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Since Monday, leading health officials from around the world have been meeting in Geneva, Switzerland for the 72nd World Health Assembly (WHA). Over the course of eight days, country delegations are reviewing, discussing, and shaping the policies, strategies, and budgets of the World Health Organization (WHO) for the coming year. Among the key topics up for discussion: emergency preparedness and response; polio eradication and transition; the effects of climate change on health; and an updated strategy for achieving universal health coverage (UHC).
Following the 40th anniversary of the Declaration of Alma Ata last October, this year’s WHA offers a window of opportunity to reflect on our collective progress toward quality healthcare for all—and the WHO’s role in helping make that dream a reality. Despite the global goal of reaching UHC by 2030, basic healthcare remains out of reach for at least half of the world’s population. Many countries are growing wealthier and transitioning from aid, yet health budgets often remain highly constrained—requiring governments to make tough choices about how best to expand UHC coverage. Many of these same countries look to the WHO as the leading source of guidelines and recommendations, which in turn influence local resource allocation. In this context, how can the WHO sharpen its role in supporting UHC, helping country health systems provide equitable, high-quality, and accessible care while recognizing local realities?
At CGD, we’ve long argued that economic evidence, used within a fair, consistent, transparent, and participatory process, is a key tool to help inform difficult coverage decisions in the face of budget constraints. Economic evidence helps us understand the opportunity cost of a given use of funds; that is, if a low- and middle-income country (LMIC) government were to implement a specific health intervention, what other opportunities to serve its population would be foregone? By allowing us to confront tough trade-offs head on, economic evidence can help ensure that a population receives equitable access to health services—avoiding implicit rationing and neglect of the most vulnerable.
Yet use of economic evidence by the WHO to inform recommendations and guidelines remains limited and often ad hoc, even when those guidelines have direct and major implications for countries’ resource allocation choices. As a result, WHO guidelines may, at times, lead to a net decrease in health if fully implemented by LMICs. CGD’s new report, Understanding the Opportunity Cost, Seizing the Opportunity: Report of the Working Group on Incorporating Economics and Modelling in Global Health Goals and Guidelines (detailed in this brief), offers a better path forward. In short, we urge the WHO to routinely incorporate economic evidence into its guideline development process, thereby helping countries to make more efficient health spending decisions and best serve their populations.
Designing evidence-based WHO guidelines: A better way
The report of the CGD Working Group on Incorporating Economics and Modelling in Global Health Goals and Guidelines—chaired by Paul Revill and Amanda Glassman—offers recommendations to promote better use of economic evidence in the development of guidelines and other priority-setting recommendations under two objectives:
Recommendation 1: Empower national governments to set evidence-based local health priorities for their populations
At the most foundational level, international agencies should recognize that decisions around whether a country should adopt or fund any given health interventions should be made at the national level or lower by decision makers who represent their citizens. These decisions should be based on standardized processes and grounded in local evidence on the efficacy and health impact of a given intervention per dollar spent.
International agencies should increase investments in local analytical capacity. Technical support and funding for locally led research activities can increase the generation and use of country-specific evidence.
International agencies should promote cross-country and interregional collaboration through regional bodies, individual partnerships, and other avenues. This allows countries to learn from and build on relevant work conducted by other agencies in the area, saving valuable time and resources.
Recommendation 2: Increase the value and local relevance of WHO guidelines
When guidelines are meant to directly inform how resources are allocated, economic evidence should be considered within the WHO guideline process. Where locally relevant economic factors are not considered within a guideline itself, the WHO should suggest how the evidence in the guideline can be used as part of other local decision-making processes (such as nationally led health technology assessment).
For some guidelines, rigorous economic modelling may not be feasible. The extent to which economic frameworks are used should always be tailored to specific guidelines in line with available data and relevance of economic analysis.
Drawing upon expert advice, the WHO should establish clear and robust principles, methods, and standards for economic evidence to reliably inform resource allocation decision making. To ensure their reliability, all economic models and analyses used in guideline development should be subjected to independent peer review.
Funding institutions and stakeholders should increase financial resources dedicated to the generation and use of economic evidence to inform resource allocation.
Resource prioritization and guidelines informed by better economic assessment and modelling can improve the efficiency of health expenditure—that is, the same budget can achieve greater and more equitable health gains. Use of economic evidence will therefore be vital if we want to achieve UHC by 2030—and we urge the WHA to elevate the issue during this week’s deliberations.
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.
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