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 launched a working group on Economics in Global Health Goals and Guidelines. The working group engaged 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 aimed to develop recommendations to help global health organizations ensure their actions lead to the greatest population health gains within the limited means available, with a final report now available.
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.
For further information, please contact CGD Visiting Fellow, Paul Revill (previll@cgdev.org), or Amanda Glassman (aglassman@cgdev.org).
Workshop #1 Attendees
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
The final report is available here.