Priority setting for health research: lessons from developing countries. The Working Group on Priority Setting

Research resources for addressing health problems of developingcountries remain disproportionately low compared with the tremendousdisease burdens borne by these countries. There is a need tofocus these scarce resources on research that will optimizehealth benefits and lead to equity. This paper reviews processesand methods that have been used for setting research priorities.Past and current processes have focused on expert-driven researchagenda, emphasizing scientific autonomy and global analyses.Methods for setting priorities have focused on the metrics ofdisease burdens, while less attention has been placed on whosets priorities and how choices are made. The paper proposes a strategy of priority setting, based onlessons learned from essential national health research (ENHR)approaches attempted in several developing countries. With equityin health and development as its goal, the proposed model isdemand-driven, and involves multi-dimensional inputs and multiplestakeholders. Various steps of the process are discussed: gettingparticipants involved; gathering evidence and information; determiningcriteria for priority setting; and implementation and evaluation.The paper concludes with a discussion of the gap between nationalresearch priorities and the research agenda set at regionaland global levels, an issue that needs to be satisfactorilyaddressed in the future.     

Accounting for health spending in developing countries

Data on health system financing and spending, together with information on the disease prevalence and cost-effectiveness of interventions, constitute essential input into health policy. It is particularly critical in developing countries, where resources are scarce and the marginal dollar has a major impact. Yet regular monitoring of health spending tends to be absent from those countries, and the results of international efforts to stimulate estimation activities have been mixed. This paper offers a history of health spending measurement, describes alternative sources of data, and recommends improving international collaboration and advocacy with the private sector for the way forward.     

An optimization model for reducing typhoid cases in developing countries without increasing public spending

This article considers the investment case for using the Vi polysaccharide vaccine in developing countries from two perspectives: reducing typhoid cases and limiting new health care spending. A case study is presented using data from South and Southeast Asia. The purpose of the paper, however, is to draw broad implications that may apply to developing countries in general. Typical consumer demand functions developed from stated preference household surveys in South and Southeast Asia are used to predict probabilities of adults and children purchasing typhoid vaccinations at different prices. These functions are incorporated in a formal mathematical model. Using data from the recent literature for South and Southeast Asia for typhoid incidence, Vi vaccine effectiveness, public cost of illness, and vaccination program cost, three mass vaccination policy alternatives are evaluated: charging adults and children different (optimal) prices, charging uniform prices, and providing free vaccines. Assuming differential pricing is politically feasible, different vaccine prices for children and adults would maximize the number of typhoid cases avoided from a mass vaccination program if the public sector faces a budget constraint on spending for the vaccination program. However, equal prices for children and adults produce very similar results, and they might be more readily accepted by the community. Alternatively, if vaccines are free, the number of cases is not significantly reduced compared to either pricing policy, but a large external financial contribution from government or donors would be required. A Monte Carlo simulation explores the effects of uncertain parameters on vaccination program outcomes.     

Diabetes in developing countries: its importance for public health

The insulin dependent (IDDM) and non-insulin dependent (NIDDM)forms of diabetes mellitus were previously considered to berare in most developing countries, but recent evidence showsthat the frequency of NIDDM has risen rapidly in some developingcountry populations, particularly in Asia and the Western Pacific.Studies on the indirect and direct costs of diabetes, mainlyfrom the USA, suggest that the economic burden due to the diseaseand its complications is very large, but equivalent studiesfrom developing countries are virtually non-existent. Althoughthere is some evidence that the incidence of NIDDM could bereduced, the prevention of diabetes in developing countriesdoes not appear to be a viable policy option. The priority lieswith a broad approach to the prevention of a range of non-communicablediseases, including diabetes, and to improved case diagnosisand management. The direct costs in case management in manydeveloping countries will be dominated by the relatively highcosts of insulin and oral hypoglycaemic drugs. A major priorityis for further research on the incidence, aetiology and preventionof IDDM and NIDDM in developing countries, particularly Africaand Latin America.     

Priority setting for school nutrition research: developing a collaborative research agenda

Priority setting in health research can assist stakeholders to identify research and policies that have the greatest potential for benefits to public health. Priority setting has been utilized by researchers to identify barriers, facilitators, and recommendations for future public health research. This commentary describes how a priority-setting approach was used as part of a workshop activity on the school nutrition environment in Ontario, Canada, to facilitate brainstorming, sorting, and rating of concepts related to the school nutrition environment. This work demonstrates an interesting and concrete case of priority setting, of interest for various planning activities (both programming and research), particularly those around school-based healthy eating programs or a related research agenda.     

Priority setting in health care: Lessons from the experiences of eight countries

All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities.     

Neonatal deaths and challenges of public health: Where do We need urgent intervention in developing countries?

Abstract

Neonatal death is child health problem which the global community seeks to reduce to the barest minimum by 2030. In 2017, sub-Sahara Africa’s average neonatal death was 27 in every 1000 successful births, while Nigeria’s neonatal death rate was 32.9. The researcher’s objective is to propose public health policies needed to reduce neonatal death drastically in Nigeria by 2030. The researchers sourced data from World Bank between 1993 and 2015, and used ordinary least squares method of analysis because of its simplicity. We recommended introduction of antenatal meal plus in Nigeria based on finding that poor nutrition causes neonatal death.     

