a quarter of full income growth in developing countries between 2000 and 2011. At this rate of return, every US$1 invested in health would produce US$9-US$20 of growth in full income over the next 20 years.

To revisit the case for health investment, an independent commission of 25 renowned economists and global health experts from around the world came together from December 2012 to July 2013. The commission’s report, “Global Health 2035: A World Converging within a Generation”, was published in The Lancet on December 3, 2013 and launched on the same day at events in London, Tunis, and Johannesburg. The report clearly states that there is an enormous payoff from investing in health, and specifically makes the case that:

– the returns on investing in health are even greater than previously estimated;

– within a generation—by 2035—the world could achieve a “grand convergence,” bringing preventable infectious, maternal and child deaths down to universally low levels;

– taxes and subsidies are a powerful and underused lever for curbing non-communicable diseases and injuries;

– progressive universalism, a pathway to UHC that targets the poor from the outset, is an efficient way to achieve health and financial protection. Although some might believe that UHC is costly, studies consistently show that, when well-managed to provide quality care, it delivers better health outcomes at lower costs.

Thus, there is now widespread agreement that health may transform communities, economies and nations. But to tap into such a potential for development, the way that health care is financed and delivered must change, to be more equitable and more effective. Costs must be shared among the entire population through pre-payment and risk-pooling, rather than shouldered by the sick, and access must be based on need and unrelated to ability to pay.

Benefits can be almost immediate. If out-of-pocket spending for health services is eliminated or even reduced, money that families have to spend on health can now be spent on sending a child to school, starting a business or coping with an emergency. More broadly, UHC policies create resilient health systems: in times of distress, they mitigate shocks to people’s lives and livelihoods; in times of calm, they improve a community’s social cohesion and economic productivity.

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Adding the COHRED touch

COHRED proudly supports UHC Day. Delivering sustainable solutions to the health and development problems of people living in LMICs will require more than tackling health financing. If the medicines, health workers and health facilities do not exist, for example, it will be impossible to move toward UHC. In other words, strengthening health systems will be the key to ensure health for everyone and everywhere.

COHRED’s strong belief is that research and innovation play a crucial role in speeding up progress towards sustainable solutions to the health and development problems of people in LMICs. Either through enabling developing countries to identify their own national research priorities, or by providing leadership and effective solutions to support countries to build their own research and innovation systems for health and development, COHRED works actively to deliver UHC.

Last year, the WHO’s annual World Health Report was focused on “Research for universal health coverage”, remarking that UHC, with full access to high-quality services for prevention, treatment and financial risk protection, “cannot be achieved without the evidence provided by scientific research”. In the report, several examples of COHRED’s work are cited. These include Health Research Web, a global platform for information and interaction on health research for development, and RHInnO Ethics, a platform for research ethics review management.

Reaffirming its own commitment to contributing to UHC through research and innovation, COHRED is currently seeding the future, by shaping novel groundbreaking initiatives. In April 2015, the COHRED Fairness Index (CFI) will be officially presented in London. CFI is designed to provide an assessment tool to stakeholders to measure and report vital information that reflects their performance with respect to transparency, level of engagement, accountability and equity in their collaborations. The aim is to encourage good practices in North-South health research collaborations, for the benefit of health development and innovation in LMICs. Furthermore, COHRED and its partners are gearing up for the Global Forum on Research and Innovation for Health 2015, “People at the Center of Health Research and Innovation”. Planned for August 2015 in Manila, Philippines, Forum 2015 will bring together all stakeholders who have a part in making research and innovation benefit health, equity and development. Finally on stage as leading role actors of their own future, LMICs will take prime position in defining the global health research agenda that better suits their needs, in presenting solutions and in creating effective partnerships for action.

Universal health coverage is the final destination of a journey the World cannot afford to delay. Many paths lead to that destination. COHRED is making its way with determination and optimism about the impact of its global action.

Anthony Nguyen and Carel IJsselmuiden

Fostering sustainable investment in research for health

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SPEED READ

– The Council on Health Research for Development (COHRED) and its partners have recently held an international meeting aimed at identifying opportunities, possible solutions and strategies for moving towards sustainable investment in research for health in low- and middle-income countries.

– The final meeting report offers an overview of innovative financing mechanisms for health research and development, also commenting on the relevance and feasibility of applying such mechanisms in low resource contexts. Recommendations for taking steps towards developing integrated innovation systems, shifting from funding to investment, and engaging in advocacy for research for health financing have also been issued.

– The creation of an ‘African research space’ was recognised as a major driver for optimising African research development while maximising local and global investments. To support this, COHRED has recently launched COHRED Africa in Gaborone, Botswana. COHRED Africa expects to make its technical, advocacy and think tank contributions to science and innovation for health in Africa – and, where appropriate, globally as well.

