Global Health Priority-Setting: A History of Organizations and Programs
Since the 1980s, the global health community has sought systematic ways to determine which medical interventions, research areas, and medicines should receive priority. Priority-setting is the process of deciding how to allocate limited resources to achieve the greatest possible health impact. While early efforts focused on narrow categories, the field has evolved into a sophisticated discipline utilizing complex metrics and multi-stakeholder collaborations.
[ไม่มีภาพประกอบ]
Key Facts
- Long-term Frameworks: The WHO Model List of Essential Medicines, established in 1977, remains one of the longest-running priority-setting tools.
- Metric Evolution: The Disability-adjusted life year (DALY)—a measure of overall disease burden—became a cornerstone for prioritization in the early 1990s.
- Funding Influence: Major philanthropic organizations, particularly the Bill & Melinda Gates Foundation, have provided significant funding for data quality and research challenges.
- Diverse Methods: Approaches range from expert judgment and the Delphi method to multicriteria decision analysis (MCDA) and cost-per-utility formulas.
The Evolution of Prioritization Frameworks
The journey of global priority-setting began with the need for standardized lists of essential tools. The World Health Organization (WHO) led this charge in 1977 with the Model List of Essential Medicines. This initiative was so successful that by 2016, at least 156 countries had developed their own national lists based on this model.
Improving Data Quality and Research
Effective prioritization requires accurate data. Programs like the Demographic and Health Surveys (DHS), conceived in 1984, and the Multiple Indicator Cluster Surveys (1995) were established to improve the quality of health data. Later, the Health Metrics Network (2005) and the Institute for Health Metrics and Evaluation (2007) further refined how the global community understands the burden of disease.
Research prioritization also emerged as a critical need. The Commission on Health Research for Development (1987–1990) eventually led to the creation of the Council on Health Research for Development (COHRED), which focused on promoting priority-setting specifically within low- and middle-income countries.
The Shift Toward Quantitative Metrics
In the 1990s, the approach shifted toward more quantitative methods. The 1993 World Development Report and the Disease Control Priorities in Developing Countries publication introduced the Disability-adjusted life year (DALY) to measure the impact of health interventions more objectively.
By the 2000s, new tools emerged to handle complex decision-making. The Combined Approach Matrix (CAM), developed by the Global Forum for Health Research in 2004, allowed decision-makers to integrate disease burden, cost-effectiveness, and macroeconomic policies, reducing reliance on personal judgment.
Major Programs and Their Impact
Various organizations have tackled priority-setting from different angles, whether through funding, policy, or technical tool development.
- The Bill & Melinda Gates Foundation: Launched the Grand Challenges in Global Health in 2003 with an initial $200 million, selecting 14 "grand challenges" from over 1,000 submissions.
- Oregon Health Services Commission (HSC): Established in 1987 to prioritize US Medicaid services, shifting focus toward preventive care and chronic disease management before its abolition in 2012.
- EVIDEM Collaboration: Established in 2009 to analyze the impact of evidence and value on decision-making using multicriteria decision analysis (MCDA).
[ไม่มีภาพประกอบ]
Timeline of Priority-Setting Initiatives
| Year/Period | Initiative/Organization | Focus Area | Key Method/Metric |
|---|---|---|---|
| 1977–Present | WHO Model List of Essential Medicines | Medicines | Explicit List |
| 1987–2012 | Oregon Health Services Commission | Health Services | Cost-per-utility / Expert judgment |
| 1993 | Disease Control Priorities Project | Developing Countries | DALY |
| 2003 | Grand Challenges in Global Health | R&D | Scientific Board Review |
| 2004 | Combined Approach Matrix (CAM) | General Methods | Multifactorial Matrix |
| 2007 | Institute for Health Metrics and Evaluation | Data Quality/Burden | Quantitative Analysis |
| 2013 | International Decision Support Initiative | Health Interventions | Decision Support |
Frequently Asked Questions
What is the Disability-adjusted life year (DALY)?
The DALY is a metric used in global health to measure the overall burden of disease, accounting for both years of life lost due to premature mortality and years lived with a disability.
How did the WHO Model List of Essential Medicines influence other countries?
The WHO list provided a standardized framework that allowed countries to identify the most necessary medicines for their populations; as of 2016, at least 156 countries have created national lists based on this model.
What is the purpose of the Combined Approach Matrix (CAM)?
The CAM is a general method used for systematic classification and organization of information. It helps decision-making committees base their choices on data—such as disease burden and cost-effectiveness—rather than personal judgment.
What role did the Bill & Melinda Gates Foundation play in priority-setting?
The foundation provided significant funding for various initiatives, including the Grand Challenges in Global Health, the Health Metrics Network, and the Institute for Health Metrics and Evaluation, focusing heavily on R&D and data quality.
What was the focus of the Oregon Health Services Commission?
The HSC focused on prioritizing health services within the US Medicaid program, placing a strong emphasis on preventive services and chronic disease management to avoid morbidity and mortality.