Better Value in Health Spending Is a Four-Letter Word – Podcast with Amanda Glassman

No one really understands why the first letter is lower case and the rest are in capitals. But one thing that is clear to anyone who has heard of iDSI is that it fills a growing gap in how developing countries decide how to allocate their strained health budgets. The International Decision Support Initiative is a network of expert organizations that helps policymakers make effective, efficient, and ethical decisions about how to prioritize limited resources. And it just got bigger, thanks to a new grant to scale up its operations (you can read about it here).

With evidence and rational decision-making at its heart, it is no surprise that iDSI began as the recommendation of a report by a 2012 CGD Working Group. Its chair and director of our global health program, Amanda Glassman, tells me in a new podcast that iDSI will become increasingly important in the years ahead.

“What really matters right now for middle-income countries, which are most of the countries in the so-called developing world, is how they choose to spend their own public resources. So informing that process with evidence and with good process, for me, it’s the only way forward,” she says.

So why is iDSI needed? Because some countries currently spend large amounts of money on ineffective treatments such as prescribing vitamins or sending a few patients overseas for costly procedures, while many thousands at home go without basic health provisions. In addition, as countries become wealthier, richer donor nations will move away from entirely underwriting their health sectors, and low- and middle-income countries (LMICs) will increase their own public health spending; thus the need for better priority-setting will skyrocket. And as more countries aim towards universal health coverage (UHC), it will be even more crucial to get the most health for their money.

It’s been a short and speedy evolution for iDSI. Following that CGD report, the initiative was set up in 2013 by the UK’s NICE (National Institute for Health and Care Excellence) and Thailand’s HITAP (Health Intervention and Technology Assessment Program), with funding by the UK’s DfID, the Bill and Melinda Gates Foundation and, earlier, the Rockefeller Foundation. Originally, it focused on five countries—Indonesia, India, Vietnam, China, and South Africa—and it is credited with helping those countries make better healthcare spending decisions. Recently, the Gates Foundation announced a $12.8 million grant to scale up the practical support iDSI offers to countries that aspire to UHC. This will mean not only working harder in the five flagship nations, but also expanding its geographical reach, particularly into sub-Saharan Africa.

We think of iDSI as a classic CGD success story: we started by identifying a problem in the economics of health (the inefficiencies of LMIC health budgets and a lack of processes and institutions to help prioritize health spending), we convened a group of experts to focus on the problem, found a toehold, and worked it until we came up a new simple, low-cost solution. Now we are delighted that policymakers and funders have seen—and realized—the potential.

As Glassman says, “I feel that’s exactly what CGD was created for. To come up with what makes sense, try and get all of these different people working in the same direction, and now it has a life of its own. Our job is to collaborate and to support and celebrate but it’s… bigger than us now and I think that’s what CGD is all about!”