Designing Health Policies

As developing countries begin to meet the first round of public health goals, they should put in place policies that anticipate the next.

Improving the health of the poor is at the top of the world’s development agenda; in fact, three of the UN’s nine Millennium Development Goals are health-related.

Around the world the rising wave of chronic disease is placing increasing strain on health system finances. Countries like the UK grapple with whether to cover expensive second-line cancer treatments that make only a marginal difference in life expectancy; in developing countries, meager resources and weak healthcare systems create very different but equally challenging cost-benefit questions. Add to that the fact that some clearly cost-effective solutions – such as malaria bed nets and using cooking stoves that are cleaner and safer – don’t work as anticipated when they come up against human behavior. As nations make progress toward eradicating malnutrition and stemming infectious diseases, they must put in place policies that anticipate the next round of health goals.

According to recent reports, progress on frontline issues has been good: in the first decade of the new millennium the number of people newly infected with HIV dropped by 33%, and global malaria deaths by around 26%. Both the maternal mortality rate and the mortality rate for children under five have nearly halved since 1990. There is much progress yet to be made on these indicators, especially in sub-Saharan Africa and South Asia; still, policymakers in developing countries are beginning to turn toward the next round of health-related  challenges – ones that high-income countries are already grappling with.

How should those policies be designed? Which lessons about what—and what not—to do can be gleaned from developed country policy innovations? What is the best system for achieving universal health coverage, and is it affordable? How can health care delivery systems designed to cure illness be re-engineered to better promote health? 

Driving bad medications out with good
Country: Uganda  |  Researchers: David Yanagizawa-Drott, Jakob Svensson, Martina Björkman-Nyqvist

We examined the market for antimalarial drugs in Uganda, which is rife with fake and low-quality medications, and found that the introduction of real medication sold at a low price by an NGO improved quality across the market. Biomedical misconceptions were common in this population, however, and the worse informed the customers, the weaker the effect of introducing quality products to the market.

Policy Partners: Living Goods and BRAC – Uganda

Funding: Children's Investment Fund Foundation, William F. Milton Fund (Harvard), and Harvard Center for Population
Measuring the effects of air and water pollution on child mortality
Country: India |  Researchers: Rema Hanna, Michael Greenstone, Eva Areco, Paulina Oliva

EPoD affiliates assembled some of the most comprehensive data files ever on pollution, regulation, and infant mortality in developing countries, and showed that that importing developed-country data to these contexts can create harmful inaccuracies, that regulations can work even countries with weak governance, and that bottom-up, market-based methods might work best – results that spurred on our environmental engagements.

Research Partner:
Funding: Harvard Center for Population and Development Studies, UCMexus

Assessing the long-run impact of improved cooking stoves
Country: India  |  Researchers: Rema Hanna, Ester Duflo

EPoD, Assessing the long run impact of cooking stovesIndoor cooking fires contribute to nearly two million deaths annually worldwide – more than malaria. When safe and cheap alternatives exist, why don’t people don’t use them? Our investigation into the issue raised important points about the difference between laboratory and real-world results and the necessity of taking human behavior into account when designing health-related products and policies.

Policy Partner: Gram Vikas, Orissa, India
Research Partner: J-PAL South Asia at IFMR – Chennai, India
Funding: MIT Energy Initiative, Centre for Microfinance at IFMR, the Institut Veolia Environement, and the Children's Investment Fund Foundation
Reducing hospital staff absenteeism with multi-function devices
Country: India |  Researchers: Rema Hanna, Iqbal Dhaliwal

A survey in Karnataka, India showed that doctors, nurses and other staff at government hospitals were absent about 50% of the time. We are developing and testing systems to improve attendance, such as a fingerprint check-in system that sends data to a central control room, and a system of rewards and penalties linked to this continuous data stream. If successful, the program could be scaled up across all primary health centers in the state.

Policy Partner: National Rural Health Mission, Karnataka, India
Research Partner: J-PAL South Asia at IFMR
Funding: USAID