World Health Organization 2 August 2018 The use of WHO-CHOICE for priority setting Jeremy Lauer, PhD Melanie Bertram, PhD Health Systems Governance and Financing WHO Geneva

Value for money and efficiency These are fundamental concerns for investment in health: Even with increased availability of resources for health in some areas and Especially in under-resourced settings Making the right choices more important than ever. Universal Health Coverage: shifting to more efficient activities is equivalent to raising new finance).

Need for a health system focus Priority setting needs to take into account health system building blocks because Achieving high impact depends on strong health systems and Health systems use many shared resources, affecting multiple outcomes and sustainability.

The circle of financing: focus on complementarity of activities What to Do (CHOICE) (OneHealth Tool) How to Do It Evaluation Monitoriing (SHA) & sector-wide priority setting (WHO-CHOICE), national strategic planning (OneHealth Tool), and expenditure tracking (System of Health Accounts).

WHO-CHOICE (what to do) WHO-CHOICE provides tools to facilitate the country-level cost-effectiveness analysis of interventions related to a wide range of health outcomes. intended for use mainly by national-level decision makers, In parallel, WHO-CHOICE has published and disseminated on line a vast knowledge base of regional-level cost- effectiveness information. responds primarily to the needs of actors in the donor community and UN agencies.

WHO-CHOICE: Generalized Cost-effectiveness Analysis Acknowledges budget constraints Allows the comparison of interventions within and outside the health sector Identifies the mix of interventions that generates the largest health gain (allocative efficiency) Improves the transferability of results across settings

Using cost effectiveness (CHOICE) to defining benefit packages Two approaches: Start with the most cost-effective interventions and add successively less cost-effective interventions until the budget is exhausted. Define a cost-effectiveness threshold and fund everything under that threshold.

Approach 1: budget based

Approach 2: threshold based

Issues: Countries usually make changes at the margin to an existing package. Existing packages rarely defined based on allocative efficiency (or other Health System goals, such as financial risk protection).

How to Get There from Here Why are there differences from allocative efficiency? Equity Financial Protection Other Health System Goals Budgetary Inertia Past Investment Decisions Are there Easy Wins? Underutilized Strategies? Things we Should be Doing More of? Role for Strategic Planning: from Theory to Practice

Strategic Planning: OneHealth Tool How to Chart a path