Priority-Setting in Health:
Building Institutions for Smarter Public Spending
A report of the Center for Global Development’s Priority-Setting Institutions for Global Health Working Group
Amanda Glassman and Kalipso Chalkidou, Co-chairs – 2012
Available online PDF [101p.] at: http://bit.ly/LYHE9Z
“…….Health donors, policymakers, and practitioners continuously make life-and-death decisions about which type of patients receive what interventions, when, and at what cost. These decisions—as consequential as they are—often result from ad hoc, nontransparent processes driven more by inertia and interest groups than by science, ethics, and the public interest. The result is perverse priorities, wasted money, and needless death and illness.
Examples abound: In India, only 44 percent of children 1 to 2 years old are fully vaccinated, yet open-heart surgery is subsidized in national public hospitals. In
Reallocating a portion of public and donor monies toward the most cost-effective health interventions would save more lives and promote health equity. The obstacle is not a lack of knowledge about what interventions are best, but rather that too many low- and middle-income countries lack the fair processes and institutions needed to bring that knowledge to bear on funding decisions.
With that in mind, the Center for Global Development’s Priority-Setting Institutions for Global Health Working Group recommends creating and developing fair and evidence-based national and global systems to more rationally set priorities for public spending on health. The group calls for an interim secretariat to incubate a global health technology assessment facility designed to help governments develop national systems and donors get greater value for money in their grants…”
Content:
Executive summary
Chapter 1 Finite resources, unlimited demand
A framework of de facto rationing mechanisms
The timing of rationing: ex ante and ex post
The rationing implications of allocation between areas and within levels of the health system
In a practical sense, however, priority is often revealed by action and spending
Rationing is constrained by historical and political processes
Why the Priority-Setting Institutions in Health Working Group?
Chapter 2 The opportunity: evidence, economies, and donor agendas converge to make explicit rationing necessary and possible
Force 1: A growing body of evidence suggests huge health gains are possible
Force 2: Public spending on health is growing in low- and middle-income countries
Force 3: Donors are beginning to restrict health aid flows, putting renewed emphasis on impact, co-financing, and value for money
Chapter 3 Considering cost-effectiveness: the moral perspective
The cost-effectiveness landscape in global health 1
The moral case
Challenges addressed
Chapter 4 Progress on policy instruments for explicit priority setting
Essential medicines lists
Health benefits plans
National Immunization Technical Advisory Committees
Health technology assessment agencies
Case studies
Chapter 5 Donors and decisions
Development assistance partners’ support to recipient country priority-setting processes
GAVI Alliance prioritization mechanisms
Global Fund prioritization mechanisms
Chapter 6 Building institutions for explicit priority setting
Institutionalizing health technology assessment systems in low- and middle-income countries
Chapter 7 Recommendations for action
Looking ahead
Appendix A – B
Appendix C Current international support to priority setting in low- and middle-income countries
Appendix D Sources for low- and middle-income countries with health benefits plans
References
KMC/2012/HSS
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