This is a joint post with Kate McQueston and Jenny Ottenhoff.
Universal health coverage (UHC) is now firmly on the global health agenda, and carries with it the ambitious goal of providing “access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost.” So where do we start? A critical first step to delivering on the aspirations of UHC is deciding which services and policies to prioritize and make available. While resources for health care are growing, they are not infinite and hard choices must be made.
Priority-setting processes for health spending specify at least a certain set of policies, services and technologies that will be financed and made available under UHC. Some will also indicate which services or technologies will not be funded and provided. Ideally, the design of a priority setting process is fair, transparent, inclusive and deliberative. And in the best cases, the selection of these services is based on cost-effectiveness and accounts for equity, financial protection and social values in a systematic way.
When priority-setting processes aren’t in place – that is, when resource allocation decisions are made based on past budgets or under pressure from interest group – less health is provided for every dollar spent. Evidence of suboptimal allocation abounds; India subsidizes open heart surgery while child vaccination rates remain low; Colombia purchases more analogous insulins per diabetic than any country in Latin America while diabetes prevention and management programs remain underfunded; and Egypt spent a fifth of its public spending on health to send a few fortunate people overseas for health treatments while a fifth of their children were stunted. (for more examples, see our report on priority-setting institutions here)
Under UHC, it will ultimately be up to countries to set their own priorities for health spending. And that’s great - reallocating a portion of public and donor monies toward the most cost-effective health interventions would save more lives and promote health equity. But too many low- and middle-income countries lack the fair and evidence-based processes and institutions needed to adequately inform funding decisions.
With that in mind, the Center for Global Development ran a working group on priority-setting institutions during 2011/12, recommending the creation and development of national and global systems to more rationally set priorities for public spending on health. The group called for an interim secretariat to incubate a global facility designed to help governments develop national systems and donors get greater value for money in their grants.
So we’re delighted to announce a new platform that does just that -- the international Decision Support Initiative (iDSI). Recently launched by NICE International, the iDSI will support low and middle income governments, and perhaps donors, in making resource allocation decisions for healthcare. Specifically, the initiative will share experiences, showcase lessons learned and identify practical ways to scale technical support for more systematic, fair and evidence informed priority setting processes. In strengthening priority-setting institutions, the iDSI will be a tool to both improve access to effective health interventions and the quality and efficiency of health care delivery. And importantly, it will help elevate the value of priority setting as a necessary, if not sufficient, condition for attaining and sustaining UHC.
The full announcement from NICE International on the iDSI can be found here and the strategic overview here. For more information on CGD’s work on Priority-Setting, see the report’s brief here and a wonkcast on the topic, here.