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Incorporating Economics and Modelling in Global Health Goals and Guidelines
A Working Group convened by the Center for Global Development, Thanzi la Onse, and The HIV Modelling Consortium
International organizations influence national-level health sector priorities by affecting how much funding is available for healthcare delivery within countries and setting limits on how that funding is used. They exert particular influence in setting disease-specific targets, developing clinical guidelines, and using investment cases. But for the most part, the processes they follow in undertaking these activities do not account for limited country resources or the other uses those resources could be put to. The Center for Global Development, Thanzi la Onse, and the HIV Modelling Consortium have launched a working group on Economics in Global Health Goals and Guidelines. The working group will engage key global health stakeholders—international organizations, national policymakers from LMICs, researchers, and others—to reflect on the use of economics in international guideline- and target-setting (in addition to other international priority-setting processes). We aim to develop recommendations to help global health organizations ensure their actions lead to the greatest population health gains within the limited means available. A final report is forthcoming.
Healthcare funding and allocation decisions often depend upon complex interactions between numerous stakeholders. In low- and middle-income countries, international organizations may hold substantial sway over prioritization decisions by providing financial and technical assistance to facilitate policy or program change to support the attainment of targets or adoption of guidelines. The actions of international organizations have certainly resulted in tremendous disease-specific health gains; however, it has been argued that current processes hinder efforts to maximize population health by channeling resources toward few health concerns, which may not have the greatest effect on population health or be aligned with priorities of national governments and their citizens. For example, the methods behind the development of World Health Organization Guidelines typically result in recommendation of interventions that have the greatest individual-level benefit (i.e. greatest benefits to those able to receive interventions), but do not necessarily minimize morbidity and mortality across a population considering limited healthcare resources.
Due consideration should be given to current methods underpinning global health decision-making. Economic analysis and epidemiological modelling could have a paramount role in informing resource allocation; through estimating disease burdens and epidemiologies across populations, the health benefits associated with policy alternatives and their costs; thereby informing priorities in the face of limited budgets and constraints upon healthcare delivery. These disciplines can provide the organizing framework within which a consideration of all relevant evidence is possible. A fresh approach is required and recommendations sought on how the actions of the global health institutions can be guided in a way that is more likely to lead to greatest population health gains from within the limited means available.
Funding has been received from iDSI, RCUK Global Challenges Research Fund (GCRF), and the Bill and Melinda Gates Foundation.
Amanda Glassman, Center for Global Development Andrew Kambugu, Infectious Diseases Institute, Uganda Andrew Phillips, University College London Anthony McDonnell, Wellcome Trust Carol Levin, University of Washington Charlie Gilks, University of Queensland Chutima Suraratdecha, Centers for Disease Control and Prevention Daniel Klein, Institute for Disease Modelling David Wilson, Bill and Melinda Gates Foundation Edward Kataika, East Central Southern Africa (ECSA) Health Community Eliana Barrenho, Imperial College London Ellen McRobie, Imperial College London Gesine Meyer-Rath, HE2RO, Wits University Ian Weller, University College London John Stover, Avenir Health Julie Jemutai, KEMRI-Wellcome Trust Research Programme, Kenya Katharina Hauck, Imperial College London Kenneth Katumba, MRC/UVRI, Uganda Marelize Gorgens, World Bank Mark Sculpher, University of York Mead Over, Center for Global Development Miqdad Asaria, International Decision Support Initiative Paul Revill, University of York Rebecca Forman, Center for Global Development Ruanne Barnabas, University of Washington Ruth Lopert, George Washington University Samantha Diamond, Clinton Health Access Initiative Sergio Bautista, Public Health Institute of Mexico Stefano Bertozzi, University of California Tim Hallett, Imperial College London Tommy Wilkinson, PRICELESS, South Africa Andrea Ciaranello, CEPAC/Massachusetts General Hospital Ayako Takemi, Center for Global Development Elizabeth Chizema, National Malaria Elimination Programme, Zambia Kalipso Chalkidou, Center for Global Development, London Krisantha Weerasuriya, Former World Health Organization Essential Medicines Elizabeth Stuart, Overseas Development Institute Martin Chalkley, University of York Nishant Jain, GIZ, India Ole Norheim, University of Bergen Rachel Silverman, Center for Global Development Yot Teerawattananon, HITAP, Thailand
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Paul Revill (email@example.com)
Amanda Glassman (firstname.lastname@example.org).
Whether it’s called strategic purchasing, evidence-informed commissioning, or value-based insurance, the quest to squeeze better value out of existing resources is global. But lack of clarity regarding global and national healthcare investment goals, coupled with low technical capacity in ministries of health and insurance funds and multiple competing interests for attracting healthcare dollars, all make proactive evidence-informed buying hard to achieve. The global health community ought to help Ghana and countries like it strengthen their national systems for allocating resources including when selecting, negotiating prices, and procuring medicines for their populations.