If you are a policy-maker working on the COVID-19 response in your country, we would love to hear about your experience and intention to work with those models, as well as your assessment of the perceived gaps. In addition, we would like to learn from you how models can be best communicated, including what they should report.

Communicating effectively and presenting results clearly is important in order to ensure that results are understood by end-users and appropriately incorporated into policy-making.

The intention of attached survey is to gather your perspective on (1) model outcomes and scenarios and their relevance to your work, (2) presentation of the results, and (3) trust/accountability of results and modellers. This survey is organised around those three sections.

The survey may take 15-20 minutes to complete.

Click here to access the survey or alternatively, use the link below

https://docs.google.com/forms/d/e/1FAIpQLSd-MC15jaUFR0fOkcfJpdDuPhvOB5x8Y-Z1qVMvRjFPB_KFfg/viewform

Should you have any questions, please address queries to ychi@cgdev.org

A HSR 2018 satellite session, which will focus on health financing towards Universal Health Coverage (UHC), has received funding from Sida, working on behalf of the Swedish Parliament and Government. The full day session is co-hosted by the Clinton Health Access Initiative, Sida and iDSI.

1. The satellite session will feature policy makers from Sub Saharan Africa sharing their experiences developing and implementing policies and reforms to make progress towards UHC. What are you hoping will come out of this session?

Low and middle-income countries are facing a very similar set of health financing challenges and implementing related reforms. There are many success stories and practical experiences to be shared from the people currently implementing reforms on the ground.

We are hoping that this session will contribute to strengthening the knowledge exchange between the decisions-makers from Low and middle-income countries in how to best address common challenges and learn from each other.

We will focus on how priority setting, defining basic health services, resource allocation and strategic purchasing can be applied to make progress towards UHC, including essential sexual and reproductive health and rights (SRHR): What do we pay for, which services and for whom, and how do we pay it? How do we make the difficult choice of prioritising certain services above others and how do we ensure that services are delivered in a sustainable and equitable way? How do we ensure key services such as SRHR are included and specific needs of for example adolescents and young women are not left behind.

2. Can you tell us more about the facilitators and panellists that will be part of the satellite session?

We are bringing together leading researchers, government officials and policy representatives from Asia and Sub-Saharan Africa that have on the ground experience in developing and implementing policies.  This includes government representatives from countries Sida is supporting, with technical assistance from the Clinton Health Access Initiative (CHAI) in health financing reforms (Ethiopia, Rwanda, Malawi, South Africa, Eswatini, Zambia).

We believe this mix of people will make for interesting discussions. We will also open up the floor after each sub-session for an audience of international attendees.

3. Investment in sexual and reproductive health and rights in Sub-Saharan Africa is major part of Swedish development cooperation. Can you tell us some more about the work of the regional team based in Lusaka and Sida’s approach?

Sweden has a feminist foreign policy and SRHR is a top priority for Swedish Development Assistance. Approximately 60 per cent of our official development assistance for health is directed towards SRHR. The regional team works on SRHR to advance the continental and regional agenda for sexual and reproductive health and rights through supporting legal and policy reform, expanding access to essential SRH-services, changing social norms around gender and sexuality, as well as advancing accountability for regional commitments. The team has partnerships with regional economic communities such as the Southern African Development Community (SADC) and East African Community, parliamentary fora such as SADC Parliamentary Forum, the UN including the United Nations Population Fund and WHO, research institutes and civil society networks. Our work with CHAI on health financing is an important part in advancing SRHR in sub-Saharan Africa. Access to SRHR services, under a model for UHC, requires a transparent and inclusive discussion on how resources are prioritised and what services to include in basic packages based on the best available evidence. For us, UHC is based on the principle that basic health services should be provided to all. If these principles are adhered to, SRHR services become naturally prioritised.

Sida’s commitment to SRHR is likely to remain for the foreseeable future. Therefore we believe in establishing long-term partnerships with organisations that can contribute to normative change in the region.

4. What do you enjoy most about your role?

My position gives me a good overview of regional SRHR issues and a chance to see how different structures and processes are related. Thanks to that overview, I have a unique opportunity to connect partners and key actors to initiative and networks where synergies can be created. The HSR 2018 satellite sessionis a good example of connecting people to achieve more. Personally, I am very happy to be part of the promotion of SRHR-interventions as a natural and integral part of basic health care packages and UHC since these services respond to common and often recurring needs in the population and therefore must be included in public commitments.

5. If you weren’t in the global health, what would you be doing instead?

Living in Sweden I would probably work for a health provider with Lean production and quality assurance or in a purchaser–provider organisation defining volumes, cost levels and quality standard of health services in assignments to health providers, both public and private. Irrespective of which job, I would make sure I was involved in organisational and operational development since it really matters “how” services are provided and what results you get for your money.

