In global health, priority-setting is a term
used for the process and strategy of deciding
which health interventions to carry out.
Priority-setting can be conducted at the disease
level (i.e. deciding which disease to alleviate),
the overall strategy level (i.e. selective
primary healthcare versus primary healthcare
versus more general health systems strengthening),
research level (i.e. which health research
to carry out), or other levels.
== Definitions ==
Priority-setting is the act of deciding which
health interventions to carry out, and can
occur at several levels of granularity.
Priority-setting can occur at the following
levels:
health budget level (i.e. deciding how much
to spend on health overall)
overall strategy level (i.e. selective primary
healthcare versus primary healthcare versus
more general health systems strengthening)
disease level (i.e. deciding which disease
to alleviate)
intervention level within each disease (i.e.
restricting to a specific disease and prioritizing
among interventions for that disease)
drug level
research level (i.e. which health research
to carry out)Synonymous terms include "prioritization
in health care and health research", "priority
determination", "health priorities", and "agenda-setting".
== Metrics ==
Various metrics have been used to compare
interventions.
These include:
Disability-adjusted life year per unit cost
(used by e.g. Disease Control Priorities Project),
quality-adjusted life year, and other forms
of cost-effectiveness analysis
Reasons that the disease burden has persisted
Adequacy of funding
== 
Who sets the priorities?
==
Priority-setting can be done by various actors.
These include:
Governments: "In most countries, health spending
by governments vastly outpaces international
health aid, so governments set most health
priorities."
Non-profits and companies that assist governments
If a country is using a Health in All Policy
(HiAP) approach, then priority-setting is
done by stakeholders who do not directly deal
with health.
International organizations
Foundations
Private donors (including high-net-worth individuals
and ultra-high-net-worth individuals): "A
common outcome is a negotiated set of priorities
that reflect some domestic needs and some
technical, political, and economic considerations
defined largely by the interests of donors."
In some highly aid-dependent countries, donors
"have huge influence on health priorities".According
to Devi Sridhar, professor of global health
at the University of Edinburgh, "the priorities
of funding bodies largely dictate what health
issues and diseases are studied".
== History of organizations and programs working
on priority-setting ==
According to Amanda Glassman et al., global-level
priority-setting has occurred since at least
the 1980s, though these efforts have only
focused on a few aspects.The following table
is a timeline of organizations and programs
working on priority-setting.
== Reception ==
Rudan et al. says that priority-setting efforts
have relied on "consensus reached by panels
of experts" and as a result have not been
systematic enough, and that this has "often
made it difficult to present the identified
priorities to wider audiences as legitimate
and fair".Glassman et al. notes that criticisms
of priority-setting include "the weak data
on which estimates of burden, cost, and effectiveness
relied; the value judgments implicit in disability-adjusted
life year age weighting and discounting decisions;
and treatment of equity issues, as well as
the political difficulties associated with
translating a ground zero package into a public
budget based on historical inputs"; and the
consideration of only health maximization
at the expense of other objectives such as
fairness.Glassman et al. also notes how there
are more cost-effectiveness studies for LMICs
(in the thousands), but that these are unlikely
to be actually applied to priority-setting
processes.Jeremy Shiffman has said that some
bodies such as the Institute for Health Metrics
and Evaluation and The Lancet are prominent
in priority-setting due to their dominion
rather than data and analysis, and also notes
that the process of creating the Sustainable
Development Goals was not sufficiently transparent.
== See also ==
Timeline of nonprofit evaluation
Timeline of global health
Effective altruism
Cost-benefit analysis
Global Burden of Disease Study
10/90 gap
Health economics
Health care rationing
Impact evaluation
Impact assessment
Open Philanthropy Project, which does broader
prioritization work
