I read the policy paper a few weeks ago and found it super interesting, that said I had some questions over what implementing marginal aid would look like in practice.
One would need to ensure national institutions take up the cost-effective programs aid now would opt not to fund, no? I suspect this coordination would be pretty difficult. Alone getting well-resourced western governments and multilaterals to spend aid cost-effectively has been a continuous fight fought by organizations such as CGD, I don’t see why we should expect an under-resourced government to make much better decisions.
I think an interesting follow up study could be to interview some of the people involved in negotiations on health service funding. Why did they opt to earmark for cost-effectiveness? Had they not earmarked, what do they expect the government would have funded instead? Had they funded marginally, do they expect the government would have taken up the cost-effective program themselves?
I worry that in practice it would just result in fewer cost-effective programs being funded. That said I can see there being a place for marginal aid in some funding of government health services.
EDIT: just looked at the pdf again and saw there was a section on implementation in practice, so apparently I didn’t read all of it! Apologies if you already answered some of the questions in that section, will give it a read later today.
Thanks Mattias, glad to know you’d already seen the paper! I would say that absolutely I think governments in many countries can and are working towards improved evidence-informed priority setting. Sure some still have some way to go (including many high-income countries btw) but many countries with less resources are developing strong prioritisation capabilities. Thailand is the classic example though several other countries have engaged in ambitious whole-health-benefits-package assessments including Ethiopia, Malawi and Pakistan. We wouldn’t expect a shift to a marginal aid approach overnight, or for all countries at the same time, but we need to imagine what the transition between the current situation and a world where countries do have effective flourishing health systems. In my view that means strengthening local priority setting and reducing fragmentation (etc) in how we provide financial support for service delivery.
Thanks for the comments on the potential value of gathering additional info, we are indeed hoping to do some work along these lines, including interviewing country officials as well.
Hi Tom welcome to the forum!
I read the policy paper a few weeks ago and found it super interesting, that said I had some questions over what implementing marginal aid would look like in practice.
One would need to ensure national institutions take up the cost-effective programs aid now would opt not to fund, no? I suspect this coordination would be pretty difficult. Alone getting well-resourced western governments and multilaterals to spend aid cost-effectively has been a continuous fight fought by organizations such as CGD, I don’t see why we should expect an under-resourced government to make much better decisions.
I think an interesting follow up study could be to interview some of the people involved in negotiations on health service funding. Why did they opt to earmark for cost-effectiveness? Had they not earmarked, what do they expect the government would have funded instead? Had they funded marginally, do they expect the government would have taken up the cost-effective program themselves?
I worry that in practice it would just result in fewer cost-effective programs being funded. That said I can see there being a place for marginal aid in some funding of government health services.
EDIT: just looked at the pdf again and saw there was a section on implementation in practice, so apparently I didn’t read all of it! Apologies if you already answered some of the questions in that section, will give it a read later today.
Thanks Mattias, glad to know you’d already seen the paper! I would say that absolutely I think governments in many countries can and are working towards improved evidence-informed priority setting. Sure some still have some way to go (including many high-income countries btw) but many countries with less resources are developing strong prioritisation capabilities. Thailand is the classic example though several other countries have engaged in ambitious whole-health-benefits-package assessments including Ethiopia, Malawi and Pakistan. We wouldn’t expect a shift to a marginal aid approach overnight, or for all countries at the same time, but we need to imagine what the transition between the current situation and a world where countries do have effective flourishing health systems. In my view that means strengthening local priority setting and reducing fragmentation (etc) in how we provide financial support for service delivery.
Thanks for the comments on the potential value of gathering additional info, we are indeed hoping to do some work along these lines, including interviewing country officials as well.