Much of the health spending in developing countries is not made on the basis of evidence of what is most efficient and effective. For example, India subsidizes open heart surgery while child vaccination rates remain low; Egypt spends one-fifth of its health budget to send a few fortunate people overseas for medical care while one-fifth of its children are stunted.
CGD’s Priority-Setting Institutions for Global Health working group proposed the creation of a new institution to support developing countries and donors in making better-informed resource allocation decisions for health care in a 2012 report. In 2014, the UK's Department for International Development and the Bill and Melinda Gates Foundation, with technical support from CGD, announced their support for the creation of the new International Decision Support Initiative (iDSI), led by NICE International.
One early outcome of the iDSI network was a 2015 agreement on a new framework for better priority-setting between emerging economy governments (Colombia, Philippines, Vietnam, and Thailand) and multinational pharmaceutical executives (from GlaxoSmithKline, Janssen, and Eli Lilly). The new strategy will help identify and bring cost-effective medicines to middle-income countries. In 2016, iDSI received a further grant to scale up its work.