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Priorities in Health Advisory Committee to the Editors Priorities in Health Advisory Committee to the Editors J. R. Aluoch Christopher Lovelace Jacques Baudouy Anthony Mbewu Fred Binka Rajiv Misra Mayra Buvini´c Perla Santos Ocampo David Challoner G. B. A. Okelo Guy de Thé Sevket Ruacan Timothy Evans Pramilla Senanayake Richard Horton Jaime Sepúlveda Sharon Hrynkow Chitr Sitthi-amorn Gerald Keusch Sally Stansfield Kiyoshi Kurokawa Misael Uribe Peter Lachmann Zhengguo Wang Mary Ann Lansang Witold Zatonski Contributing Writers William D. Savedoff and Anne-Marie Smith, Social Insight Priorities in Health Editors Dean T. Jamison Joel G. Breman Anthony R. Measham George Alleyne Mariam Claeson David B. Evans Prabhat Jha Anne Mills Philip Musgrove THE WORLD BANK Washington, D.C. ©2006 The International Bank for Reconstruction and Development / The World Bank 1818 H Street NW Washington, DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org E-mail: [email protected] All rights reserved 123409080706 This volume was funded in part by a grant from the Bill & Melinda Gates Founda- tion and is a product of the staff of the International Bank for Reconstruction and Development / The World Bank, the World Health Organization, and the Fogarty International Center of the National Institutes of Health. The findings, interpreta- tions, and conclusions expressed in this volume do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent, the World Health Organization, or the Fogarty International Center of the National Institutes of Health. The World Bank, the World Health Organization, and the Fogarty International Center of the National Institutes of Health do not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgement on the part of The World Bank, the World Health Organization, or the Fogarty Interna- tional Center of the National Institutes of Health concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this publication is copyrighted. Copying and/or transmitting por- tions or all of this work without permission may be a violation of applicable law. The International Bank for Reconstruction and Development / The World Bank encourages dissemination of its work and will normally grant permission to reproduce portions of the work promptly. For permission to photocopy or reprint any part of this work, please send a request with complete information to the Copyright Clearance Center Inc., 222 Rosewood Drive, Danvers, MA 01923, USA; telephone: 978-750-8400; fax: 978-750-4470; Internet: www.copyright.com. All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2422; e-mail:pubrights@worldbank. org. ISBN-10: 0-8213-6260-7 ISBN-13: 978-0-8213-6260-0 eISBN: 978-0-8213-6261-7 DOI: 10.1596/978-0-8213-6260-0 Library of Congress Cataloging-in-Publication data has been applied for. Contents Foreword by Rajiv Misra vii Acknowledgments xiii Abbreviations and Acronyms xvii 1. Accomplishments, Challenges, and Priorities 1 Historical Achievements in World Health 2 Accounting for Health Gains 5 Health and Economic Growth 7 Equity 8 An Agenda for Action 13 Putting DCP2 to Use 16 This Volume 20 2. Success in Addressing Priorities 23 Successes despite Weak Health Systems 27 Successes That Strengthened Weak Health Systems 28 Cost-Effective Interventions Aimed at Building Health Systems 31 Cost-Effective Interventions That Furthered Existing Health Systems 33 Cost-Effective Interventions beyond Health Systems 34 Conclusion 36 3. Cost-Effectiveness Analysis 39 Why Use Cost-Effectiveness Analysis? 39 What Is Cost-Effectiveness Analysis? 42 How Reliable Is Cost-Effectiveness Analysis? 48 What Are Appropriate Tasks for Cost-Effectiveness Analysis? 50 How Can Policy Makers Use Cost-Effectiveness Analysis? 52 Summary for Using Cost-Effectiveness Analysis Properly 56 v 4. Cost-Effective Strategies for the Excess Burden of Disease in Developing Countries 59 Infectious and Communicable Diseases 60 Maternal and Neonatal Health 82 5. Cost-Effective Strategies for Noncommunicable Diseases, Risk Factors, and Behaviors 97 Cardiovascular Disease, Diabetes, High Blood Pressure, Cholesterol, and Bodyweight 98 Cancer 104 Congenital and Developmental Disorders 106 Unintentional Injuries 110 Tobacco Use 112 Alcohol Abuse 120 Mental Health 124 Conclusion 126 6. Providing Interventions 129 Levels of Care 130 Cross-Level Services and Inputs 139 Integration of Services across the Life Cycle 149 7. Pillars of the Health System 155 Information, Surveillance, and Research 155 Management of Health Services 164 Human Resources 168 Financing 173 8. The Way Forward: A Blueprint for Action 179 References 