International Development

Power and Priorities: The Growing Pains of Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”

Power and Priorities: The Growing Pains of Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”
Int J Health Policy Manag 2015, 4(x), 1–2

Karen A. Grépin

Shiffman has argued that some actors have a great deal of power in global health, and that more reflection is needed on whether such forms of power are legitimate. Global health is a new and evolving field that builds upon the historical fields of public and international health, but is more multi-disciplinary and inter-disciplinary in nature. This article argues that the distribution of power in some global health institutions may be limiting the contributions of all researchers in the field

China’s role as a global health donor in Africa: what can we learn from studying under reported resource flows?

China’s role as a global health donor in Africa: what can we learn from studying under reported resource flows?
Globalization and Health 2014, 10:84 doi:10.1186/s12992-014-0084-6

Grépin, KA, Fan, VY, Shen, GC, Chen L


There is a growing recognition of China’s role as a global health donor, in particular in Africa, but there have been few systematic studies of the level, destination, trends, or composition of these development finance flows or a comparison of China’s engagement as a donor with that of more traditional global health donors.


Using newly released data from AidData on China’s development finance activities in Africa, developed to track under reported resource flows, we identified 255 health, population, water, and sanitation (HPWS) projects from 2000–2012, which we descriptively analyze by activity sector, recipient country, project type, and planned activity. We compare China’s activities to projects from traditional donors using data from the OECD’s Development Assistance Committee (DAC) Creditor Reporting System.


Since 2000, China increased the number of HPWS projects it supported in Africa and health has increased as a development priority for China. China’s contributions are large, ranking it among the top 10 bilateral global health donors to Africa. Over 50% of the HPWS projects target infrastructure, 40% target human resource development, and the provision of equipment and drugs is also common. Malaria is an important disease priority but HIV is not. We find little evidence that China targets health aid preferentially to natural resource rich countries.


China is an important global health donor to Africa but contrasts with traditional DAC donors through China’s focus on health system inputs and on malaria. Although better data are needed, particularly through more transparent aid data reporting across ministries and agencies, China’s approach to South-South cooperation represents an important and distinct source of financial assistance for health in Africa.

Why Theory and Practice are Different: The Gap Between Principles and Reality in Subnational Revenue Systems

Why Theory and Practice are Different: The Gap Between Principles and Reality in Subnational Revenue Systems
In Richard Bird and Jorge Martinez Vazquez, eds. Taxation and Development: The Weakest Link. (Cheltenham, UK and Northampton, MA: Edward Elgar, 2014).

Paul Smoke

Ensuring adequate subnational revenues is a core concern of fiscal decentralization. Available empirical evidence suggests that subnational revenue generation in developing countries rarely meets needs and expectations, even where conventional advice has been or seems to have been followed. Are mainstream principles inappropriate, or are they just poorly applied? This chapter argues that both factors are often at play. Basic principles can be challenging to use, ignore certain critical factors, and say nothing about implementing the often demanding reforms they call for. The chapter outlines and illustrates common factors and dynamics at play and suggests how policy analysts might use and move beyond the mainstream principles to define more pragmatic and sustainable paths to subnational revenue reforms.

Comparison of rehospitalization rates in France and the United States

Comparison of rehospitalization rates in France and the United States
Gusmano, MK, et al. Journal of Health Services Research & Policy; 20(1): 18-25.

Gusmano, MK. Rodwin, VG. Weisz, D. Cottenet, J. and Quantin, C.

Objective: To compare rates of 30-day all-cause rehospitalization in France and the US among patients aged 65 years and older and explain any difference between the countries.

Methods: To calculate rehospitalization rates in France, we use an individual identifying variable in the national hospital administrative dataset to track unique individuals aged 65 years or more hospitalized in France in 2010. To calculate the proportion of rehospitalized patients (65þ) who received outpatient visits between the time of initial discharge and rehospitalization, we linked the hospital database with a database that includes all medical and surgical admissions. We used step by step regression models to predict rehospitalization.

Results: Rates of rehospitalization in France (14.7%) are lower than among Medicare beneficiaries in the US (20%). We find that age, sex, patient morbidity and the ownership status of the hospital are all correlated with rehospitalization in France.

Conclusions: Lower rates of rehospitalization in France appear to be due to a combination of better access to primary care, better health among the older French population, longer lengths of stay in French hospitals and the fact that French nursing homes do not face the same financial incentive to rehospitalize residents.

