Helen Saxenian

Global health 2035: a world converging within a generation

Prompted by the 20th anniversary of the 1993 World Development Report a Lancet Commission revisited the case for investment in health and developed a new investment frame work to achieve dramatic health gains by 2035. The report has four key messages each accompanied by opportunities for action by national governments of low-income and middle-income countries and by the international community. Conclusion 1: there is a very large payoff from investing in health. Conclusion 2: a grand convergence is achievable within our lifetime. Conclusion 3: scale-up of low-cost packages of interventions can enable major progress in NCDs and injuries within a generation. Conclusion 4: progressive universalism is an effi cient way to achieve health and fi nancial protection.

Overcoming challenges to sustainable immunization financing: early experiences from GAVI graduating countries

Over the 5-year period ending in 2018, 16 countries with a combined birth cohort of over 6 million infants requiring life-saving immunizations are scheduled to transition (graduate) from outside financial and technical support for a number of their essential vaccines. This support has been provided over the past decade by the GAVI Alliance. Will these 16 countries be able to continue to sustain these vaccination efforts? To address this issue, GAVI and its partners are supporting transition planning, entailing country assessments of readiness to graduate and intensive dialogue with national officials to ensure a smooth transition process. This approach was piloted in Bhutan, Republic of Congo, Georgia, Moldova and Mongolia in 2012. The pilot showed that graduating countries are highly heterogeneous in their capacity to assume responsibility for their immunization programmes. Although all possess certain strengths, each country displayed weaknesses in some of the following areas: budgeting for vaccine purchase, national procurement practices, performance of national regulatory agencies, and technical capacity for vaccine planning and advocacy. The 2012 pilot experience further demonstrated the value of transition planning processes and tools. As a result, GAVI has decided to continue with transition planning in 2013 and beyond. As the graduation process advances, GAVI and graduating countries should continue to contribute to global collective thinking about how developing countries can successfully end their dependence on donor aid and achieve self-sufficiency.

Implementing pro-poor universal health coverage.

Universal health coverage (UHC) - the availability of quality affordable health services for all when needed without financial impoverishment - can be a vehicle for improving equity health outcomes and financial wellbeing. It can also contribute to economic development. In its Global Health 2035 report the Lancet Commission on Investing in Health (CIH) set forth an ambitious investment framework for transforming global health through UHC. The CIH endorsed pro-poor pathways to UHC that provide access to services and financial protection to poor people from the beginning and that include people with low income in the design and development of UHC health financing and service provision mechanisms.

Transforming Global Health by Improving the Science of Scale-Up.

In its report Global Health 2035, the Commission on Investing in Health proposed that health investments can reduce mortality in nearly all low- and middle-income countries to very low levels, thereby averting 10 million deaths per year from 2035 onward. Many of these gains could be achieved through scale-up of existing technologies and health services. A key instrument to close this gap is policy and implementation research (PIR) that aims to produce generalizable evidence on what works to implement successful interventions at scale. Rigorously designed PIR promotes global learning and local accountability. Much greater national and global investments in PIR capacity will be required to enable the scaling of effective approaches and to prevent the recycling of failed ideas. Sample questions for the PIR research agenda include how to close the gap in the delivery of essential services to the poor, which population interventions for non-communicable diseases are most applicable in different contexts, and how to engage non-state actors in equitable provision of health services in the context of universal health coverage.

Alma-Ata at 40 years: reflections from the Lancet Commission on Investing in Health

Department of Medicine, University of Washington, Seattle, WA, USA (D A Watkins MD); Center for Policy Impact in Global Health, Duke University, Durham, NC, USA (Prof G Yamey MD, O Ogbuoji ScD); Open Consultants, Berlin, Germany (M Schäferhoff PhD); Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA (O Adeyi DrPH); Pan American Health Organization, Washington, DC, USA (Prof G Alleyne MD); Department of Global Health, University of Washington, Seattle, WA, USA (Prof A Alwan MD); Gavi, the Vaccine Alliance, Geneva, Switzerland (Prof S Berkley MD); Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA (Prof R Feachem DSc[Med], Prof D T Jamison PhD); Office of the President, University of Miami, Miami, FL, USA (Prof J Frenk PhD); Development Policy and Finance, Bill & Melinda Gates Foundation, Seattle, WA, USA (G Ghosh MSc); Harvard TH Chan School of Public Health, Boston, MA, USA (Prof S J Goldie MD, M Kruk MD); School of Public Health, Peking University Health Science Center, Beijing, China (Prof Y Guo MPH); Center for Global Development, Washington, DC, USA (S Gupta PhD); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA (Prof F Knaul PhD); RTI International, Seattle, WA, USA (R Nugent PhD); Office of Population Research, Princeton University, Princeton, NJ, USA (J Qi MA); Public Health Foundation of India, Delhi, India (Prof S Reddy DM); Results Alma-Ata at 40 years: reflections from the Lancet Commission on Investing in Health