Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness

Document Type : Editorial


1 Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

2 Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

3 Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA

4 Africa Centre for Population Health, Mtubatuba, South Africa


Priority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs) in their strive for universal health coverage (UHC). However, present initiatives on priority setting are mainly geared towards the development of more cost-effectiveness information, and this evidence does not sufficiently support countries to make optimal choices. The reason is that priority setting is in reality a value-laden political process in which multiple criteria beyond cost-effectiveness are important, and stakeholders often justifiably disagree about the relative importance of these criteria. Here, we propose the use of ‘evidence-informed deliberative processes’ as an approach that does explicitly recognise priority setting as a political process and an intrinsically complex task. In these processes, deliberation between stakeholders is crucial to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. Such processes then result in the use of a broader range of explicit criteria that can be seen as the product of both international learning (‘core’ criteria, which include eg, cost-effectiveness, priority to the worse off, and financial protection) and learning among local stakeholders (‘contextual’ criteria). We believe that, with these evidence-informed deliberative processes in place, priority setting can provide a more meaningful contribution to achieving UHC.


Commentaries Published on this Paper

  • Health Technology Assessment: Global Advocacy and Local Realities; Comment on “Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness”

          Abstract | PDF

  • Evidence-Informed Deliberative Processes for Universal Health Coverage: Broadening the Scope; Comment on “Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness”

          Abstract | PDF

  • Priority Setting for Universal Health Coverage: We Need to Focus Both on Substance and on Process; Comment on “Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, not Just More Evidence on Cost-Effectiveness”

          Abstract | PDF

  • Don’t Discount Societal Value in Cost-Effectiveness; Comment on “Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness”

          Abstract | PDF


Authors' Response to the Commentaries

  • Evidence-Informed Deliberative Processes – Early Dialogue, Broad Focus and Relevance: A Response to Recent Commentaries

          Abstract | PDF


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