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11. Oil: A Blessing for Politicians and a Curse for the People of Basra

Author:
Azhar Al-Rubaie
Publication Date:
07-2024
Content Type:
Commentary and Analysis
Institution:
The Washington Institute for Near East Policy
Abstract:
The deterioration of public health in oil extraction cities requires tangible actions to end the suffering of the affected people by providing specialized treatment centers funded by the social benefits from petroleum profits. In June 2023, Iraq’s Council of Representatives approved the federal budget for 2023, 2024, and 2025. The state has allocated 198.9 trillion dinars ($153 billion) for each year, a staggering sum and the largest in the country’s history. Although Iraq is a top oil-producing country, observers have been alarmed at this uptick in spending, and they have good reason to believe that these vast sums will not reach the citizens but instead fill the pockets of the corrupt. According to Transparency International’s Corruption Perceptions Index, Iraq consistently ranks as one of the most corrupt governments, and despite the massive budgets approved in Baghdad, everyday Iraqis continue to suffer from weak infrastructure, lack of job opportunities, and poor services in essential sectors such as healthcare. In the oil-rich city of Basra in Iraq’s south, local residents living near oil sites complain about the high rates of cancer, respiratory illness, and nervous system diseases, along with the scarcity of medicines and poor healthcare in the public sector. The dearth of basic services frequently forces patients to travel abroad to countries like Iran, India, Turkey, Jordan, and Lebanon, spending up to $6 million monthly to receive medical treatment. This contributes to the waste of public funds and their diversion abroad, which some might use to justify the smuggling of hard currency, especially to Iran.
Topic:
Corruption, Development, Oil, Services, and Public Health
Political Geography:
Iraq, Middle East, and Basra

12. The Partograph: A Tool to Reduce Mother-Child Mortality Rate During Labour

Author:
Fobella Nkengafac, Regina Sinsai, Ghyslaine Bruna Djeunang Dongho, Solange Dabou, Evrard Kepgang, and Ronald Gobina
Publication Date:
11-2024
Content Type:
Working Paper
Institution:
The Nkafu Policy Institute
Abstract:
The Safe motherhood initiative is a fundamental aspect of healthcare that was launched in 1987 with an aim to reduce maternal mortality and ensure positive birth outcomes in developing countries(1) [1]. In many parts of the world, women face numerous challenges during childbirth. As a result, maternal and child mortality remains a global concern as the rates continue to remain high with more than 69% of maternal deaths occurring in African countries with rates ranging between 500 and 999 deaths per 100 000 live births (2) [2]. These elevated rates of maternal mortality are generally attributed to complications that arise, during pregnancy, before birth, during birth or after birth, and are commonly avoidable through appropriate interventions. WHO set as part of the 2030 Sustainable Development Goals (SDG), to reduce maternal deaths to 70 maternal deaths per 100 000 live births (1) [1]. Despite significant progress in healthcare, complications during labour and delivery continue to contribute to a substantial number of preventable deaths. The partograph, a simple yet effective tool, has shown promising results in reducing these mortality rates during labour. Yet, its use remains relatively low in some medical facilities in Cameroon (2,3) [2,3]. This article aims to shed light on the importance of the partograph, its role in improving maternal and child health outcomes and highlights its role in reducing complications during labour.
Topic:
Women, Public Health, Healthcare System, and Infant Mortality
Political Geography:
Africa and Cameroon

13. Beyond the “Gavi-Eligible”: High-Leverage Opportunities for Gavi to Enhance Vaccine Access and Uptake in Ineligible Middle-Income Countries

