Priorities in Global Health 2020

The overall objective of ”Priority Setting in Global Health 2020” was to develop tools to incorporate equity concerns and non-health benefits alongside cost-effectiveness information to aid priority setting across interventions and health service delivery platforms relevant for global health. Two key contributions from this project has been the clarifications of principles of fair distribution and the development of methods to integrate distributional effects in health economic analyses.

A secondary objective that became clearer along the way was the need for translating basic research in ethics, health economics and priority setting into practical advice for improved decision making in global health. Several of our publications and reports have contributed to this objective (especially the report “Making fair choices on the path to UHC”, WHO 2014).

In summary, we recommend that low- and middle-income countries – that implement Universal Health Coverage (UHC) as part of their SDG-strategy – should set priorities based on data and analysis that takes into account both effectiveness, fair distribution and poverty reduction. To be concrete, we recommend priorities on the basis of three fundamental criteria: 1) Cost- effectiveness, 2) priority to the worse off (both in terms of health, poverty and other forms of vulnerability), and 3) financial risk protection.

Scientists in the research group (lead by Ingrid Miljeteig, Kjell Arne Johansson, Tryge Ottersen and Ole Frithjof Norheim, with contributions from international partners) have been conducting qualitative studies of prioritisation in practise, analysis of development aid for health, performed contextualised health economic analysis, and contributed to ethical theory on fair priority setting in health and health care. The group has also contributed to the development of a new method called “Extended Cost-Effectiveness Analysis” (with partners in the project, professors Dean Jamison and Stephane Verguet).

The research team in Priorities 2020 has published (as lead or co-authors), all together 87 scientific articles in relevant journals (such as Lancet, Lancet Global Health, Science, BMJ Global Health, Bulletin of WHO and Health Policy and Planning) in addition to reports and book chapters – as well as making contributions to popular science in media targeting health professionals and lay people. Two article collections on theory development will be published by Oxford University Press in the near future (Norheim et al. ”Priority setting in global health: beyond cost-effectiveness” OUP 2018; Gamlund & Solberg ”Saving lives from the badness of death” OUP 2018).

Solid funding, including Norad`s former quota system, has enabled the establishment of a strong research group for Global Health Priorities at the Department of Global Public Health and Primary Health Care at UiB. Significant international cooperation has been established and the project has successfully contributed to capacity building in Tanzania and Ethiopia (all together six PhD candidates). Two completed PhD candidates (Solomon Memirie and Mieraf Tolla) were given the opportunity for further research at Harvard University and are now taking part in the project “Disease Control Priorities – Ethiopia” (funded by Bill and Melinda Gates Foundation) based at Harvard and the Center for Ethics and Priority Setting, Addis Ababa University. UiB has over a long period of time focused on international cooperation and national capacity building as a central strategy to contribute to sustainable development. This project has benefited from this in terms of trust from key decision-makers positioned within the Ministry of Health and academic institutions.

The project has strengthened international cooperation with leading actors in global health and priority setting, such as the World Health Organization, World Bank, Harvard University, Oxford University, University of Washington, IHME, IDSI, London School of Economics, Chatham House, and the NIH Bioethics Center. National collaboration includes the Norwegian Institute of Public Health and University of Oslo. The cooperation with Norad and the Ministry of Foreign Affairs has nudged the project in the right direction and they provided valuable input and opened doors to important international health policy processes. The cooperation with Disease Control Priorities 3rd Edition, led by Professor Dean Jamison, must be mentioned in particular. DCP3 has been one of the most important providers of evidence-based recommendations on prioritisation within the framework of Universal Health Coverage (UHC).