Innovations in Health Service
Evaluation Techniques
GHEC
Transcending Global Health Barriers:
Education & Action UNIVERSITY OF WASHINGTON
April 3 - 5, 2009

Unprecedented rise in resources for improving health…
19
Billions
18
17
US NGOs
16
Other US Foundations
15 Gates Foundation
European Commission
14
UN System
13 GAVI & GFATM
Regional Development Banks
12
World Bank IDA & IBRD
11
Direct Bilateral ODA
10
9
8
7
6
5
4
3
2
1
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Development Assistance (Billions US$) for Health by Institution, 1990 - 2006
2

…. proliferation of global goals, funders and initiatives
Goals
• 1978: Alma-Ata: Primary Health Care and Health for All
• 1984: Universal childhood immunization by 1990
• 2000: Millennium Development Goals
• 2003: 3 by 5 – 3 million people on antiretroviral drugs by 2005
• 2008: Malaria Elimination
Private philanthropic organizations
• 2000: Bill and Melinda Gates Foundation
• 2006: Warren Buffet pledged additional US$30 to BMGF
Global Health Initiatives
• 2000: Global Alliance for Vaccines and Immunizations (GAVI)
• 2002: Global Fund for Aids, Tuberculosis and Malaria (GFATM)
• 2003: US President’s Emergency Plan for AIDS Relief (PEPFAR)
• 2005: US President’s Malaria Initiative (PMI)
• 2007: International Health Partnership (IHP+)
3

…implementation of national health sector reforms
2001: Thailand Universal Coverage
• 30 Baht Scheme
2003/04: Mexico Health Sector Reforms
• System of Social Protection in Health including Seguro Popular
2005: Indian National Rural Health Mission
• Health worker training and infrastructure development
4

A host of questions for policy… and few answers…
• How do levels and the distribution of population health across countries
compare?
• How do different health systems compare?
• What progress is being made towards health goals?
• How much of this progress can be attributed to specific initiatives (e.g. GAVI)
or health sector reforms (e.g. Seguro Popular)?
5

… increasing financial constrains
• Increased focus on program results and demonstrated returns on investment
• Greater pressure to cut funding for programs which are not effective or not
cost effective
6

…require new approaches to monitoring and evaluation
• Development of new statistical methods
• Adoption of solutions to known barriers in evaluation
• Independent evaluations
• Examination of health impacts of programs
• Transparency and reproducibility of methods
• Increased data collection and public access to primary data
• Development of global standards incorporating these solutions
7