Author:
Rachel Bonnifield, Morgan Pincombe, and Janeen Madan Keller
Publication Date:
04-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
The global locus of undervaccination is increasingly shifting from the poorest countries in the world—which are eligible for support from Gavi, the Vaccine Alliance (Gavi)—to middle-income countries (MICs) that do not qualify for traditional Gavi support. Given these growing challenges, Gavi must rethink its engagement with those MICs that are ineligible for traditional support. Although this engagement is intended to be “catalytic” and has been intentionally targeted to country needs, it also has been relatively small-scale and ad hoc. Gavi’s next five-year strategic period from 2026 to 2030, known as “Gavi 6.0,” offers a window of opportunity for its board and leadership to consider new and different ways for Gavi to engage with MICs to advance global vaccine access and improve vaccination outcomes. To have the greatest impact in this context, Gavi must lean into its comparative advantage in market shaping and demand consolidation to drive its contributions to global vaccination efforts with finite resources. We offer recommendations for Gavi to operationalize broader engagement with MICs, specifically by enabling an expanded cohort of MICs to access more affordable prices for both newer, costlier vaccines and future vaccines via opt-in framework agreements and by supporting a global coordinating hub to shape a forward-looking immunization innovation agenda.
Topic:
Public Health, Vaccine, Global Health, and Middle-Income Countries
Political Geography:
Global Focus

14. Starting from the Source: Methods and Priorities for Explaining Lead Exposure

Author:
Rachel Bonnifield
Publication Date:
08-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
Lead is a dangerous neurotoxin, and lead poisoning remains one of the most serious and neglected public health challenges in the developing world, with major negative impacts on global health, education, and overall economic development. There is now growing international momentum to mitigate lead pollution, with the goal of dramatically reducing human lead exposure and consequent adverse effects. Yet before lead exposure can be effectively mitigated, it is essential to understand why humans are being exposed to lead in the first place and therefore how policymakers can intervene to stop further exposure. To date, such research into the major sources of lead exposure—broadly referred to as source assessment—in developing countries has been limited. Thus, there is limited information and no global scientific consensus about the most important causes of global lead exposure. Given growing global interest in addressing lead poisoning, there is an urgent need to better understand the major sources of lead exposure in different settings by increasing the volume and quality of related research. Tailored to a policy audience, this paper offers a state-of-the-science review of methods for doing so. First, it provides background for understanding lead exposure—that is, how and why lead enters the environment, how it behaves once there, and how environmental lead results in elevated blood lead levels for humans. Second, it outlines basic principles for source assessment, including a discussion of objectives and terminology. Third, it details the range of methods available for understanding the sources of lead exposure and describes how such methods can be used in combination to understand major sources of lead exposure in a given context. Finally, it considers major policy-relevant gaps in the literature base about sources of global exposure and offers suggestions for a research agenda in this space.
Topic:
Development, Public Health, Global Health, and Lead
Political Geography:
Global Focus

15. Financing the Pandemic Cycle: Prevention, Preparedness, Response, and Recovery and Reconstruction

Author:
Victoria Fan, Sun Kim, Diego Pineda, and Stefano Bertozzi
Publication Date:
08-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
The COVID-19 pandemic exposed critical gaps in the global response to health crises, particularly in the financing of pandemic prevention, preparedness, response, recovery, and reconstruction. This paper presents a comprehensive framework for pandemic financing that spans the entire pandemic cycle, emphasizing the need for timely, adequate, and effective financial resources. The framework is designed to support policymakers in both low- and middle-income countries (LMICs) and high-income nations, providing a guide to appropriate financing tools for each stage of a pandemic, from prevention and preparedness to response and recovery. Key economic concepts such as global public goods, time preference, and incentives are explored to underscore the complexities of pandemic financing. The paper also highlights the importance of timely, accessible, and sustainable financial instruments. The paper lists the pandemic financing instruments used for health during the COVID-19 pandemic, identifying 23 different tools. We also used the IHME 2024 Financing Global Health database to estimate that US$91.6 billion was spent for COVID-19 health support, primarily for response financing, over 2020 to 2023. The COVID-19 pandemic wrought significant economic impacts on the order of trillions of dollars, even as investments in pandemic preparedness to mitigate future risks is relatively small, on the order of $10 billion annually. The paper concludes with policy recommendations, calling for the establishment of a rapid-response financing mechanism, tailored to the unique challenges of pandemics, and a redesign of global health governance to better address these threats.
Topic:
Finance, Crisis Management, Public Health, Pandemic, and COVID-19
Political Geography:
Global Focus