Conference delegates can attend ‘Health financing towards UHC’ from in conference room 13 from 8.30am on Monday 8 October as part of HSR 2018 of which the overaching theme is ‘advancing health systems for all in the Sustainable Development Goals era’. Find out more at www.healthsystemsresearch.org/hsr2018

Just days ago, Bill Gates had visited the country to meet with prime minister Nadendra Modi, where the multibillion dollar philanthropist commended the PM on his efforts to improve the country’s population health. Indeed, Gates followed up his visit with a guest editorial in the Times of India, reflecting on his week of meetings in the capital and history of collaboration in India, stating that “With the right investment in India’s economy and India’s people, what lies ahead will be even more impressive”. Is it a coincidence that the PM waited until Gates had left the country before announcing cuts to the country’s largest public health program? I think not.

Reuters further reports that ‘officials familiar with the plan said the finance ministry reduced planned funding because of other spending priorities and because of state governments’ poor track record of spending the health budgets they’ve been allotted in the past’. This news is not new, and indeed an analysis by India Spend of 2017 Reserve Bank of India data on state budgets released in July this year, reported that nine of India’s poorest states spent less money than was allocated to them, and that these same states had the poorest performance indicators in the country.

I wrote a blog when the India Spend analysis was released in July this year, titled ‘More money does not mean more health’. In this blog I highlighted that system inefficiencies needed to be effectively addressed if countries, and states in the case of India, are to adequately utilise resources to improve health outcomes. While few would argue against the notion that India will not come close to achieving its ambition of achieving universal health coverage (UHC) with the current health spend of 1.4%GDP, one of the lowest spends globally, the notion that more money does not guarantee more health may come as a surprise to some.

We know from global surveillance data that health expenditure is rising in most countries across the world, yet figures released by the OECD reveal that a considerable proportion of this expenditure has little to no impact on improving people’s health. This is consistent with a 2010 WHO analysis which concluded that 20-40% of healthcare spending globally is wasted. This tells us that when the right systems are not in place to spend money wisely, effectively implement policy decisions, and govern their deployment.

So is the government of India justified in not increasing the budget allocated for health and raising the expenditure from the current 1.4% GDP? The answer is no. Unless more money is invested into the Indian health system to meet the growing demands of the 1.3bn strong population, the country will never realise its ambition of providing UHC. Consider the counterfactual – if investment in health stays stable or drops, are the population health indicators likely to improve? The latest Human Development Index, released in 2016 saw India slip to a rank of 131 out of a possible 188 countries in the world, behind neighbours Sri Lanka and the Maldives. If drastic action to rectify falling health indicators is not taken, evidenced by a stronger financial and practical commitment to health, the wellbeing of the population will continue to slide backwards.

Strong strategic planning and support should be undertaken to complement increased spending to ensure that additional funds are adequately absorbed and spent wisely. Such planning to not only spend more money, but spend it better is essential to maximise the value of every rupee spent, and ultimately improve the health of the population.

The key messages outlined in the earlier blog are highlighted here again, as follows:

• An important determinant of success or failure of Indian states to improve their health indicators will be the strength of system-wide mechanisms to engage in effective priority setting of resources and govern their deployment.
• Effective uptake of resource allocation decisions requires a system able to deliver and strong governance mechanisms to ensure that policies are properly implemented.
• Evidence-based priority setting of resources is important to maximise health gains made within the constraints of a finite budget.
• Without robust surveillance and governance mechanisms, the value of effective priority setting is severely diminished.
• Ensuring an adequate number of well-trained and reasonably paid health professionals with access to necessary equipment and infrastructure is critical to ensure a fit for purpose delivery system and address supply-side inefficiencies.

Key features of the policy include the establishment of the HTA unit in the Department of Health (DOH), a description of the principles, criteria and process, as well as the composition and qualifications of the appraisal body. These provisions strengthen existing policies related to HTA, such as the Philippine National Formulary System (PNFS) in DOH and the Priority Setting Process in PhilHealth. The bill is a legislative priority of the current administration so we are hopeful that it receives substantial support from the upper house. We recognise HTA as a key tool to achieve universal health coverage in the country as per the HITAP sponsored World Health Assembly 2014 HTA Resolution, especially since service coverage remains fragmented and out-of-pocket payments are still high at 53.7% of total health expenditure (2014), despite 92% of the population having health insurance.

