Priority-setting in Health Building Institutions fo Smarter Public Spending
(2012; 101 pages)


Data, methods, and evidence on the costs, effectiveness, and equity of health interventions and technologies are increasingly available, but there is a persistent gap between this evidence and the uses of scarce public budgets for health in low- and middle-income countries. This is illustrated by low coverage of highly cost-effective health care interventions, dependency on donor finance for the most basic health care interventions, and—sometimes—public subsidies for care considered ineffective in the world’s wealthiest countries. These anomalies that reduce the impact of public and donor spending on health are the result of ad hoc decision making on budgets, driven more by inertia and interest groups than science, ethics, and the public interest. Many more lives could be saved and health equity enhanced by reallocating part of public and donor monies toward the most cost-effective and equity-enhancing health interventions and technologies.

Yet too many countries lack the fair processes and institutions needed to make the connection between evidence and decisions on public spending and spell out the opportunity costs of one decision versus another, while managing the myriad interest groups and ethical conundrums that revolve around new technologies and scarce budgets. In this report, the Center for Global Development’s Priority - Setting Institutions for Health Working Group has identified core features of priority-setting processes and institutions worldwide, recommending direct substantive support for creating fair and evidence-based national and global health technology assessment systems that will be applicable in any kind of health system...

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