[review] Achieving a “grand convergence” in global health…

Achieving a “grand convergence” in global health: modeling the technical inputs, costs, and impacts from 2016-2030

article by Colin Boyle, Carol Levin, Arian Hatefi, Solange Madriz and Nicole Santos; part of the “Grand Convergence in Global Health” PLos Collection.

The authors estimate investment costs necessary to achieve the “Grand Convergence” goals by 2030. Their conclusion is that convergence – to reduce infectious, child and maternal mortality to low levels universally – is possible through “effective scale up of proven health interventions, strengthening of health systems, and sustained investment in innovation” (Boyle et al., p. 3).

The study is based on the investment case generated by the UN Interagency OneHealth Tool (OHT), adding to it estimated costs of (i) health system strenghtening (HSS); (ii) research and development (R&D) costs; (iii) scaling-up costs; and (iv) neglected tropical diseases (NTDs)-related costs.

HSS costs were projected based on known estimates and calculated for 49 low-income countries (LICs) and 3 large lower-middle income countries (LMICs). R&D costs for LICs are estimated at US$3 billion per year based on the Consultative Expert Working Group on Research and Development (CEWG) recommendation. An enhanced scenario is created in which that amount is spent yearly, which delivers a 2% benefit across all indexes – child mortality, stillbirths etc. -, as opposed to a non-enhanced scenario in which investments on R&D are kept constant.

In regard to NTDs, the authors chose five of them which are the most amenable to very low-cost mass drug administration: oncocerchiasis, lymphatic filariasis, schistosomiasis, blinding trachoma and soil-transmitted helminths. They estimate annual costs of US$300-400 million up to about the year 2020, when costs would begin to fall due to reduction in transmissions and in the burden of disease.

These lines of projections are then analyzed under both a conservative, constant investment rates scenario, and an enhanced investment in R&D scenario. In LICs, this amounts to 6 million more deaths averted in the enhanced scenario compared to the conservative one. In LMICs, the number would be 6,6 million deaths averted in the enhanced R&D investment scenario. In total numbers, deaths averted would be as followed (ibidem, p. 12):

In LICs, the investments to scale up critical interventions strengthen health systems, and implement new tools would avert more than 60 million deaths (including stillbirths) over this 19-year period compared to the scenario where coverage is maintained at current levels. In LMICs, the total number of deaths averted would be more than 70M over this time period. Roughly two-thirds of these deaths averted would be children under 5.

The difference is due not only to the benefit brought by the R&D investments in the form of new health technologies, but also the spillover effects of strengthening and broadening coverage, building infrastructure and training personnel.

The total annual incremental costs estimated to achieve the grand convergence would be of US$22-27 billion per year for LICs and an increase from US$35 billion in 2016 to US$56 billion in 2030 for LMICs. Annual global R&D incremental increase of spending would have to be US$3 billion, plus US$300-400 million for NTDs. Overall, this would mean an average annual incremental cost of approximately US$62 billion in 2015 and US$86 billion in 2030.

The authors consider that, while these figures may seem too much compared to current spending, the perspective of GDP growth of around trillions of dollars in LICs and LMICs in the period studied indicate that these costs might be met even solely from domestic investments in some cases. On top of that, the authors highlight the benefits of adopting a strategy directed at achieving a grand convergence, which encompasses synergies in health benefits that may reach other health issues not included in the study.

References deserving further study:

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