Priority setting of public spending in developing countries: do not try to do everything for everybody

Area of Science:

• Health economics
• Public health policy
• Resource allocation

Background:

• Developing countries face challenges in funding comprehensive essential health services due to insufficient public spending.
• Inequitable and inefficient resource use arises from attempts to provide universal free services and funding low-impact interventions.

Purpose of the Study:

• To present a rational approach for targeting and prioritizing public health spending.
• To apply this approach to the context of Ghana's health system.

Main Methods:

• Interventions were evaluated for economic justification for public funding.
• Prioritization was based on medical and non-medical criteria to determine target populations (whole population vs. poor only).

Main Results:

• A ranked order of interventions was established, specifying target populations for public funding.
• High priorities include prevention of mother-to-child HIV/AIDS transmission and childhood diarrhea treatment (oral rehydration therapy) for the entire population.
• Childhood pneumonia case management is a priority for the poor only, while interventions for blood pressure, tobacco, and alcohol abuse received low priority for public funding.

Conclusions:

• Governments should avoid attempting to provide all services universally.
• Strategic prioritization can lead to more equitable and efficient health system resource utilization.