Economic evaluation of disease elimination: an extension to the net benefits framework and application to human African trypanosomiasis

The net benefits framework has become a mainstay of the cost-effectiveness literature, guiding decision-makers to select among strategies in the presence of budget constraints and imperfect information. However, disease elimination programs are socially desirable but not always cost-effective. Therefore, analytical frameworks are necessary to consider the additional premium for reaching global goals that are beyond the cost-effective use of country resources. We propose a modification to the net benefits framework to consider the implications of switching from an optimal strategy (in terms of cost-per-burden-averted) to a strategy with a higher likelihood of meeting the global target (i.e. elimination of transmission by a specified date). Our expanded framework informs decisions under uncertainty, determines the share of funding necessary to align local and global priorities, enabling local partners to use their resources efficiently while cooperating to meet global health targets. We illustrate the advantages of our framework by considering the economic case of efforts to eliminate transmission by 2030 of gambiense human African trypanosomiasis (gHAT), a vector-borne parasitic disease in West and Central Africa. Significance Statement Various diseases have now been earmarked for elimination by the global health community. While the health economic implications of elimination have been discussed before, one important topic remains unexplored: uncertainty and its consideration within extant cost-effectiveness frameworks. Here we extend the ubiquitous net benefits framework to consider the comparative efficiency of alternative elimination strategies when these strategies have different probabilities of reaching elimination. We evaluate the premium of elimination, and we apply our method to efforts against human African trypanosomiasis in three settings. This method could be directly applied to simulation-based studies of the cost-effectiveness of other disease elimination efforts, therefore giving the global health community a common metric by which to budget for such initiatives.

Reinforcing locally led solutions for universal health coverage: a logic model with applications in Benin, Namibia and Uganda

Development assistance for health programmes is often characterised as donor-led models with minimal country ownership and limited sustainability. This article presents new ways for low-income and middle-income countries to gain more control of their development assistance programming as they move towards universal health coverage (UHC). We base our findings on the experience of the African Collaborative for Health Financing Solutions (ACS), an innovative US Agency for International Development-funded project. The ACS project stems from the premise that the global health community can more effectively support UHC processes in countries if development partners change three long-standing paradigms: (1) time-limited projects to enhancing long-lasting processes, (2) fly-in/fly-out development support to leveraging and strengthening local and regional expertise and (3) static knowledge creation to supporting practical and co-developed resources that enhance learning and capture implementation experience. We assume that development partners can facilitate progress towards UHC if interventions follow five action steps, including (1) align to country demand, (2) provide evidence-based and tailored health financing technical support, (3) respond to knowledge and learnings throughout activity design and implementation, (4) foster multi-stakeholder collaboration and ownership and (5) strengthen accountability mechanisms. Since 2017, the ACS project has applied these five action steps in its implementing countries, including Benin, Namibia and Uganda. This article shares with the global health community preliminary achievements of implementing a unique, challenging but promising experience.

A real-time policy dashboard can aid global transparency in the response to coronavirus disease 2019

There has been great provision of open data across the coronavirus disease 2019 (COVID-19) pandemic response, with, for example, dashboards presenting real-time descriptions of new daily cases and risk factors. Transparency has been an important discussion point and there have been concerns and criticisms of governments for not publishing the evidence base that is informing their decision-making. A ‘policy dashboard’ could act as a hub to show the localised reasoning behind COVID-19 policy decisions and allow the global health community to provide further support to governments and international stakeholders.

The Lancet–O’Neill Institute/Georgetown University Commission on Global Health and Law: The Power of Law to Advance the Right to Health

The Lancet–O’Neill Institute/Georgetown University Commission on Global Health and Law published its report on the Legal Determinants of Health in 2019. The term ‘legal determinants of health’ draws attention to the power of law to influence upstream social and economic influences on population health. In this article, we introduce the Commission, including its background and rationale, set out its methodology, summarize its key findings and recommendations and reflect on its impact since publication. We also look to the future, making suggestions as to how the global health community can make the best use of the Commission’s momentum in relation to using law and legal tools to advance population health.