Banks and Microbanks

Banks and Microbanks
Journal of Financial Services Research (2014) 46:1–53. DOI 10.1007/s10693-013-0177-z

Robert Cull, Asli Demirgüç-Kunt, and Jonathan Morduch

We combine two datasets to examine whether the presence of banks affects the profitability and outreach of microfinance institutions.We find evidence that competition matters. Greater bank penetration in the overall economy is associated with microbanks pushing toward poorer markets, as reflected in smaller average loans sizes and greater outreach to women. The evidence is particularly strong for microbanks relying on commercial-funding and using traditional bilateral lending contracts (rather than group lending methods favored by microfinance NGOs). We consider plausible alternative explanations for the correlations, including relationships that run through the nature of the regulatory environment and the structure of the banking environment, but we fail to find strong support for these alternative hypotheses.

Using Comparative Analysis to Address Health System Caricatures

Using Comparative Analysis to Address Health System Caricatures
International Journal of Health Services; 44(3): 547–559. doi:

Gusmano, MK. Rodwin, VG. and Weisz, D.

To learn from health care systems abroad, we must move beyond simplistic characterizations and compare different systems with respect to salient performance measures. Despite findings from recent cross-national studies suggesting that many health care systems outperform the United States, claims by U.S. public officials often fail to acknowledge the actual accomplishments of health care systems abroad. We document significant variation among the United States and France, Germany, and England, which provide universal coverage, albeit in different ways. As previously documented, the United States has the highest rate of mortality amenable to health care. We extend this work by adding two indicators: (a) access to timely and effective primary care as measured by hospital discharges for avoidable hospital conditions; and (b) use of specialty services as indicated by coronary revascularization (bypass surgery and angioplasty), adjusted for the burden of coronary artery disease. Our findings indicate that: (a) the United States suffers the gravest consequences of financial barriers to primary care; (b) in all four countries, older people (65+) receive fewer revascularizations than their younger counterparts once we account for disease burden; and (c) in France, patients receive the most revascularizations, after adjusting for the burden of disease.

Decentralization in Uganda: Reforms, Reversals, and an Uncertain Future

Decentralization in Uganda: Reforms, Reversals, and an Uncertain Future
In Tyler Dickovich and James Wunsch, eds., Decentralization in Africa: A Comparative Perspective. (Boulder, CO: Lynne Rienner Publishers, 2014).

Smoke, P., W. Muhumuza and E. Ssewankambo

Uganda was long considered one of the most successful cases of public sector devolution in the developing world. The post-conflict national government began robust empowerment of local governments in the early 1990s. The drive for reform emerged largely from domestic political forces with little involvement of the external donor agencies that have often promoted decentralization in countries with similar development profiles. Two decades after this highly touted reform began, the system has severely deteriorated on almost every aspect by which decentralization is usually judged. This chapter documents the economic, political and social dynamics that led to the rise of decentralization and also laid the foundation for its decline. The chapter concludes by suggesting possible future scenarios for the intergovernmental system in Uganda and drawing potential lessons for other countries considering such bold reforms.

‘Big Push’ To Reduce Maternal Mortality In Uganda And Zambia Enhanced Health Systems But Lacked A Sustainability Plan

‘Big Push’ To Reduce Maternal Mortality In Uganda And Zambia Enhanced Health Systems But Lacked A Sustainability Plan
doi: 10.1377/hlthaff.2013.0637 Health Aff June 2014 vol. 33 no. 6 1058-1066

Margaret E. Kruk, Miriam Rabkin, Karen Ann Grépin, Katherine Austin-Evelyn, Dana Greeson, Tsitsi Beatrice Masvawure, Emma Rose Sacks, Daniel Vail and Sandro Galea

In the past decade, “big push” global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. We evaluated the first six to twelve months of the program’s implementation, its ownership by national ministries of health, and its effects on health systems. The project’s impact on maternal mortality is not reported here. We found that the Saving Mothers, Giving Life initiative delivered a large “dose” of intervention quickly by capitalizing on existing US international health assistance platforms, such as the President’s Emergency Plan for AIDS Relief. Early benefits to the broader health system included greater policy attention to maternal and child health, new health care infrastructure, and new models for collaborating with the private sector and communities. However, the rapid pace, external design, and lack of a long-term financing plan hindered integration into the health system and local ownership. Sustaining and scaling up early gains of similar big push initiatives requires longer-term commitments and a clear plan for transition to national control.


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