Priority-setting for achieving universal health coverage

Chalkidou, Kalipso; Glassman, Amanda; Marten, Robert; Vega, Jeanette; Teerawattananon, Yot; Tritasavit, Nattha; Gyansa-Lutterodt, Martha; Seiter, Andreas; Kiény, Marie Paule; Hofman, Karen; Culyer, Anthony J.

doi:10.2471/blt.15.155721

Cited by 137 publications

(134 citation statements)

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“…Lack of systematic priority setting can lead to inefficient resource allocation and poor-quality healthcare [3]. In light of this and the global trend towards pursuing Universal Health Coverage (UHC), countries are increasingly acknowledging the importance of explicit priority setting and evidence-based decision-making [4,5]. Priority-setting tools, for example Health Technology Assessments (HTAs), provide valuable evidence which could be useful for decision-making in LMICs, both in terms of maximising health and enhancing equity [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…As such, an integral part of the network is knowledge sharing, collaboration and capacity building [13–15]. Knowledge sharing is vital to providing potential insights, aids and strategies for strengthening evidence-based decision making and the employment of tools such as HTA [4,16]. An exploration of the development of HTA systems in China, India and South Africa could provide beneficial insights for the other BRICS countries Brazil and Russia, as well as other Global South countries.…”

Section: Introductionmentioning

confidence: 99%

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Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa

MacQuilkan

Baker

Downey

et al. 2018

Global Health Action

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Background: Resource allocation in health is universally challenging, but especially so in resource-constrained contexts in the Global South. Pursuing a strategy of evidence-based decision-making and using tools such as Health Technology Assessment (HTA), can help address issues relating to both affordability and equity when allocating resources. Three BRICS and Global South countries, China, India and South Africa have committed to strengthening HTA capacity and developing their domestic HTA systems, with the goal of getting evidence translated into policy. Through assessing and comparing the HTA journey of each country it may be possible to identify common problems and shareable insights.Objectives: This collaborative paper aimed to share knowledge on strengthening HTA systems to enable enhanced evidence-based decision-making in the Global South by: Identifying common barriers and enablers in three BRICS countries in the Global South; and Exploring how South-South collaboration can strengthen HTA capacity and utilisation for better healthcare decision-making.Methods: A descriptive and explorative comparative analysis was conducted comprising a Within-Case analysis to produce a narrative of the HTA journey in each country and an Across-Case analysis to explore both knowledge that could be shared and any potential knowledge gaps.Results: Analyses revealed that China, India and South Africa share many barriers to strengthening and developing HTA systems such as: (1) Minimal HTA expertise; (2) Weak health data infrastructure; (3) Rising healthcare costs; (4) Fragmented healthcare systems; and (5) Significant growth in non-communicable diseases. Stakeholder engagement and institutionalisation of HTA were identified as two conducive factors for strengthening HTA systems.Conclusion: China, India and South Africa have all committed to establishing robust HTA systems to inform evidence-based priority setting and have experienced similar challenges. Engagement among countries of the Global South can provide a supportive platform to share knowledge that is more applicable and pragmatic.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa

MacQuilkan

Baker

Downey

et al. 2018

Global Health Action

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“…1 The lack of institutional mechanisms for priority setting in developing countries allows interest groups to put forward their own priorities and divert resources away from investments that may have produced better gains in health system performance and health outcomes. 1,2 The Philippines is facing these problems of priority setting as it works toward UHC. Since 2010, the Philippines has been taking significant steps to achieve UHC by strengthening the Philippine Health Insurance Corporation (PHIC), an agency attached to the Department of Health (DOH).…”

Section: Introductionmentioning

confidence: 99%

Priority Setting for Health Service Coverage Decisions Supported by Public Spending: Experience from the Philippines

Wong¹,

Uy²,

Haw³

et al. 2017

Health Systems & Reform

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Abstract-Achievement of universal health coverage requires better allocative efficiency in health systems. Countries like the Philippines, however, do not have quality local data for these decisions. We present a method that applies existing global data, e.g., Global Burden of Disease and Disease Control Priorities project, into creating a local priority list of diseases and interventions that may be useful in providing a rational plan for expanding coverage of health services paid by public financing. In the context of the Philippines, this refers to the Department of Health for vertical programs like immunization and disease control, and the Philippine Health Insurance Corporation for inpatient and outpatient health services. We found that the top 48 (or 22%) of diseases account for 80% of total disability-adjusted life years (DALYs), reflecting a well-known concept in management, the Pareto principle. Due to its simplicity and widespread applicability, the Pareto principle facilitated interest in rational priority setting among high-level officials in the Philippine health sector. Priority setting must not be limited to disease burden and cost-effectiveness criteria. Our lists can be used after further deliberation and stakeholder consultation. Priority setting is a complex, value-laden process, and a purely utilitarian approach to prioritization may lead to further deterioration in the health status of vulnerable populations. We recommend that DOH and PHIC set up a joint, independent agency primarily responsible for implementing a sustainable, transparent, and participatory priority-setting process that will advise them on future service coverage expansions.

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“…HTAs consequently can inform the development of clinical guidelines, the composition of benefit packages and reimbursement mechanisms for health care providers, and are essential to the realisation of Universal Health Coverage policies [1]. …”

Section: Introductionmentioning

confidence: 99%

Strengthening expertise for health technology assessment and priority-setting in Africa

Doherty

Wilkinson

Edoka

et al. 2017

Global Health Action

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Background: Achieving sustainable universal health coverage depends partly on fair priority-setting processes that ensure countries spend scarce resources wisely. While general health economics capacity-strengthening initiatives exist in Africa, less attention has been paid to developing the capacity of individuals, institutions and networks to apply economic evaluation in support of health technology assessment and effective priority-setting. Objective: On the basis of international lessons, to identify how research organisations and partnerships could contribute to capacity strengthening for health technology assessment and priority-setting in Africa. Methods: A rapid scan was conducted of international formal and grey literature and lessons extracted from the deliberations of two international and regional workshops relating to capacity-building for health technology assessment. ‘Capacity’ was defined in broad terms, including a conducive political environment, strong public institutional capacity to drive priority-setting, effective networking between experts, strong research organisations and skilled researchers. Results: Effective priority-setting requires more than high quality economic research. Researchers have to engage with an array of stakeholders, network closely other research organisations, build partnerships with different levels of government and train the future generation of researchers and policy-makers. In low- and middle-income countries where there are seldom government units or agencies dedicated to health technology assessment, they also have to support the development of an effective priority-setting process that is sensitive to societal and government needs and priorities. Conclusions: Research organisations have an important role to play in contributing to the development of health technology assessment and priority-setting capacity. In Africa, where there are resource and capacity challenges, effective partnerships between local and international researchers, and with key government stakeholders, can leverage existing skills and knowledge to generate a critical mass of individuals and institutions. These would help to meet the priority-setting needs of African countries and contribute to sustainable universal health coverage.

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Priority-setting for achieving universal health coverage

Cited by 137 publications

References 8 publications

Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa

Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa

Priority Setting for Health Service Coverage Decisions Supported by Public Spending: Experience from the Philippines

Strengthening expertise for health technology assessment and priority-setting in Africa

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