International Journal of Health Policy and Management

International Journal of Health Policy and Management

Progressive Realisation of Universal Health Coverage in Low- and Middle-Income Countries: Beyond the “Best Buys”

Document Type : Original Article

Authors
Melanie Y. Bertram 1
Jeremy A. Lauer 1
Karin Stenberg 1
Ambinintsoa H. Ralaidovy 2
Tessa Tan-Torres Edejer 1
1 Health Systems Governance and Financing, World Health Organization (WHO), Geneva, Switzerland
2 Science Division, World Health Organization (WHO), Geneva, Switzerland
10.34172/ijhpm.2020.245
Abstract
Background
World Health Organization Choosing Interventions that are Cost-Effective (WHO CHOICE) has been a programme of the WHO for 20 years. In this latest update, we present for the first time a cross programme analysis of the comparative cost-effectiveness of 479 intervention scenarios across 20 disease programmes and risk factors.
 
Methods
This analysis follows the standard WHO CHOICE approach to generalized cost-effectiveness analysis applied to two regions, Eastern sub-Saharan Africa and Southeast Asia. The scope of the analysis is all interventions included in programme specific WHO CHOICE analyses, using WHO treatment guidelines for major disease areas as the foundation. Costs are measured in 2010 international dollars, and benefits modelled beginning in 2010, or the nearest year for which validated data was available, both for a period of 100 years.
 
Results
Across both regions included in the analysis, interventions span multiple orders of magnitude in terms of cost-effectiveness ratios. A health benefit package optimized through a value for money lens incorporates interventions responding to all of the main drivers of disease burden. Interventions delivered through first level clinical and nonclinical services represent the majority of the high impact cost-effective interventions.
 
Conclusion
Cost-effectiveness is one important criterion when selecting health interventions for benefit packages to progress towards universal health coverage (UHC), but it is not the only criterion and all calculations should be adapted to the local context. To support country decision-makers, WHO CHOICE has developed a downloadable tool to support the development of data for this criterion.
Keywords
Cost-Effectiveness
Economic Evaluation
Efficiency
Universal Health Coverage

 

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  • Received Date 01 February 2020
  • Revised Date 18 November 2020
  • Accepted Date 28 November 2020
  • First Published Date 17 February 2021
  • Published Date 01 November 2021