Global collaboration

iDSI, has provided support to the Philippines during the PNFS’ early stages. In 2011, NICE International started work with the MoH under The Rockefeller Foundation support, and in 2012, the National Center for Pharmaceutical Access and Management (NCPAM) (now called the Pharmaceutical Division in DOH) together with HITAP, conducted two policy relevant evaluations on the PCV and HPV vaccine. This project enabled NCPAM staff to visit HITAP and publish articles in international peer-reviewed journals, some articles can be viewed here and here. Two of the DOH staff are now back in Thailand pursuing a postgraduate programme in HTA at Mahidol University under iDSI scholarships.

More recently, the DOH also arranged a visiting scholarship of the HTA team lead to the Global Health and Development Group (GHD) at Imperial College London (the successor to NICE International), where they received guidance on: developing the country’s HTA roadmap, the revised process guidelines, and on economic evaluation for COPD drugs. It was also through the participation in knowledge sharing activities and international conferences that HTA was brought back on the policy agenda last year. Philippine policy makers and researchers participation in the Prince Mahidol Award Conference 2016 (co-hosted by HITAP, NICE international, and others) re-ignited the policy discussions and research on HTA and priority setting in PhilHealth and DOH.

HTA as a tool to achieve universal health coverage

Under the current bill’s whole system, society, & government approach, the vision is that the country coordinates a multisectoral approach, inclusive of all stakeholders, which looks at each component and function of the health system to realise UHC. This entails establishing a single institution that sets actionable (i.e. reimbursable) priorities for payers of healthcare. However, much capacity building is needed in terms of individual research skills, as well as sectoral capacity to manage and implement such processes. There is also a need to enhance policy makers’ understanding of what HTA is, how it is done, when and where it should be done, as HTA is not the answer to all policy questions. For example, the legislation specifies the use of HTA as an input in revising the Health Benefits Package. Another use could be in pricing discussions with manufacturers. Further, effective HTA has to accommodate existing health system features, including the interplay of different financing agents, private and public healthcare providers, and other stakeholders.

Despite these challenges, we believe that as a country, we have made significant progress towards building our national HTA institution. Last July, a HTA study group was established in the Health Research Division of the Health Policy Development and Planning Bureau in the DOH. The team has full-time researchers in charge of coordinating and implementing HTA related research activities. The DOH also just approved a revised process guideline for HTA, which expands the scope to cover all interventions (not just drugs), uses explicit decision criteria, and a multi-stakeholder process from topic selection, to assessment and appraisal. These achievements would not have been possible without international collaboration with universities, development agencies, and other HTA institutions outside the country, all of which will be featured on the bureau’s website as soon as it is up and running.

While we are still quite a way from having a NICE or HITAP counterpart in the country, the path towards institutionalisation is much clearer now that there is political support, and as we are slowly developing capacity. The DOH is set to scale-up HTA implementation by hiring more full time staff in the coming months, and investing in capacity building programmes. Collaboration with international partners such as iDSI must be fostered in order to sustain momentum. A Letter of Intent for Cooperation between the Philippine Department of Health, HITAP and the Imperial team was recently signed paving the way for further collaboration in the future.

Professor Karen Hofman explains how a sugary beverage tax could reduce diabetes and obesity in South Africa in her recent lecture at Imperial College London.

As part of a Global Health & Development lecture, Professor Karen Hofman discussed the research evidence that informed the tax on sugary beverages in South Africa, to be promulgated in 2017/2018; and the political economy of potentially introducing such a levy.

A growing body of evidence indicates that excessive sugar consumption is driving epidemics of obesity and related non-communicable diseases (NCDs) around the world. South Africa (SA), a major consumer of sugar, is the most obese country in Sub Saharan Africa, and 40% of all deaths in the country are NCD related. Several fiscal, regulatory, and legislative levers could reduce sugar consumption in SA. These low cost instruments are a “Best Buy” and could save lives from obesity related diseases, save health care costs and generate revenue. This talk will focus on a sugar sweetened beverage (SSB) tax first proposed by the SA Treasury in 2016. Professor Hofman presented some of the analysis that informed key SA policymakers, the cost of inaction and discussed lessons learned from other middle income settings.

This event was chaired by Professor Franco Sassi, Professor of International Health Policy and Economics.

Here’s some of our Twitter highlights from Professor Hofman’s lecture…

In a recent policy brief, Oxford Policy Management and the International Decision Support Initiative (iDSI) have asked “would the VfM analysis that the UK’s Department for International Development conduct on their programme expenditure be more useful if lessons were learnt from the iDSI Reference Case for Economic Evaluation?”. It is argued that significant methodological improvements are available to DFID – which could make the information they generate more useful for their decision makers. These recommendations are also applicable to other donors who follow similar guidelines for monitoring their VfM.

Alex Jones’ blog post exploring some of the issues raised in the brief is available on the Oxford Policy Management website.