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Sunday, January 21, 2018

Heller Faculty Notes

Meeting global health needs effectively with limited resources

A conversation with A.K. Nandakumar, Professor of the Practice

Allyala Krishna Nandakumar (Nanda), PhD, is a Professor of the Practice at Brandeis University where he is the Director of the PhD Program at the Heller School for Social Policy and Management and is the founding Director of the Institute for Global Health and Development. His association with the Heller School began in 1991 and since then he has held various positions including those of Associate Professor and Director of the MS Program in International Health Policy and Management. Nanda was recently appointed as the first Chief Economist for Global Health at U.S. Agency for International Development (USAID). He is an internationally recognized health economist, known specifically for his work in resource tracking, health financing, and healthcare policy and research.

A former Indian Administrative Services Officer, Nanda’s thinking is framed by the importance of governance, driven by the need for greater accountability arising from limited resources and a growing demand to demonstrate results. After leaving the Indian Administrative Service Nanda was an Assistant Professor at the Harvard School of Public Health, a Principal Associate with Abt Associates and a Senior Health Economist with RTI International. He took a leave of absence from Brandeis to work at the Bill and Melinda Gates foundation as a Senior Program Officer where he assisted with the development of the Global Health Delivery Area strategy, the India strategy and also represented the Foundation in international working groups such as the GAVI Health System Strengthening Task Team and the AIDS2031 Cost and Financing Working Group. Nanda has also worked as a Director in the Emerging Markets Group at Deloitte Consulting. His recent research has focused on the fungibility of donor assistance, factors affecting technology adoption in low- and middle-income countries, the linkages between health expenditures and maternal and infant mortality, and the relationship between growth in a country’s income and its healthcare spending. He contributed to the World Bank-led development of a Global Strategy for the Institutionalization of National Health Accounts and the USAID-led effort on developing a global strategy for Resource Tracking. He was among the experts who were invited to review and contribute to the development of the Resource Tracking component of the Accountability Commission on Women’s and Children’s Health.

Nanda has a Master of Science Degree in Mathematics from Bangalore University where he specialized in the General and Special Theory of Relativity and a PhD in Economics from Boston University. Nanda has worked and conducted research in several countries, including Bangladesh, Egypt, India, Jordan, Kenya, Lebanon, Mongolia, Rwanda, Tonga, Western Samoa, United States, Sudan, Yemen and Zambia.

Q: What interests you about global health and development?

A: If you look at the distribution of the burden of disease globally, over 85% of that burden is in low- and middle-income countries. And then if you look at where the global resources go, only 15% of the money actually goes to low- and middle-income countries. This means that 85% of the money is spent on dealing with 15% of the global burden.

The real question when we look at the global health financing architecture is this imbalance between the needs and the financing resources available to meet these needs. It requires us to learn how to optimize impact and outcomes with very limited financial resources. Another issue is that in high-income countries, most of the money comes from public sources, while in low-income countries, the vast majority of the money either comes from people paying out of pocket or from donor assistance. The fragmentation and complexity of financing in these countries leads to interesting challenges regarding the most efficient way to mobilize and allocate money. These are problems of equity, sufficiency, and how to spend most effectively.

Q: What should the American public know about global health and development?

A: I think there is a myth that the United States spends a huge amount of money on foreign aid. The U.S. actually spends a very small proportion of its GDP on international assistance. Even so, the U.S. is the single largest financier of donor-to-global health in the world. I think this aid has been instrumental in dealing with major global health problems, such as maternal/infant mortality and AIDS, over time.

People need to realize that while we are not spending a lot of money proportionally, the impact that the U.S. has on the lives of the people who need it most is tremendous, and therefore there is a need for the U.S. to do more and not less. Even in today’s very resource-constrained environment, it would be a great pity if U.S. international assistance were scaled back.

Q: What are your broad areas of research and inquiry?

A: My team has focused on two broad areas of investigation. The first is looking at whether some of the hypotheses that we believe hold true in high-income countries also hold in low- and middle-income countries. What we have found seems to indicate that this is not the case. For example, our research has shown that the adoption and diffusion of technologies occurs for different reasons in high-income versus low- and middle-income countries.

The second issue that we are investigating is how to understand and quantify the flow of resources going to health from all sources and overlay on this an accountability dimension. For example, we are examining why so much money is being spent on malaria and yet there doesn't seem to be a commensurate impact. So these are the two broad areas of research and inquiry that we are pursuing: both understanding resource flows and how the funds are being used.

Most of what I do is fairly quantitative. The methods I use to investigate these issues are sophisticated econometric methods. However, my team and I spend a fair amount of time translating this research into policy so that we can present it to different audiences. We work with very senior policymakers in countries, including ministers of health and officials from ministries of finance, so the idea is to translate our research into language that practitioners understand and policymakers can use.

Q: What are your future goals?

A: I am really excited about my new role as the Chief Economist for Global Health at USAID. The global agenda is that health is dynamic and economic transition will mean a number of countries will see increasing incomes and therefore the ability to increasingly fund their health needs. This means agencies such as USAID will need to redefine their role as well as their model for engaging with countries.  There is increasing focus on ensuring both equity and value for money and this is where the application of health economics becomes very important. I am grateful to be able to shape the global discussion in these areas. Equally valuable is the ability to bring my learning to the classroom at Heller.

Heller has always had a top-notch PhD program. It has recently undergone a curriculum review that makes our offering even more rigorous and addresses the needs of the next generation of students. I am looking forward to increasing the profile of the PhD program and attracting even stronger students to Heller.

I am convinced that the Institute for Global Health and Development is going to serve an important purpose in translating research into practice and producing the rigorous analyses that are needed in this field.

Q: Is there anything else that you would like prospective students and colleagues to know about the Heller School?

A: I would like people to know that the Heller School is a very special place. At Heller and in all the research and policy institutes, we genuinely care about social justice. We invest a tremendous amount of time and resources in not only attracting the best students, but also in making sure they receive the best education and mentoring. And we have such a diverse group of researchers and faculty. My colleagues and I have rich diversity in our past positions, both in academia and in the field, and often these relationships with nonacademic institutions continue while we are at Heller. The faculty are lawyers, political scientists, anthropologists, economists, sociologists...It makes for a unique, interdisciplinary and enriching environment. I think it’s the best place a person can be.

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