Evidence-informed capacity building for setting health priorities in low- and middle-income countries: A framework and recommendations for further research

Ryan Li; Francis Ruiz; Anthony J Culyer; Kalipso Chalkidou; Karen J Hofman

doi:10.12688/f1000research.10966.1

Evidence-informed capacity building for setting health priorities in low- and middle-income countries: A framework and recommendations for further research

F1000Res. 2017 Mar 7:6:231. doi: 10.12688/f1000research.10966.1. eCollection 2017.

Authors

Ryan Li¹, Francis Ruiz¹, Anthony J Culyer^{2

3}, Kalipso Chalkidou¹, Karen J Hofman⁴

Affiliations

¹ Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK.
² University of York, York, UK.
³ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁴ Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA), MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits University School of Public Health, Johannesburg, South Africa.

Abstract

Priority-setting in health is risky and challenging, particularly in resource-constrained settings. It is not simply a narrow technical exercise, and involves the mobilisation of a wide range of capacities among stakeholders - not only the technical capacity to "do" research in economic evaluations. Using the Individuals, Nodes, Networks and Environment (INNE) framework, we identify those stakeholders, whose capacity needs will vary along the evidence-to-policy continuum. Policymakers and healthcare managers require the capacity to commission and use relevant evidence (including evidence of clinical and cost-effectiveness, and of social values); academics need to understand and respond to decision-makers' needs to produce relevant research. The health system at all levels will need institutional capacity building to incentivise routine generation and use of evidence. Knowledge brokers, including priority-setting agencies (such as England's National Institute for Health and Care Excellence, and Health Interventions and Technology Assessment Program, Thailand) and the media can play an important role in facilitating engagement and knowledge transfer between the various actors. Especially at the outset but at every step, it is critical that patients and the public understand that trade-offs are inherent in priority-setting, and careful efforts should be made to engage them, and to hear their views throughout the process. There is thus no single approach to capacity building; rather a spectrum of activities that recognises the roles and skills of all stakeholders. A range of methods, including formal and informal training, networking and engagement, and support through collaboration on projects, should be flexibly employed (and tailored to specific needs of each country) to support institutionalisation of evidence-informed priority-setting. Finally, capacity building should be a two-way process; those who build capacity should also attend to their own capacity development in order to sustain and improve impact.

Keywords: INNE framework; capacity development; evidence-informed priority setting; health policy; health technology assessment; institutions; knowledge transfer and exchange; universal health coverage.

Grants and funding

This paper was produced as part of iDSI ( www.idsihealth.org), a global initiative to support decision makers in priority-setting for UHC. The work received funding from Bill & Melinda Gates Foundation (grant OPP1087363, “Establishing Priority Setting Institutions in Developing Countries”), the UK Department for International Development, and the Rockefeller Foundation.