Milestones :: Perspectives
December 12, 2018 [Editor’s text bolding]
“Policymakers’ decisions about what healthcare to make available and at what cost can be a life or death decision for people across the developing world.”
London – A global consortium working with low- and middle-income countries as they aim to make healthcare investment decisions that reflect the best value for money has received a $14.5 million grant from the Bill & Melinda Gates Foundation, announced the Center for Global Development today. The grant covers the next five years and specifically supports the International Decision Support Initiative (iDSI), made up of health policymakers, researchers, and development experts.
The most cost-effective health interventions produce as much as 15,000 times the benefit as the least cost-effective, and up to $2.8 trillion USD is reported to be wasted each year and could be redirected to save more lives. This means that allocating healthcare according to maximum health gain could save countless lives.
iDSI will harness the funding to extend its engagement with policymakers and healthcare payers in low- and middle-income countries, primarily in sub-Saharan Africa, working with them to understand and respond to the challenges they face when deciding on benefits—whether ensuring the financial sustainability of a health insurance fund or fair access to good quality care across public health facilities.
The network endeavors to generate long-term, locally owned solutions to healthcare challenges through building capacities for using evidence in policy and clinical decisions. Its impact to date includes influencing policy in eight countries—China, India, Indonesia, Philippines, Vietnam, South Africa, Tanzania, and Ghana—where there has been tangible progress toward national institutions being established to embed value-for-money into decision-making about what medicines, vaccines, or other health services should be offered to the population, and how these could be procured in the most cost-effective way. Already the coalition has supported Tanzania to prioritise its Essential Medicines List from 500 to 400 drugs, reducing spending on poor-value items and freeing up resources to improve access to the most cost-effective medicines; trained Kenya’s Health Benefits Package Committee on measuring the added value of a new health intervention compared to existing ones; piloted a local quality improvement initiative with hospital staff in Vietnam to reduce inappropriate antibiotic prescribing for pneumonia; and brought together more than 100 policymakers working across sub-Saharan Africa to share knowledge and best practices.
“With government and aid budgets under pressure, many developing countries have to make difficult choices,” said iDSI Director Kalipso Chalkidou, who also directs the Global Health Policy program at the Center for Global Development and is a professor of global health practice at Imperial College London. “Policymakers’ decisions about what healthcare to make available and at what cost can be a life or death decision for people across the developing world. We will inform these critical decisions with data and evidence that map out how best to spend limited funds to improve outcomes and save lives.”
The Chinese, Thai, and Norwegian governments have backed iDSI, which also receives funding from the Department for International Development, a United Kingdom government department responsible for administering overseas aid; and this renewed phase will see a stronger emphasis on sub-Saharan Africa. iDSI’s flagship countries include Kenya and Ghana, where global health funders will be departing and domestic health care spending is on the rise. Additionally, many sub-Saharan African countries are currently introducing national health insurance or coverage plans and making important decisions about what health services and technologies should be included in universal health coverage offerings, where value-for-money considerations could make a huge difference in health outcomes.
The Center for Global Development…will lead iDSI. The six other core partners in this global effort include the Global Health and Development Group at Imperial College London; the Asia HTA consortium, which includes the National Health Foundation of Thailand, the Saw Swee Hock School of Public Health at the National University of Singapore, and Health Intervention and Technology Assessment Program (HITAP); the China National Health Development Research Center; the Health Economics Research Unit (HERU) of the KEMRI Wellcome Trust Programme; the Norwegian Institute of Public Health; and the Clinton Health Access Initiative, Inc. (CHAI).
iDSI was born out of the recommendations of the Center for Global Development’s Priority-Setting Institutions for Global Health Working Group in 2012.
“Previous healthcare decision-making in developing countries has too often been driven by inertia and lobbying rather than science, economics, ethics, and the public interest,” said Amanda Glassman, Chief Operating Officer at the Center for Global Development. “We want to change that.”