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evidence-informed policy, health technology assessment, priority-setting, universal health coverage
Kalipso Chalkidou is the Director of Global Health Policy and a Senior Fellow at the Center for Global Development. Previously, she was the Director of Global Health and Development Group at the Institute of Global Health Innovation, Imperial College London, helping governments build technical and institutional capacity for improving the value for money of their healthcare investment. She is interested in how local information, local expertise, and local institutions can drive scientific and legitimate healthcare resource allocation decisions whilst improving patient outcomes.
She has been involved in the Chinese rural health reform and also in national health reform projects in the USA, India, Colombia, Turkey and the Middle East, working with the World Bank, PAHO, DFID and the Inter-American Development Bank as well as national governments. Between 2008 and 2016 she founded and ran NICE International, a non-profit group within the UK’s National Institute for Health and Care Excellence (NICE).
Culyer, Anthony J., and Kalipso Chalkidou. "Economic Evaluation for Health Investments En Route to Universal Health Coverage: Cost-Benefit Analysis or Cost-Effectiveness Analysis?" Value in Health, July 2018. (Open Access)
With aid budgets shrinking and even low-income countries increasingly faced with cofinancing requirements, this is the right time for global health funders such as the Global Fund and their donors to formally introduce Health Technology Assessment (HTA), both at the central operations level and at the national or regional level in recipient countries. In this CGD Note, we explain why introducing HTA is a good idea. Specifically, we outline six benefits that the application of HTA could bring to the Global Fund, the countries it supports, and the broader global health community.
In April this year, the National Academies of Science, Engineering, and Medicine (NASEM) published a report making the case for “Integrating Clinical Research into Epidemic Response.” As reflected in its title, the 250-page-plus-appendices report makes a strong evidence-informed argument for integrating health service delivery with clinical research conducted during epidemics. The goal is to produce critical information on the efficacy and safety of potential therapeutics and vaccines for tackling such epidemics after they occur, or, better still, for preventing them from happening. Earlier this week, the group reconvened at the Wellcome Trust to discuss “what next.” The need to focus on systematic support and funding for the data collection and research functions in outbreak-affected countries came out again as the top priority.
Vaccinate children against measles and mumps or pay for the costs of dialysis treatment for kidney disease patients? Pay for cardiac patients to undergo lifesaving surgery, or channel money toward efforts to prevent cardiovascular disease in the first place? For universal health care (UHC) to become a reality, policymakers looking to make their money go as far as possible must make tough life-or-death choices like these.
Many low- and middle-income countries aspire to universal health coverage (UHC), but for rhetoric to become reality, the health services offered must be consistent with the funds available, which may require tough tradeoffs. An explicit health benefits package—a defined list of services that are and are not subsidized—is essential in creating a sustainable UHC system.
Global Burden of Disease (GBD) country rankings can strengthen the case of advocates at global and national levels for prioritising investment towards the major drivers of mortality and morbidity. But as discussed in our earlier blog post, when it comes to informing specific investment cases within these broader priorities, GBD data alone are not enough to allow consideration of trade-offs and of opportunity costs of alternative investment choices addressing the same problem. The next step in using data to trigger action ought to be the generation, in conjunction with domestic stakeholders, of what we call below “super-local data.”
Earlier this month, the first analysis of countries’ progress towards attaining the health-related Sustainable Development Goals (SDGs) was published in the Lancet. The Institute for Health Metrics and Evaluation (IHME) used Global Burden of Disease Data (GBD 2016) to create an index for 37 (out of 50) health-related SDG indicators between 1990–2016, for a total of 188 countries. Based on the pace of change recorded over the past 25 years or so, the researchers then projected the indicators to 2030. The punchline: if past is prologue, the median number of SDG targets attained in 2030 will be five of the 24 defined targets currently measured. Not very inspiring.
Global health policy enthusiasts will be excited to see that WHO has recently published a draft Concept Note on the 2019-2023 Programme of Work under the stewardship of its new Director-General. We see two glaring missed opportunities: 1) more centrality to universal health coverage (UHC) as an organizing principle for WHO and its work, and 2) more emphasis on enhancing the value for money of public spending on UHC and elsewhere.