A NICE Idea for Priority Setting in Global Health – Amanda Glassman

March 31, 2014

In India, the government subsidizes open heart surgery but fails to provide sufficient vaccinations for all children. In Egypt, the government pays to fly affluent citizens overseas for advanced medical care, yet one out of five Egyptian children are stunted, meaning they are shorter or weigh less than they should for their age because of poor health and insufficient nutrition.

Developing countries and outside donors spend billions of dollars a year on health care in the developing world. Yet without systems for setting priorities, highly effective, low-cost treatments too often go unfunded even as public money is spent on much more expensive procedures.

What can be done? CGD senior fellow Amanda Glassman, my guest on this week’s Wonkcast, believes that part of the solution is to create a new institution that draws upon medical and scientific literature to support low- and middle-income governments and donors in resource allocation decisions for healthcare.  This recommendation was first put forth by CGD’s Priority-Setting Institutions for Global Health working group, co-chaired by Amanda and Kalipso Chalkidou from NICE International.  

I’ve invited Amanda on the show to tell me more about some encouraging news concerning international progress on health care priority setting:

“We learned that the Bill and Melinda Gates Foundation and the UK aid agency have funded an International Decisions Support Initiative (IDSI) at NICE International,“ a branch of the UK’s National Institute for Health and Care Excellence,” Amanda tells me.

Americans who care about development often look at the UK’s Department for International Development (DfID) with envy, so some may be surprised to learn that NICE is a separate entity whose primary job is to advise the UK’s national health service.

“They also have an arm that works internationally to help developing countries, and to some extent donors, develop their own processes for assessing cost-effectiveness,” Amanda explains. The new funding, a modest $3 million, will make it possible to extend this work.

“The idea is to show that institutions can be built in countries willing to prioritize spending according to value for money criteria,” Amanda explains. “In the next phase, we hope to see more funding going toward this kind of activity.”

Listen to the Wonkcast to learn more about how the new initiative will function, and the importance of tailoring recommendations to country characteristics and values.

“The point is to have a process or rules of the game that allow all kinds of considerations to be brought out and discussed in a transparent way, in an evidence-based way,” Amanda explains.  


CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.