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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
This blog post is co-authored with Martin Ravallion, who has been the Director of the World Bank’s Development Economics Research Group for several years and is currently Acting Chief Economist and Senior Vice President of the Bank. The blog is cross-posted on the World Bank site here.
These days there is a lot of discussion within development organizations and governments across the globe (including the World Bank) about how to assure a greater emphasis on development impact. It would no doubt help if senior management gave stronger verbal signals on the ultimate goals of the institution, and more actively supported staff to attain those goals. But such “low-powered incentives” have been tried before, and the problems seem to persist.
As the Global Fund’s November board meeting approaches – where the future of the Affordable Medicines Facility for Malaria (AMFm) hangs in the balance – there is much anxiety that AMFm will be terminated in 2013. The reason for such anxiety is clear: no donors have pledged funding commitments for after December 2012. But there’s another elephant in the room: the US government’s apparent lack of support, particularly its legislated “opt-in” stance on AMFm: “the Global Fund should not support activities involving the ‘Affordable Medicines Facility-malaria’ or similar entities pending compelling evidence of success from pilot programs as evaluated by the Coordinator of United States Government Activities to Combat Malaria Globally.” (Conversely, an opt-out stance would be to support AMFm unless no compelling evidence is presented.) This very specific and strict provision makes the AMFm’s continued survival all but impossible without an explicit endorsement by US Global Malaria Coordinator (currently Rear Admiral Tim Ziemer) who leads the US President’s Malaria Initiative (PMI) housed in the US Agency for International Development (USAID).
Two messages reigned supreme at last month’s International AIDS Conference (IAC) in Washington DC: 1) that there should be universal coverage of HIV/AIDS treatment and 2) that international funding for HIV/AIDS has been flat-lining recently and may even shrink. The most optimistic scenario to reach universal coverage will cost $22 billion dollars annually, which means raising an additional $6 billion per year. Clearly, the goal to provide treatment to the 34 million people currently living with AIDS, and the approximately 2.5 million newly infected each year, conflicts with the reality of shrinking aid budgets.
This month, both Health Affairs and the Journal of Acquired Immune Deficiency Syndrome (JAIDS) released special thematic issues on the US President’s Emergency Plan for AIDS Relief (PEPFAR) in which the articles – mainly commentaries but some analyses – provide an exceptionally positive readout on PEPFAR’s past performance and future direction. In principle, this is great – any insights into PEPFAR are always welcome, and it’s clearly valuable to discuss and disseminate lessons learned from the program. If these articles were posted on the PEPFAR website, or released as official PEPFAR reports, we wouldn’t bat an eye. But within scientific, peer-reviewed journals, the articles read more like PEPFAR PR rather than commentary and analysis from independent, third-party observers and stakeholders. A quick skim of the titles in the table of contents illustrates this point (see word cloud of selected title excerpts), and a closer look at the contributors sheds some light on why this may be the case: most authors of the articles are somehow affiliated with PEPFAR or with organizations that have received money from the program.
Yesterday was an exciting day for me. In a debate at the World Bank timed to coincide with the International AIDS Conference a colleague and I took an unpopular position against two development celebrities in front of a potentially hostile audience and changed some minds. The proposition was:
“Continued AIDS investment by donors and governments is a sound investment, even in a resource constrained environment”
The "Mukta" (meaning "Freedom") Project, as it is locally known, is an initiative of Pathfinder International, a partner of the Gates Foundation/Avahan Project in India. Pathfinder International works in 10 districts of Maharashtra state in India to reduce the prevalence of STIs and HIV/AIDS among female sex workers (FSWs), men who have sex with men (MSM), and their partners. This peer-led program works with a network of NGOs, private and public sector health sites, combined with community mobilization, and interaction with public health and other departments to create an enabling environment for this marginalized population. Through interventions like peer-based BCC, delivery of comprehensive healthcare services with a strong focus on quality STI management and care, and availability and utilization of free and socially marketed condoms, Mukta had reached over 25,000 FSWs and MSM who are at risk of being exposed to HIV and other STIs and reduced the STI rate among FSWs and MSM by over 30% by the end of its first phase. As the Mukta Project enters its second phase, please join us as Director Darshana Vyas discusses the successes and challenges of scaling up a prevention program, as well as transitioning program implementation and management to the government and communities, where empowerment is especially crucial to program sustainability.
CGD senior fellow Mead Over and Owen McCarthy offer a users' manual and Stata software to help students and instructors of public health, development economics, or health economics to project the future budgetary cost of AIDS treatment in poor countries and to explore the many factors affecting the calculation.
U.S. spending on global AIDS is widely seen as a significant foreign policy and humanitarian success, but this success contains the seeds of a future crisis. Treatment costs are set to escalate dramatically and new HIV infections continue to outpace the number of people receiving treatment. Three bad options thus loom ahead for U.S. foreign policy: indefinitely increase foreign assistance spending on an open-ended commitment, eliminate half of other foreign aid programs, or withdraw the medicine that millions of people depend upon to stay alive. CGD senior fellow Mead Over provides another option: implementing a sustainable policy that concentrates on prevention in order to drastically cut new infections while sustaining the reduction in AIDS-related deaths.
This dataset compiles selected global variables on AIDS and its treatment and prevention. The data are in the format developed by the Stata statistical software corporation and are intended for use with Over and McCarthy's AIDSCost package for the purpose of projecting the future budgetary cost of scaling up AIDS treatment.