Internationally set goals and guidelines directly influence the setting of health care priorities at the national level, affecting how limited resources are generated and allocated across health care needs. The influence of global priority setting, such as through the formulation of overarching goals or normative guidelines for specific disease areas, is particularly significant in low- and middle-income countries that rely heavily on overseas development assistance. Because no systematic approach exists for dealing with resource constraints, however, which vary across countries, goals and guidance are often inappropriate for some country contexts; their implementation can, therefore, reduce the efficiency and equity of health care spending.
The Working Group on Incorporating Economics and Modelling in Global Health Goals and Guidelines, co-convened by the Center for Global Development, Thanzi la Onse, and the HIV Modelling Consortium, has brought together disease specialists, policymakers, economists, and modelers from national governments, international organizations, and academic institutions across the globe to address these issues, to take stock of current approaches, and make recommendations for better practice. The Working Group deliberated on the roles and purposes of goals and guidelines and considered how economic evidence might be formally incorporated into policy recommendations and health care decision making. The target audiences for this report are international health institutions, large stakeholders in disease programs across the world, and national governments.
The Working Group has established core principles and accompanying recommendations for policymakers seeking to support national governments in setting locally relevant priorities. The report also offers recommendations to international organizations—in particular, the World Health Organization (WHO)—on the appropriate use of economic analysis in the development of international guidelines.
The principles and recommendations emphasize the importance of recognizing local context and enabling and strengthening the capacity of national governments to set priorities locally. They also stress the strengths and limitations of international WHO guidelines; the value of epidemiological modeling and economic assessment to guiding policy under resource constraints; the importance of good-quality epidemiological and economic data to inform country decision making; and the benefits of increased interagency and intergovernmental cooperation, accountability, transparency, and information sharing.
The principles and recommendations are outlined below. If implemented in full, the recommendations would lead to a systemic shift, from a situation where priorities are largely set internationally and implemented locally to one where international priorities account for local contexts and constraints on delivery. These principles and recommendations are anticipated to lead to greater population health gains attained from within the limited resources available for health care by facilitating the use of resources where they have the largest beneficial impacts.
This approach has risks. When necessary evidence and capacity are lacking—a common scenario—priorities set using it may still be inappropriate, given local objectives and constraints. The final section of the report thus considers unanswered questions and outlines an agenda for additional research.
The Working Group on Incorporating Economics and Modelling in Global Health Goals and Guidelines.