Priority Setting in Health: Building Institutions for Smarter Public Spending — Amanda Glassman

Given a small budget, would it make sense to vaccinate 10 children against childhood diseases, or provide medicines to one woman which would prevent transmission of HIV to her unborn child?In today’s global health arena where resources are limited and demands are growing, policy makers constantly face such budgetary dilemmas with little expert guidance.My guest on this week’s Wonkcast is Amanda Glassman –a research fellow and director of CGD’s global health program. Her recent report, Priority Setting in Health: Building Institutions for Smarter Public Spending, draws on the expertise of a CGD working group to offer recommendations for improving the allocation of scarce health funding, despite political and bureaucratic constraints.“This report is really about saving more lives for the money,” Amanda explains.  “In a context of limited resources you have to set priorities. When faced with a patient who needs something, most clinicians would immediately like to provide everything possible. But in really resource-constrained environments you have to make some horrible choices.”Lack of mechanisms for identifying health priorities can result in some seemingly nonsensical allocations, Amanda tells me.For example, in Egypt, one out of five children are stunted due to poor nutrition but 20 percent of public spending on health is used to send patients overseas for treatment. In India, six out of ten children are not fully vaccinated against common childhood diseases, while public funds are spent on open-heart surgery.The solution recommended by the working group, Amanda tells me, is the creation of a global health technology assessment facility, an institution that would provide technical and consultative support to global funding agencies and developing country governments.The recommendation is based on the success of national health priority setting institutions in countries as diverse as Poland and Thailand. The best known of these is the UK's National Institute for Health and Clinical Excellence (NICE). Amanda says that Nice “carries out the gold standard of examining the evidence, deliberating around that evidence, and taking a decision on both that evidence and a deliberative process.”“What we’re recommending is a global health technology assessment facility that could carry out analyses that would be better done together in groups, so you wouldn’t have to repeat studies in different countries,” Amanda explains.“The facility would also advise countries in setting up their own processes to consider the evidence and collect the local data that’s necessary to link that data to a deliberative process and to decision making. “I ask Amanda who would take the reins of this new global health technology assessment facility. More specifically, could the World Health Organization (WHO) take the lead?Amanda tells me that while the WHO is an important candidate, it may not have the capacity to start a new program given budgetary constraints. However, there could be a natural role for the UK government to support this facility because they have been a leader in relating budget decision making to this kind of analysis and deliberation.Regardless of who is at the helm, Amanda tells me this type of work is extremely important.“It’s important to have the evidence and it’s important to compare it to what else you could be funding. It’s also important to deliberate with all the different groups and take a decision that’s informed by everyone’s evidence, information, and viewpoints,’ she says.Listen to the Wonkcast to learn more. If you have iTunes, you can subscribe to get new episodes delivered straight to your computer every week. My thanks to Alexandra Gordon for her production assistance on the Wonkcast recording and for assistance in drafting this blog post.