Inequalities in health in developing countries: Challenges for public health research

Inequalities in health are important for overall well-being even in developing countries. But research into this area has lagged behind developed countries partly because of the lack of routine and longitudinal data. Insights from developed countries have highlighted how risk factors are clustered around poor people and the ways in which pathways of poverty and poor health are formed during their lives. This is being overlaid by the process of globalization that seems to be accentuating these processes. The paucity of reliable routine data should encourage public health researchers in developing countries to stretch their methodological imagination to include qualitative insights in order to facilitate a more probing investigation that moves beyond describing inequalities but begins to describe how they are produced and reproduced.     

Debt relief and public health spending in heavily indebted poor countries

The Heavily Indebted Poor Countries (HIPC) Initiative, which was launched in 1996, is the first comprehensive effort by the international community to reduce the external debt of the world's poorest countries. The Initiative will generate substantial savings relative to current and past public spending on health and education in these countries. Although there is ample scope for raising public health spending in heavily indebted poor countries, it may not be advisable to spend all the savings resulting from HIPC resources for this purpose. Any comprehensive strategy for tackling poverty should also focus on improving the efficiency of public health outlays and on reallocating funds to programmes that are most beneficial to the poor. In order to ensure that debt relief increases poverty-reducing spending and benefits the poor, all such spending, not just that financed by HIPC resources, should be tracked. This requires that countries improve all aspects of their public expenditure management. In the short run, heavily indebted poor countries can take some pragmatic tracking measures based on existing public expenditure management systems, but in the longer run they should adopt a more comprehensive approach so as to strengthen their budget formulation, execution, and reporting systems.     

The income elasticity of health care spending in developing and developed countries

To date, international analyses on the strength of the relationship between country-level per capita income and per capita health expenditures have predominantly used developed countries’ data. This study expands this work using a panel data set for 173 countries for the 1995–2006 period. We found that health care has an income elasticity that qualifies it as a necessity good, which is consistent with results of the most recent studies. Furthermore, we found that health care spending is least responsive to changes in income in low-income countries and most responsive to in middle-income countries with high-income countries falling in the middle. Finally, we found that ‘Voice and Accountability’ as an indicator of good governance seems to play a role in mobilizing more funds for health.     

Tuberculosis behind bars in developing countries: a hidden shame to public health

In developing countries, prisons do not have adequate healthcare systems. The problem is particularly acute for tuberculosis (TB) and is exacerbated by crowding and HIV infection. Improved passive TB detection is a priority for control, but in highly endemic prisons mass screening may be needed to obtain a more rapid decrease in incidence. The provision of health care in prisons is made more difficult by social conditions within prisons and the political climate in which they operate. International guidelines seem to be largely ignored.     

Palliative care: a public health priority in developing countries

Palliative care is an emerging specialist discipline worldwide with the majority of services located in developed countries. Developing countries, however, have higher incidences of cancer and AIDS and most of these patients would benefit from palliative care. While there is prominent coverage of this issue in the palliative care literature, there is limited coverage in the specialist public health literature, which suggests that the challenges of palliative care may not yet have been generally recognized as a public health priority, particularly in developing countries. The aim of this article is to introduce the topic of "Palliative care in developing countries" into the specialist public health literature to raise awareness and stimulate debate on this issue among public health professionals and health policy makers, thereby potentially facilitating establishment of palliative care services in developing countries.     

Workgroup report: public health strategies for reducing aflatoxin exposure in developing countries

Consecutive outbreaks of acute aflatoxicosis in Kenya in 2004 and 2005 caused > 150 deaths. In response, the Centers for Disease Control and Prevention and the World Health Organization convened a workgroup of international experts and health officials in Geneva, Switzerland, in July 2005. After discussions concerning what is known about aflatoxins, the workgroup identified gaps in current knowledge about acute and chronic human health effects of aflatoxins, surveillance and food monitoring, analytic methods, and the efficacy of intervention strategies. The workgroup also identified public health strategies that could be integrated with current agricultural approaches to resolve gaps in current knowledge and ultimately reduce morbidity and mortality associated with the consumption of aflatoxin-contaminated food in the developing world. Four issues that warrant immediate attention were identified: a) quantify the human health impacts and the burden of disease due to aflatoxin exposure; b) compile an inventory, evaluate the efficacy, and disseminate results of ongoing intervention strategies; c) develop and augment the disease surveillance, food monitoring, laboratory, and public health response capacity of affected regions; and d) develop a response protocol that can be used in the event of an outbreak of acute aflatoxicosis. This report expands on the workgroup's discussions concerning aflatoxin in developing countries and summarizes the findings.     

Priority setting in health care systems: too much or not enough

Introduction  

Various forms of the managed-care concept have been conceived to reconcile the medical professionalism with necessary cost-cutting measures in health-care provision. A plethora of bureaucratic regulations and required paperwork result in increasing resignation among physicians and withdrawal from patient care.     

Regulating private health insurance to serve the public interest: policy issues for developing countries

Private health insurance plays a large and increasing role around the world. This paper reviews international experiences and shows that private health insurance is significant in countries with widely different income levels and health system structures. It contrasts trends in private health insurance expansion across regions and highlights countries with particularly important experiences of private coverage. It then discusses the regulatory approaches and policies that can structure private health insurance markets in ways that mobilize resources for health care, promote financial risk protection, protect consumers and reduce inequities. The paper argues that policy makers need to confront the role that private health insurance will play in their health systems and regulate the sector appropriately so that it serves public goals of universal coverage and equity.