179 LMICs, 1 iDSI: Where do we start? Setting priorities in international development

By Ryan Li May. 29, 2015

Priority-setting is important for all countries, regardless of level of economic development, if the goal is to achieve and sustain universal health coverage (UHC). One year ago in Geneva, the World Health Assembly endorsed a resolution on Health Intervention and Technology Assessment (HITA), calling on member countries to support each other in strengthening institutional and technical capacity for priority-setting. The question for iDSI and our funders was, with 179 low- and middle-income countries (LMICs) in the world: where should we start? How would we decide where our practical support would generate the greatest impact, in helping countries achieve better decisions for better health? To answer these questions, the Office of Health Economics in conjunction with NICE International has published a report mapping out the priority-setting landscape in 17 LMICs across Asia, Africa and Latin America.

We needed to know who were making priority-setting decisions in the respective health systems, how these decisions were being made and financed, what technical capacity countries had to implement HTA processes, as well as the key challenges facing their health systems. But at the time, there was no comprehensive literature covering all of these issues of relevance to priority-setting, within a broad enough geographical scope. Existing surveys on HTA (including those done by NICE International and HITAP) tended to focus narrow on its technical aspects, whereas studies from the health systems research field didn’t go deep enough into the important facets of priority-setting such as who are the stakeholders, what evidence is used, and so on.

With the end goal of selecting a country to offer iDSI practical support that would be feasible, in demand, and generate significant impact, we set out to assess how ready countries were for priority-setting support. We developed a conceptual framework, methods (including a country selection process), qualitative and quantitative indicators, and data collection tools (including questionnaires and interview guides) for priority-setting readiness. The mapping combined published and grey literature, insights from iDSI partners, and primary data collection from in-country key opinion leaders. And thanks to the hard work of iDSI partners worldwide, we successfully completed mapping of 17 countries within the space of 7 months.

Since completing the mapping, we have used it to select Indonesia as our focal country partner, where HITAP, NICE International and PATH are working in collaboration with local decision makers and academics to support HTA development. We have also subsequently secured additional funding to support a Sub-Saharan African regional hub for priority-setting around PRICELESS SA, South Africa.

One year on from the HITA resolution, there has been a proliferation of regional mapping exercises for priority-setting capacity, coinciding with the global momentum to support HITA. These include WHO-led efforts as well as iDSI partnerships with WHO regional initiatives (such as the Asia Pacific Observatory on Health Systems and Policies, and Advance HTA with PAHO). As the global health and political scene is so fast moving, some of the findings in the iDSI mapping report are inevitably already out of date. My hope is that these latest efforts will add to our global knowledge and provide practical insights to international donors and development partners, in order to support country partners in building capacity for better priority-setting in health.