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Health economics, Applied econometrics, Epidemiological and economic simulation modeling, Impact evaluation, AIDS.
Mead Over is a senior fellow at the Center for Global Development researching economics of efficient, effective, and cost-effective health interventions in developing countries. Much of his work since 1987, first at the World Bank and now at the CGD, is on the economics of the AIDS epidemic. After work on the economic impact of the AIDS epidemic and on cost-effective interventions, he co-authored the Bank’s first comprehensive treatment of the economics of AIDS in the book, Confronting AIDS: Public Priorities for a Global Epidemic(1997,1999). His most recent book is Achieving an AIDS Transition: Preventing Infections to Sustain Treatment (2011)in which he offers options, for donors, recipients, activists and other participants in the fight against HIV, to reverse the trend in the epidemic through better prevention. His previous publications include The Economics of Effective AIDS Treatment: Evaluating Policy Options for Thailand (2006). Other papers examine the economics of preventing and of treating malaria. In addition to ongoing work on the determinants of adherence to AIDS treatment in poor countries, he is working on optimal pricing of health care services at the periphery, on the measurement and explanation of the efficiency of health service delivery in poor countries and on optimal interventions to control a global influenza pandemic.
In addition to his numerous research projects at the Center, Over currently serves as a member of PEPFAR’s Scientific Advisory Board and as a member of the Steering Committee of the HIV/AIDS modeling consortium funded by the Bill & Melinda Gates Foundation.
Recruited to the World Bank as a Health Economist in 1986, Mead Over advanced to the position of Lead Health Economist in the Development Research Group, before leaving the World Bank to join the Center for Global Development in 2006. Each spring since 2005, he has taught a module on “Modeling the Cost-Effectiveness of Interventions against Infectious Diseases” as part of the master’s degree program in health economics for developing countries at the Centre d'Etudes et de Recherches sur le Développement International (CERDI) at the University of the Auvergne, Clermont-Ferrand, France.
"Evaluating the Impact of Organizational Reforms in Hospitals," with Naoko Watanabe, Chapter 3 in A. Preker and A.Harding (eds.) Innovations in health service delivery: The corporatization of public hospitals. World Bank, March 2003
The Center for Global Development presents a brownbag seminar
Financing Universal Health Coverage: Lessons and Pitfalls
Friday, February 8, 2013
**Please bring your lunch--beverages provided**
Director, Health Financing Policy
World Health Organization
With DiscussantAdam Wagstaff
Research Manager, Human Development & Public Services team
Development Research Group, World Bank
Hosted byMead Over
Center for Global Development
The idea of achieving universal health coverage was introduced in high income countries after World War II and has since influenced rationale for health coverage policy worldwide. However, many health financing reforms introduced in developing countries - often involving ideas borrowed from their developed neighbors - have exacerbated social inequalities and fragmentation in the name of "starting insurance." Fortunately, recent reforms in several low and middle income countries provide an alternative approach, combining streamlining revenue sources and using output- and needs-oriented provider payment. The WHO noted in the World Health Report 2000 that "the path to universal coverage must be home grown," but should still be guided by lessons from experience. Joseph Kutzin will illustrate examples, best practices and pitfalls.
This is a joint post with Mead Over and Denizhan Duran.
In mid-2011, one of the biggest developments in HIV/AIDS research took place. The HPTN 052 study found that early antiretroviral therapy treatment could reduce HIV transmission by 96% in couples where one partner is HIV positive and the other is HIV negative. The study was heralded as the breakthrough of 2011 by Science, and was hailed as a game changer by many others, including UNAIDS, The Economist and The Lancet. The World Health Organization wrote a comprehensive guideline for TasP, or treatment as prevention, in June 2012, asserting that “TasP needs to be considered as a key element of combination HIV prevention and as a major part of the solution to ending the HIV epidemic.”
Around this time last year, world leaders called for “the beginning of the end of AIDS” and an “AIDS-free generation”, and committed to reaching the ambitious disease-specific targets for HIV/AIDS: the virtual elimination of mother-to-child transmission; 15 million people on treatment and a reduction in new adult and adolescent HIV infections — all by a rapidly approaching 2015. And this year, US Secretary of State Hillary Clinton recommitted to these ambitious goals in the release of the PEPFAR Blueprint, saying “An AIDS-free generation is not just a rallying cry — it is a goal that is within our reach”. While the overarching World AIDS Day message remains clear – we have made tremendous progress thus far, and there is still a long way to go in the fight against AIDS – one question remains: is this really the beginning of the end of AIDS?
Braving freezing temperatures and gusty winds, hundreds of development experts and members of the policy community packed a Washington hotel ballroom for a panel discussion on the outlook for global development policy in the new Obama administration, just four days before the inauguration of the new U.S. president.
