Intended for healthcare professionals


Helping poorer countries make locally informed health decisions

BMJ 2010; 341 doi: (Published 16 July 2010) Cite this as: BMJ 2010;341:c3651
  1. Kalipso Chalkidou, director1,
  2. Ruth Levine, vice president for programmes and operations2,
  3. Andrew Dillon, chief executive3
  1. 1NICE International, National Institute for Health and Clinical Excellence, London WC1V 6NA
  2. 2Centre for Global Development, 1800 Massachusetts Avenue NW, Washington, DC 20036, USA
  3. 3National Institute for Health and Clinical Excellence
  1. Correspondence to: K Chalkidou kalipso.chalkidou{at}
  • Accepted 30 May 2010

Health spending in low income countries is too often driven by outside pressure rather than local evidence. Kalipso Chalkidou, Ruth Levine, and Andrew Dillon report on efforts to help them match spending to local needs

With more money available for health in poorer countries, as well as increasing demand for services and new products, policy makers are looking for ways to expand access, reduce out of pocket spending, and improve outcomes without bankrupting national budgets. Decisions are still largely driven by historical norms, the priorities of foreign donors, and lobbying pressures, and it is uncommon for countries to have functional mechanisms for making decisions based on their own needs. However, demand is growing from foreign governments and funding agencies to give countries technical and strategic support to develop the capability to make decisions based on local evidence and values. The National Institute for Health and Clinical Excellence (NICE) has been working in partnership with national governments to strengthen local decision making. We use this experience to suggest ways in which decision makers can be empowered locally.

More money

Recently, development aid for health has increased substantially, from $5.6bn (£3.7bn; €4.5bn) in 1990 to $21.8bn in 2007.1 The increase has coincided with the emergence of partnerships focusing resources on specific diseases or products such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance for promoting access to vaccines.2

National spending in poorer countries is also growing. With the encouragement of the international community, countries such as Sierra Leone and Ghana are making services free for vulnerable populations3 or launching insurance schemes.4 The Chinese government has committed over $120bn over the next three years to expand healthcare coverage to all 800 million Chinese farmers.5 India is making a similar, albeit more fragmented, …

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