Priority setting for health

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Table 10.2 shows a practical framework for setting research priorities.

The research priorities are also derived from an analysis of the relative share of the burden that can or cannot be averted with existing technologies. Table 10.3 illustrates the need for and type of research depending on the responsiveness of the health problem to currently available technologies.

Table 10.2: A practical framework for setting priorities in health research

Five steps in priority setting

Data and analytic requirements i What is the burden of the disease/risk factor?

II Why does the burden of disease (BoD) persist? What are the determinants?

II What is the present level of knowledge?

Health status

Assessment of the burden of disease (DALYS, QUALYS, etc.)

Acquisition of knowledge about disease determinants

What is known today about existing and new potential interventions? How cost-effect^ they?

Is research likely to produce more cdstPeffeeiiv > interventions than the present ones?

Assessment of the public and private ri source 'lows

IV How cost-effective could future interventions be?

V What are the resource flows for that disease/risk factor?

Table 10.3: Relating research needs to efficacy of currently available technologies

1. Averted with current mix of interventions and Consolidate current control measures population coverage

2. Avertable with improved efficiency

Health systems research to improve efficiency and effectiveness

3. Avertable with existing but not cost-effective interventions

Biomedical research to develop new and improved tools - drugs, vaccines, diagnostic methods and vector control measures

4. Cannot be averted with existing interventions

DALY, disability-adjusted life years (see p. 20).

DALY, disability-adjusted life years (see p. 20).

In situations where more effective control of a disease can be achieved through efficient application of existing technologies, health systems research can provide useful answers. For example, although tetanus neonatorum can be prevented by a simple, affordable measure of toxoid immunization of pregnant women, about a quarter of a million children die each year from this preventable disease. Health services research would help to identify the under-served communities and develop strategies for ensuring that all pregnant women receive this simple and cost-effective intervention. On the other hand, for HIV/ AIDS, there is an urgent need for biomedical research to discover and develop effective vaccines and new drugs to replace the current technologies that are crude, cumbersome and costly.


Severe resource constraint is a major issue in designing and managing the health services in developing countries. Since the available funds cannot meet all the health needs of the community, it is vital to ensure that the limited resources are wisely spent so as to achieve the maximum returns for minimum spending. A number of developing countries, notably Chile, Sri Lanka, China and Cuba have devised and managed highly successful health programmes with the limited resources available to them. Their models for achieving 'good health at low cost' have provided worthy examples for other countries to follow. There are relatively cost-effective interventions available against the diseases that account for most of disease, disability and death in developing countries and particularly to combat deaths and health losses among young

Box 10.1: Cost-effective packages recommended by the

World Bank

The essential public health and clinical packages The essential public health package proposed in the World

Development Report (World Bank Report, 1993) includes the following:

■ the expanded programme on immunization, including micronutrients (iron, vitamin A and iodine) supplementation;

■ school health programmes to treat worm infections and micronutrients deficiencies and to promote health education;

■ programmes to increase public knowledge about family planning and nutrition, about self-care or indications for seeking care, and about vector control and disease surveillance activities;

■ programmes to reduce consumption of tobacco, alcohol, and other drugs and AIDS prevention programmes with a strong sexually transmitted disease component.

The essential clinical package recommended includes:

■ prenatal and delivery care;

■ family planning services;

■ treatment of tuberculosis;

■ case management of sexually transmitted disease.

children. Highly cost-effective interventions, costing less that US$100 per disability-adjusted life years (DALY) averted can deal effec%ely with the commonest causes of disease, disability and death fit developing countries. In its 1993 World Development Report, the World Bank recommended cost-effective public health and clinical ; 3ckases (Box 10.1).

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