On the panel were David Gergen, senior political analyst for CNN, editor-at-large at U.S. News and World Report, and advisor to four presidents; CGD president Nancy Birdsall; and CGD senior fellows Steve Radelet, Vijaya Ramachandran, and David Wheeler. CGD’s Lawrence MacDonald was panel moderator.
Gergen, a member of CGD’s board of directors, saw both opportunities and risks for greater attention to development under the new administration. On the one hand, new president Barack Obama has first-hand experience of poverty in developing countries, having lived as a child in Indonesia. On the other hand, Gergen said, Obama faces a crowded policy agenda and the immense fiscal demands of responding to a global financial crisis.
“We have an incoming president who will embrace development and accept some sacrifices to further the development agenda,” Gergen said. He added, however, that an anticipated flood of countercyclical spending to stimulate the economy would be followed by extremely tight budgets, possibly squeezing out development initiatives.
Birdsall responded that it is precisely in such a situation that sound policy ideas, such as those offered in CGD’s newest book, The White House and the World: A Global Development Agenda for the Next U.S. President, are most valuable
Discussion with David Gergen on Obama's Development Policy (video)
White House and the World (book)
White House and the World (briefs)
“I would ask the president to be a champion for development,” said Birdsall. “It’s not just about foreign aid. It’s about using all the tools that the United States has, including trade as a development policy, how to deal with climate change, how to maximize the development benefits of bringing the private sector to Africa, and how to think across the board about the relevance of development in making Americans more prosperous,” she said.
Panel members suggested ways that the United States could have a big positive impact on the economies of poor countries by making policy changes that also benefit Americans and cost relatively little in budgetary terms.
Ramachandran, author of a forthcoming book on ways to improve the business climate in Africa, outlined how the United States can help to foster private-sector investment to address the continent’s chronic infrastructure shortages, especially roads and power. For example, she said, U.S. companies are leaders in small-scale renewable power that could provide off-grid electricity to rural Africans.
Wheeler, an expert on development and environmental issues, said that his conversations with senior officials in China and India have convinced him that they are prepared to act to reduce their countries’ greenhouse gas emissions—provided that the United States first moves aggressively to reduce its own emissions, which on a per-capita basis are many times higher.
Radelet, who served as a senior official in the U.S. Treasury under both Democratic and Republican administrations, and is co-chair of the Modernizing Foreign Assistance Network or MFAN, urged the administration to create a National Strategy for Global Development. This would provide the basis, he said, for a grand bargain between the legislative and executive branches on modernizing U.S. foreign assistance, including new legislation to replace the burdensome and outdated Foreign Assistance Act of 1961.
Gergen said that these and other ideas in The White House and the World were “critically important for the future of the world and for redesigning American international policy.”
During a lively audience Q&A session, topics included trade, migration, corruption, and the U.S. response to humanitarian crises.
Summing up, Gergen said “Obama is incredibly strategic. This is a man who thinks long-term.”
Birdsall interjected: “That is why Obama can be a champion for development.”
“That’s exactly right,” Gergen responded.
Using panel data from Mozambique collected in 2007 and 2008, the authors explore the impact of the food crisis on the welfare of households living with HIV/AIDS. While HIV households have not suffered more from the crisis than others, infected people who experienced a negative income shock also expereinced a reduction or a slower progression in outcomes when treating their illness.
At our recent event, “How Can Finance Ministries Support a Sustainable HIV Response?” representatives from PEPFAR and the US Department of Treasury came together to discuss an innovative partnership between them and with finance ministries around the world. The partnership aims to improve the coordination and productivity of resources devoted to combatting HIV/AIDS in low- and middle-income countries, and to strengthen the long-term feasibility of these efforts.
Our recent report on next generation financing models looks at how global health donors, specifically the Global Fund to Fight AIDS, Tuberculosis and Malaria, can enhance the health impact of grants by tying grant payments to achieved and verified results. Yet there are several ways to condition payments on performance, and some ways would likely work better than others. Can economic theory suggest specific features of contract designs which would generate more health for the money?
In the final installation of a three-part series, Mead Over estimates the fiscal burden of international AIDS treatment programs, and suggests ways that donors, governments, and patients can sustain current treatments while preventing future cases.
Navigating the global health funding landscape can be confusing even for global health veterans; there are scores of donors and multilateral funding mechanisms, each with its own particular structure, personality, and philosophy. For the uninitiated, PEPFAR, GAVI, PMI, WHO, the Global Fund, UNITAID, and the Gates Foundation can all appear obscure and intimidating. But if your head is spinning from acronym-induced vertigo, fear not! We are here to help you make sense of it all. How, you ask? With a clear method for donor identification: comparing the donors to your parents.
Senior fellow Mead Over estimates the effect of AIDS on poverty in South Asia and analyzes public policy options to help the region’s predominantly private health care systems meet the challenge of treating AIDS. He finds that South Asian governments should play a larger role in AIDS treatment than in other aspects of health care, in the interest of both efficiency and equity.