Setting fundable priorities for universal healthcare coverage: global concept, local applications

Between 20-40% of the $7.1 trillion spent annually on healthcare is wasted (1). Development assistance for health makes up less than 1% of this (~$36bn) (2) – and if global health gains are to be made –as codified in the recently-endorsed Global Goals (3)- aid must leverage greater efficiency of spending in low- and middle-income countries themselves (4). Since the goal of moving towards universal health coverage is gaining support globally and locally, it raises public expectations in health investment, not only to ensure good health but also equitable access to health services (5). To achieve defensible resource allocation decisions which improve efficiency and meet the distributional objectives of societies and their representatives, priority setting processes must be put in place which allow comparative evidence (including economic evidence) and values to be accounted for (6), (7). For the past ten years or so, the authors have been working on enhancing the institutional, technical and evidential capacities for evidence-informed priority setting through effective South-South and North-South partnerships of policy makers, researchers and frontline practitioners. More recently, their work has been carried out through the international Decision Support Initiative (www.idsihealth.org), a network funded by the UK's DFID, BMGF and Rockefeller. IDSI is a demand driven collaborative and practical support network with active presence in Indonesia, India, China, South Africa, Ghana, Myanmar and Vietnam.S T Le