The most cost-effective health interventions produce as much as 15,000 times the benefit as the least cost-effective. In sub-Saharan Africa, less than US$4 out of every US$100 in public budget monies go to the health maximizing intervention or technology. Up to US$2.8tn spent annually on healthcare is said to be wasted  This means that hundreds, thousands, and even millions of deaths are a direct result of our inability to allocate according to maximum health gain. Although public budgets are set to grow, if we fail to reverse inertial and wasteful resource allocation by governments, we will squander most of the value of the additional resources available, or end up funding highly cost-effective interventions in an ad hoc and funder-dependent way.

Yet too many LMIC health systems lack the tools and institutional mechanisms to prioritise the interventions and products that generate the most health for the money. iDSI directly addresses this weakness in priority-setting methods, capacity and processes, and responds to demand for knowledge diffusion and translation, bridging the disconnect between evidence and the policy decisions that drive allocation of public and external funder monies across LMICs.

iDSI is a global platform for resource allocation in health, working to maximise development impact across disease areas and assuring that:

• Capacities to generate and use evidence are developed among global development partners and national governments
• LMICs are empowered to invest in key cost-effective global health priorities
• The efforts of development partners such as WHO to improve LMIC policy decisions are more efficient and effective, drawing on iDSI as a technical resource to work with national priority-setting institutions
• Global funders’ offerings and transition arrangements support the most cost-effective use of funds available
• All efforts connect with and respond to LMIC governments’ policy processes and local realities, and progress towards UHC.

iDSI activities comprise two core programmatic areas, Country Engagement and Knowledge Products. The two programmatic areas are synergistic, such that country engagements are informed by iDSI knowledge products, such as the iDSI Reference Case, and at the same time valuable global public goods may arise from the country work.

There is a small but consistent body of evidence suggesting that HTA – both in the sense of individual cost-effectiveness analyses and related priority-setting decisions, and of a sustained programme of analyses or HTA institution – is extremely good value for money with very high returns on investment. iDSI’s past country engagements illustrate that enormous value can be recovered by choosing the most cost-effective technologies for public subsidy (e.g.  Ghana and Vietnam), and the relatively low cost of the HTA function – less than 0.1% of a country’s healthcare budget – when compared to the savings and health gains from more cost-effective uses of public monies.

Country engagement will be oriented towards achieving two closely interlinked strategic objectives: institutional strengthening to develop lasting in-country institutional capacity for evidence-informed priority-setting; and implementing cost-effectiveness evidence for smart purchasing for UHC (e.g. evidence-informed health benefits package planning and purchasing). iDSI regional hubs will enable impact at scale and ensure sustainability beyond donor funding.

iDSI is applying its principles, values, methods and expertise, as well as from other global initiatives, in LMICs anticipating or entering epidemiological and financing transitions. We envision two broad types of country: flagship countries, where there is clear unmet demand from policymakers for evidence-informed priority-setting and local capacities that could be utilised to meet this demand; and scale-up countries where demand is less clearly articulated and that stand to benefit from our global and regional hub activities.

Regional hubs

Central to our responsive engagement approach is having trusted implementing partners who share iDSI’s values and can provide efficient local (in-country and regional) presence and influence key stakeholders. In order to scale up their impact and build sustaining capacity to respond to the growing demand for practical support in a greater number of African countries, iDSI regional hubs will over time serve the following functions:

• Lead and deliver context-specific, responsive practical support to governments and other partner institutions within the region, and demonstrate policy and ultimately population health impact through implementing evidence-informed priority-setting
• Diffuse knowledge and scale up impact, by plugging into WHO country and regional offices, and regional policy networks and economic unions such as Southern African Development Community (SADC) and East African Community (EAC); and global networks such as HTAi, HTAsiaLink and the Joint Learning Network for UHC.
• Convene regional networks and collaborations, with a commitment to form in-country and regional partnerships, and identify potential new partner countries
• Build and strengthen institutional, technical, and informational capacities, to attain a critical mass of priority-setting expertise and allow evidence-informed priority-setting to be self-sustaining
• Secure and leverage additional funding sources to ensure long-term sustainability, for instance through bids to high-income country global research funders that will buy in staff capacity whilst addressing policy-relevant research priorities

Given that political contexts, levels and interconnectedness of capacity, and institutional relationships will vary from country to country, we anticipate that regional ‘hubs-and-spokes’ may take different forms. iDSI will be working closely with local partners in scoping out regional hubs for Southern Africa and East Africa, to be based in South Africa and Kenya respectively.