Intended for healthcare professionals

Rapid response to:


Helping poorer countries make locally informed health decisions

BMJ 2010; 341 doi: (Published 16 July 2010) Cite this as: BMJ 2010;341:c3651

Rapid Response:

Strengthening capacity for local decision making

We agree that empowering local authorities to make decisions is
critical to enhance local decision making. South Africa has a history of
such efforts both preceding and following the fall of Apartheid
(1,2,3,4,5). Over the past 18 months we have established an initiative to
support and strengthen this process in South Africa. An extensive and
rewarding consultation with stakeholders culminated in a national-level
Steering Committee to provide high-level direction and oversight. At the
launch of this initiative (6), Dr. Molefi Sefularo (the late Deputy
Minister of Health), noted that SA needed “increased capacity, as a
country, to make better, quality and informed decisions in the health

The broad goals of PRICELESS SA (Priority Cost Effective Lessons for
Systems Strengthening) are to 1) Ensure that priority setting for health
care systems is based on good evidence; and 2) Support the development of
evidence-based information and tools to determine how best to use
existing/scarce resources so that health systems work more effectively and
efficiently. To maximize the usefulness of this information for resource
allocation decisions, work is underway in close collaboration with local
policy makers and analysts and their engagement so far has been highly
encouraging. One of the key innovations that is that the economic
evaluation will measure not just traditional vertical interventions, but
will address how to gain efficiency for an intervention(s) at lower cost
across the key service delivery “platforms” that are used to deliver
public health and medical care interventions. Tools are being developed
and field tested to determine whether they can provide nationally-relevant
results. Several cost-effectiveness analyses of district health / primary
care platforms are underway including their articulation with integrated
approaches to the management of chronic disease including vascular illness
and/or TB/HIV; and Maternal and Child Health.

PRICELESS SA is part of a wider network of countries including India that
are beginning to undertake similar efforts as part of the Disease Control
Priorities Network (DCP-N) based at the Institute for Health Metrics and
Evaluation at the University of Washington, Seattle. The success of the
PRICELESS SA initiative over time will depend on several issues, not least
of which, as noted in your article is the promotion of local technical
expertise in order to carry this kind of work forward. An intensive
workshop to enhance proficiency and provide researchers in South Africa
with the practical skills to compile burden of disease data and to model
the cost-effectiveness of health interventions recently took place.

Participants included government representatives from Ministries of Health
and Finance at both national and provincial level. Developing further
technical competence in SA is essential to realize the gains from the
government’s considerable investment in health.

Karen Hofman

Hon Senior Lecturer, University of Witwatersrand School of Public Health

MRC/Wits Rural Public Health and Health Transitions Research Unit, School
of Public Health, University of the Witwatersrand, Johannesburg, South

Director, Division of International Science Policy, Planning and
Evaluation Fogarty International Center, National Institutes of Health,
Bethesda, USA

Stephen Tollman

Director and Associate Professor, MRC/Wits Rural Public Health and Health
Transitions Research Unit, University of Witwatersrand School of Public
Health, Johannesburg, South Africa







6. Cherry M. Setting priorities for health spending in South Africa. S Afr
J Sci 2009;105(7-8):245-246.

Competing interests:
None declared

Competing interests: No competing interests

05 August 2010
Director, Policy Office, Fogarty International Cntr, NIH; Hon Snr Lecturer Wits S of Public Health
STEPHEN TOLLMAN ; MRC/Wits Rural Public Health and Health Transitions Research Unit, University of Witwatersrand School of Public Health,