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Health donors, policymakers, and practitioners continuously make life-and-death decisions about which type of patients receive what interventions, when, and at what cost. These decisions—as consequential as they are—often result from ad hoc, nontransparent processes driven more by inertia and interest groups than by science, ethics, and the public interest. The result is perverse priorities, wasted money, and needless death and illness. Examples abound: In India, only 44 percent of children 1 to 2 years old are fully vaccinated, yet open-heart surgery is subsidized in national public hospitals. In Colombia, 58 percent of children are fully vaccinated, but public monies subsidize treating breast cancer with Avastin, a brand-name medicine considered ineffective and unsafe for this purpose in the United States.
Reallocating a portion of public and donor monies toward the most cost-effective health interventions would save more lives and promote health equity. The obstacle is not a lack of knowledge about what interventions are best, but rather that too many low- and middle-income countries lack the fair processes and institutions needed to bring that knowledge to bear on funding decisions. With that in mind, the Center for Global Development’s Priority-Setting Institutions for Global Health Working Group recommends creating and developing fair and evidence-based national and global systems to more rationally set priorities for public spending on health. The group calls for an interim secretariat to incubate a global health technology assessment facility designed to help governments develop national systems and donors get greater value for money in their grants.
Oil and gas discoveries in developing countries are often associated with short-sighted economic policies and, in response, calls to insulate resource management from populist impulses. We report on a randomized experiment testing methods to overcome this apparent tension between sound resource governance and democratic politics. Soon after Tanzania’s discovery of major natural gas reserves, we invited a nationally representative sample of voters to an intensive public deliberation of policy options featuring nationally recognized experts and small-group discussions.