BACKGROUND
 

The Prince Mahidol Award Conference (PMAC) is an annual international conference focusing on policy-related health issues of global significance. The conference is hosted by the Prince Mahidol Award Foundation, the Thai Ministry of Public Health, Mahidol University and other global partners where their institutional mandates are relevant to the Conference theme. It is an international policy forum that Global Health Partners, public, private and civil society organizations, can co-own and use for driving global health agenda. The Conference in 2016 is co-hosted by the Prince Mahidol Award Foundation, the World Health Organization, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Japan International Cooperation Agency, the U.S. Agency for International Development, the China Medical Board, the Rockefeller Foundation, NICE International, the Bill & Melinda Gates Foundation, and the National Evidence-based Healthcare Collaborating Agency, South Korea with the support from other key related partners. The Conference is held in Bangkok, Thailand, from 26 -31 January 2016.

RATIONALE

Universal health coverage (UHC) is high on the global agenda as a means to ensure population health, equity and social development. In most countries where current access to essential health care is limited, introducing UHC prompts serious concerns among government leaders on the growing expenditures and demands for public resources. As such, priority setting is indispensable and has been applied at various levels, to ensure that finite health resources can be used in the most cost-effective ways, to provide a high quality and appropriate package of healthcare for the population. At the macro level, priority setting can be used to set limits of the health budget and how much should be spent on health insurance; at the meso level, how much should be spent on infrastructure development and human resources; at the micro level, how much should be spent on particular drugs, technologies, intervention, and policies within a health problem.

Priority setting involves explicit and implicit approaches and the focus of the theme is explicit approaches, which encourages the use of evidence, transparency, and participation. Although priority setting cannot avoid politics, evidence should come first and politics are complementary to what evidence cannot address because evidence-based priority setting can make UHC acceptable and sustainable. It is noteworthy that since health-related decisions are driven by the Health in All Policy notion, priority setting is undertaken not only by policy makers in the Ministry of Health and Health Insurance Office, but also by stakeholders in non-health sectors such as the Ministry of Finance, development partners, and civil society organizations.

The role of health intervention and technology assessment (HITA), not only as a technical exercise but also as a deliberative process, is increasingly recognized as a tool for explicit priority setting, including in the development of the health benefits package, which is an integral part of UHC – what kind of services to provide and to whom. The concept of HITA and its contribution to UHC were endorsed in the resolutions of the WHO Regional Committees for the Americas in 2012 and Southeast Asia in 2013, the Executive Board in January 2014, and the World Health Assembly (WHA) resolution in May 2014. All these resolutions call for movements on capacity building for and introduction of HITA in all countries, especially in those resource-finite settings. It is anticipated that these movements will increase awareness and demand for HITA studies in the health sector. The WHA resolution also requests the WHO Director-General to report back to the WHA in May 2016. Thus the PMAC in January 2016 would be most timely to track the progresses and recommend further actions.

CONCEPTUAL FRAMEWORK 

The PMAC 2016 sessions were developed on the conceptual framework illustrating essential elements of health priority setting that addresses the need for evidence-informed decision making in support of universal health coverage (UHC) (figure). In this sense, priority setting of health problems and solutions involves two major steps of evidence generation (Subtheme 1) and use of evidence in resource allocation, program management and quality assurance in health delivery (Subtheme 2). Priority setting in particular health systems is implicated by a wide range of political, economic and sociocultural factors, through the following building blocks:

• Governing structure, functions and regulation of respective institutes and their interrelationship; 

• Resource availability and mobilization to support priority setting activities; 

• Capacity building programs for well understanding and knowledge concerning health priority setting among policymakers, researchers and other stakeholders including general public; and

• Collaboration and networks of local, international and global organizations those aim to strengthen UHC policy decisions.

Evidence generation, either from research studies or from relatively simpler analysis of information, requires not only capable human resources, but also reliable and up-to-date data/information, rigorous methods and practical approaches. Health technology assessment has been recognized as a useful tool for priority setting of biomedical interventions and public health measures. Other approaches for determining priority health interventions also exist. Meanwhile, connection between evidence, priority setting processes and policy decisions is politically-oriented, as it is shaped by social values (such as efficiency, equity, morality, and solidarity) and variety of interests, all of which are usually competing with each other. 

In practice, health priority setting (Subtheme 3) in most low- and middle-income countries is imperfect, owing to constraints in the four building blocks. Importantly, the absence of good governance can result in inadequate resources, system capacity and support from different organizations. These allow powerful interests, with certain values, to dominate both the technical and political aspects of priority setting, and subsequently undermine quality of evidence as well as political commitment to using evidence to inform coverage decisions, disinvestment, program designs and guidelines formulation in the UHC context.    

SUB-THEMES

Topics to be discussed fall under three main sub-themes, with a focus on organizing priority setting, using priority setting in UHC decisions, and practical experiences of priority setting. The three sub-themes are interrelated and may somewhat overlap, thus, the issues in each sub-theme may be similar, but with different perspectives depending on the sub-theme.  

Sub-theme 1: Organizing priority setting: what evidence is needed?

Various tools are available to support priority setting; some are well established and widely used, others are emerging and under development. Moreover, some analytical methods, such as economic evaluation, comprise different approaches, e.g. generalized cost-effectiveness analysis, extended cost-effectiveness analysis, etc. Notably, there is not a single tool that addresses all priority setting concerns among decision makers and stakeholders. The effectiveness of a tool depends on the objective and context of use. This sub-theme provides not only basic information to participants who are not familiar with priority setting and its technical terms, but also, in some sessions, offers in-depth dialogues on current challenges in order to call for collaborations in order to address these challenges in the future. 

Objectives

• To overview techniques and approaches available for priority setting including their advantages and disadvantages
• To discuss what evidence is required in priority setting for the whole range of interventions from single technologies to complex interventions, health systems arrangements, and disinvestment of existing interventions/technologies
• To discuss the governance of priority setting  

Sub-theme 2: Using priority setting evidence in making UHC decisions 

The main objective of this sub-theme is to demonstrate political economy and options to link evidence to UHC policy. This sub-theme also addresses current challenges in this area, including the lack of integration of evidence in policy development, such as the revision of the benefits package, national formularies, standard practice guidelines, and designs of public health programs. 

Objectives

• To discuss political economy of priority setting for UHC, including why decision makers do or do not use evidence in decision making 
• To address how evidence is applied, transcendent across geographical boundaries, and communicated in UHC decisions in different country contexts

Sub-theme 3: Priority setting in action: learning and sharing country experiences  

This sub-theme covers real world experiences by development partners and countries where priority setting mechanisms exist or HITA studies have been conducted, as well as countries without formal mechanisms. The sub-theme offers an opportunity for learning and sharing country experiences with different levels of development towards UHC and priority setting capacities, and the role of development partners in these countries. It will also discuss missed opportunities of countries without explicit health priority setting. The sub-theme will lead to policy and practical recommendations for the establishment or maintenance of priority setting mechanisms for the sustainability of UHC. 

Objectives

• To learn and share experiences on priority setting for UHC in different country contexts 
• To develop policy recommendations for establishing or maintaining priority setting mechanisms for UHC