16. Do Abortion Bans Affect Reproductive and Infant Health? Evidence from Texas’s 2021 Ban and its Impact on Health Disparities

Author:
Raymond Caraher
Publication Date:
07-2024
Content Type:
Working Paper
Institution:
Political Economy Research Institute (PERI), University of Massachusetts Amherst
Abstract:
The overturning of Roe v. Wade led to a wave of abortion bans in state legislatures across the United States. This emergence of a restrictive reproductive health policy environment has the potential to affect a wide range of reproductive health outcomes. This paper uses Texas’s 2021 6- week ban on abortion as a case study to examine the causal effect of an abortion ban on reproductive health outcomes, specifically abortion rates, fertility rates, and infant health outcomes. It examines how these effects may be heterogeneous by group, especially focusing on how the effects of abortion bans on reproductive health may be concentrated in those who are already facing disparities in reproductive health outcomes such as Black women. Using a difference-in-differences strategy, the analysis finds that the ban decreased abortion rates by over 40 percent, and increased fertility rates by about 4 percent, with the largest increases for Black non-Hispanic women and for counties far from a state with less restrictive abortion laws. This paper then constructs a measure of unmet reproductive health needs after an abortion ban, and finds that the unmet needs after the Texas 6-week ban are largest in counties with higher proportions of Black non-Hispanic residents, as well as counties which are furthest away from states which did not ban abortion after the Dobbs decision. The analysis then examines the effect of the ban on infant health outcomes, specifically focusing on heterogeneity in the effect of the ban on birth weight and infant mortality. This paper finds that the ban led to increases in the probability of an infant being born with very low birth weight of about 7 percent, with Black non-Hispanic infants experiencing the largest increases in the likelihood of very low birth weight. Additionally, the analysis finds significant increases in the infant mortality rate of about 6 percent after the abortion ban, again with Black non-Hispanic infants experiencing the largest increases in mortality. Further, the ban increased infant mortality rates more in counties which are further away from states which did not ban abortion after the Dobbs decision. The results suggest that the effects of abortion bans tend to be especially concentrated in marginalized populations, as well as those who are least able to shift their fertility options away from in-state abortions after a ban. The analysis shows that the trend towards an increasing number abortion bans will further exacerbate disparities in reproductive health outcomes.
Topic:
Public Health, Reproductive Health, and Abortion
Political Geography:
Texas and United States of America

17. Health Care for Women: How the U.S. Compares Internationally

Author:
Munira Z. Gunja, Relebohile Masitha, and Laurie Zephyrin
Publication Date:
08-2024
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
Recently released federal data once again show the United States with by far the highest rate of maternal deaths of any high-income nation, despite a decline since the COVID-19 pandemic.1 Racial disparities are also extreme: Black women in the U.S. are nearly three times more likely to die from pregnancy-related complications than white women are. But maternal deaths and complications may be an indicator of the nation’s wider failures with respect to women’s health and health care. Compared to women in other high-income countries, American women have long had worse access to the health care they need. While the U.S. spends more on health care than other countries do, surveys regularly find that Americans avoid seeking care because of costs at the highest rates, even as the U.S. continues to lead in the prevalence of chronic disease.2 At the same time, limited access to primary care and inadequate coordination of health services are likely factors in the nation’s poor performance when it comes to the prevention, diagnosis, and management of diseases.3 In this brief, we compare selected measures of health care access and outcomes for women in high-income countries. We drew upon data from four sources: the Commonwealth Fund’s 2023 International Health Policy Survey of Australia, Canada, France, Germany, the Netherlands, New Zealand, Switzerland, the United Kingdom, and the United States, which allowed us to analyze responses by race and ethnicity;4 the Centers for Disease Control and Prevention National Vital Statistics System; the Organisation for Economic Co-operation and Development (OECD); and the Institute for Health Metrics and Evaluation Global Burden of Disease. The latter two data sets permitted us to show results on selected measures for five additional countries — Chile, Japan, Korea, Norway, and Sweden. (See “How We Conducted This Survey” for more details.)
Topic:
Women, Public Health, Healthcare System, and Life Expectancy
Political Geography:
United Kingdom, Canada, France, Germany, Australia, and United States of America

18. Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System

Author:
David Blumenthal, Evan D. Gumas, Arnav Shah, Munira Z. Gunja, and Reginald D. Williams II
Publication Date:
09-2024
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Goal: Compare health system performance in 10 countries, including the United States, to glean insights for U.S. improvement. Methods: Analysis of 70 health system performance measures in five areas: access to care, care process, administrative efficiency, equity, and health outcomes. Key Findings: The top three countries are Australia, the Netherlands, and the United Kingdom, although differences in overall performance between most countries are relatively small. The only clear outlier is the U.S., where health system performance is dramatically lower. Conclusion: The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.
Topic:
Development, Public Health, Efficiency, and Healthcare System
Political Geography:
North America and United States of America

19. Insights into the U.S. Maternal Mortality Crisis: An International Comparison

Author:
Munira Z. Gunja, Evan D. Gumas, Relebohile Masitha, and Laurie Zephyrin
Publication Date:
06-2024
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
The United States continues to have the highest rate of maternal deaths of any high-income nation, despite a decline since the COVID-19 pandemic. And within the U.S., the rate is by far the highest for Black women. Most of these deaths — over 80 percent — are likely preventable.1 With policies and systems in place to support women during the perinatal period, several high-income countries report virtually no maternal deaths. As policymakers and health care delivery system leaders in the U.S. seek ways to end the nation’s maternal mortality crisis, these countries may offer viable solutions. This brief updates an earlier Commonwealth Fund study of differences in maternal mortality, maternal care workforce composition, and access to postpartum care and social protections between the U.S. and other high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.2 In this edition, we have also included data on Chile, Japan, and Korea — all high-income countries with universal health care systems. For our analysis, we used the most recently available data from the U.S. Centers for Disease Control and Prevention (CDC) and from the Organisation for Economic Co-operation and Development (OECD), of which the U.S. is a member. Where country-specific data are more than five years old, we note whether more recent published data from other sources are available for that country. Readers should be aware that because the methods we used to derive updated numbers from other sources may be different from methods the OECD uses, data points may not be comparable to the U.S. rates. For complete details on our methods, see “How We Conducted This Study.”
Topic:
Development, Inequality, Public Health, and Maternal Mortality
Political Geography:
United Kingdom, Canada, Norway, France, Germany, Australia, Switzerland, North America, Sweden, Netherlands, New Zealand, and United States of America

20. Hospital Global Budgeting: Lessons from Maryland and Selected Nations

Author:
Bob Atlas
Publication Date:
06-2024
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Issue: Maryland has utilized hospital global budgeting for a decade, but the approach is rarely used elsewhere in this country. The Centers for Medicare and Medicaid Services now hopes to test global budgeting in more states to help scale up this form of cost containment. Goals: Examine the ways Maryland, Canada, the Netherlands, New Zealand, and Norway employ hospital global budgeting and the lessons they offer to those hoping to see wider adoption in the United States. Methods: Analysis of the various health systems and expert interviews. Key Findings and Conclusion: Maryland and the four selected countries vary significantly in their approaches to hospital global budgeting. With its previous experience using price controls and current global budgeting approach, Maryland has succeeded in holding hospital spending growth steady for nearly a decade. While Norway combines fixed and variable payments to support global budgeting, the Netherlands and Canada’s province of Ontario are moving away from global budgeting in favor of other approaches. Meanwhile, New Zealand has added multiyear rolling forecasts and budgets to support its own model. Future approaches in the U.S. could prove more effective by factoring in the complexities, conflicting incentives, and potential unintended consequences of global budgeting.
Topic:
Public Health, Healthcare System, and Budgeting
Political Geography:
Canada, Maryland, Netherlands, New Zealand, and United States of America