1. 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

2. 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).

3. 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.

4. 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).

5. 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.

6. 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

7. 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.

8. Approach 1: budget based

10. Approach 2: threshold based

13. 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).

16. 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

17. Strategic Planning: OneHealth Tool
How to Chart a path