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Financing health research in a changing landscape

“Healthcare demands in Africa are changing. Ensuring access to clean water and sanitation, battling ongoing communicable diseases and stemming the tide of preventable deaths still dominate the healthcare agenda in many countries. However, the incidence of chronic disease is rising fast, creating a new matrix of challenges for Africa’s healthcare workers, policy makers and donors.” These words, from a recent Economist Intelligence Unit’s report on the future of healthcare in Africa, give a precise idea of the challenges African countries, and more in general low- and middle-income countries (LMICs), will have to face in order to tackle the public health needs of an ever-growing population.

As most stakeholders agree, for health systems in LMICs to be able to cope with existing and future challenges, it is of absolute importance to increase investments in research and development (R&D). But who should pay for health-related R&D in Africa and LMICs? How to mobilise research funding? Can innovative financing mechanisms be identified to help meeting the growing health burden through investing in R&D?

To address these crucial issues, last June, in the framework of the seventh EDCTP Forum in Berlin, Germany, COHRED, in partnership with the West African Health Organisation (WAHO) and the New Partnership for Africa’s Development (NEPAD) Agency, held a meeting on “Sustainable Investment in Research for Health”. Attended by 35 participants from both the public and private sectors and representing European and African institutions, the meeting aimed at identifying opportunities, possible solutions and strategies for moving towards sustainable investment in research for health.

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Integrated innovation systems must be in place

“To help reduce the burden of disease, meet constitutional obligations and spur economic growth, African countries need to increase their investments in health research and innovation”, recently remarked John Ouma-Mugabe, Professor of Science and Innovation Policy at the University of Pretoria, South Africa, in a policy brief.

However, most African countries still rely heavily on external donors and partnerships to fund local research, with the result that research activities do not necessarily respond to development needs of local population but rather of those inhabiting developed countries. In addition, the volume of R&D is significantly insufficient. To break this dependence-poor R&D budget loop and to focus efforts and resources on domestic health demands and priorities, African countries will need to promote innovation, attract investments, and raise funds. Tapping into the possibilities offered by innovative financing mechanisms to either mobilise new revenue or improve the use of existing funds, will certainly play a pivotal role in addressing such complex problems.

Besides overviewing innovative financing mechanisms and assessing the relevance and feasibility of applying such mechanisms in low resource contexts, meeting participants discussed in depth aspects seen as essential for creating the environment in which research financing can happen and the funds eventually raised be spent in a productive way. Accordingly, the issuing meeting report carries recommendations for taking steps towards developing integrated innovation systems, shifting from funding to investment, and engaging in advocacy for research for health financing.

Highlighted actions that should be taken around these issues include, but are not limited to, foster political will and interest through understanding what priorities governments have and showing how research can respond to these; show the actual investments made in research to demonstrate tangible return on investment; create integrated research and innovation platforms to make efficient use of existing resources and thereby incentivise investment; strengthen accountability and transparency to attract potential investors through strong financial and administrative systems; engage the media as an advocate by maximising opportunities to communicate research findings through research-savvy journalists and media-savvy researchers; widen the scope of the audience to include, for example, a range of stakeholders and sectors, such as finance, business, information technology and so on, showing return on investment and thus making health research attractive to all.

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Jacintha Toohey (above), Policy Project Adviser COHRED, and Carel IJsselmuiden (down), Executive Director, The COHRED Group, at the launch of COHRED Africa in Gaborone, Botswana,6 November 2014

Towards an ‘African research space’

Another key point discussed at length during the Berlin meeting was centered on the recognition that moving towards a shared research space would have the benefit of optimising African research development while maximising local and global investments. Although it is still a matter of discussion whether creation of this space – either in the form of a network, an organisation, or a virtual space – should be first implemented at a regional level or immediately be continent-wide, a number of steps were identified as critical in its creation:

– Map the landscape to understand what is already in place and how it can be utilised or improved.

– Harmonise stewardship through tapping into regional leadership bodies and establishing common regulation processes and research agendas.

– Engage all stakeholders through open dialogue and continuous feedback, both during the creation of this space and its operation.

– Secure consistent funding by identifying a range of funding mechanisms to ensure sustainability of the research space.

– Leverage Africa’s potential by creating a strong cohesive whole to stimulate innovation and give it an equal place at the global table.

To support this, COHRED itself has formally launched COHRED Africa in Gaborone, Botswana, three years after appointing the first staff. COHRED Africa is the basis for all our work done in Africa – but – also it will have its own expertise to contribute to COHRED’s global clients and activities. In the company of high level representatives of Botswana, Swaziland, Malawi, Kenya and the African Development Bank, many colleagues with whom COHRED has worked over the years and continues to do so, key partners such as the EDCTP and Pfizer, COHRED Africa expects to make its technical, advocacy and think tank contributions to science and innovation for health in Africa – and, where appropriate, globally as well.

Sylvia de Haan and Carel IJsselmuiden

Note: find below a few examples of the press coverage on the launch of COHRED Africa and relevant discussion

Invest in research to attract funding, African governments told

Scientists contest the value of research

COHRED Africa office prioritises research ethics