183 About the Editors 187 Advisory Committee to the Editors 195 Contributing Writers 196 Table of Contents, Disease Control Priorities in Developing Countries, 2nd Edition 197 Table of Contents, Global Burden of Disease and Risk Factors 205 Index 207 Photo Credits 217 vi | Contents Foreword Priorities in Health is the companion volume to the second edition of Disease Control Priorities in Developing Countries (DCP2), a successor to the first edition (DCP1) published in 1993, but with a vastly expanded mandate. DCP1 proved to be a highly influential document in shaping health policies globally. The World Bank’s (1993) path- breaking publication World Development Report 1993: Investing in Health, which incorporated DCP1’s main concepts and messages, became the standard reference for health policy makers worldwide and even today continues to enjoy that status. In India, the impact was dramatic, and I was greatly privileged to be in a position to manage and oversee the transition to greatly improved implementation of public health interventions in terms of both cover- age and effectiveness. A serendipitous set of circumstances facilitated this, namely: an unprecedented fiscal and balance of payments crisis that compelled India to seek structural adjustment lending from the International Monetary Fund and the World Bank and resulted in severe fiscal compression; a shift in World Bank lending policies whereby the International Development Association was to emphasize social sectors; a paucity of health and education projects in the pipeline to use the highly concessional International Development Association allocation at a time when India was experiencing a severe foreign exchange crunch; and finally, an extraordinarily sympathetic and sup- portive team at the World Bank’s India desk. We became aware of DCP1’s main concepts well before its publica- tion by means of a seminar at Delhi’s All India Institute of Medical Sciences in early 1992, at which Dean Jamison and his colleagues pre- sented the main findings of DCP1 and the World Development Report 1993, including the concepts of disability-adjusted life years, burden of vii disease, epidemiological transition, and cost-effectiveness analysis as a tool for priority setting. These concepts provided a completely new way of determining priorities objectively based on evidence and eco- nomic analysis. Despite some initial and understandable skepticism about the methodologies and the estimates, the overall response was highly favorable. At the same time, the World Bank was looking for objective criteria for identifying projects in the health sector. A commonality of ap- proach developed between the World Bank and the Ministry of Health to use DCP1 techniques, which led to the revamping and scaling up of all major disease control projects in record time—particularly those against leprosy, blindness, tuberculosis, and malaria—in addition to new initiatives for dealing with the emerging threat of HIV/AIDS. Simultaneously, projects for system strengthening were also under- taken in several states to improve capacity. As a result, the develop- mental outlays for the Department of Health rose more than 5-fold and the external component rose more than 25-fold between 1990–1 and 2001–2 (India Health Report 2003), which not only increased available financial resources beyond anyone’s expectations, but also completely changed how projects were formulated and implemented. This is a success story of which both the Indian government and the World Bank can legitimately be proud, that is, the contribution of DCP1 to channeling additional resources to cost-effective interven- tions to deal with the conditions responsible for a major share of the burden of disease. COVERING NEW GROUND DCP2 is a much more comprehensive, and indeed ambitious, effort. It goes well beyond updating the technical content, burden of disease, and cost-effectiveness estimates of DCP1. It covers new ground by ex- amining important, complex areas, such as the delivery, management, and financing of health care and health research. It clearly recognizes that objective priority setting is only the first step: identified interven- tions have to be delivered to the targeted population efficiently to de- rive the full benefits of cost-effectiveness exercises; individual health interventions are rarely effective in isolation; and not only must the entire health system perform well to achieve positive outcomes but so do such related sectors like nutrition, drinking water, sanitation, and viii | Foreword education. Raising the capabilities of the whole
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