Additional considerations
Judgements about resource use and costs
In settings with limited resources, policymakers are deeply
concerned about resource use and the costs and savings associated
with different options. The term ‘costs’ in this context is used
broadly but it is important to be aware that it includes both the
costs of actual resource use (e.g. the time of health workers) and
the monetary value (or prices) attached to those resources (e.g.
wages or fees).
The costs and cost-effectiveness of an intervention need to be
assessed in a specific setting so that differences in patterns of
resource use and prices can be taken into account. To help decision
makers to make these assessments, the authors of policy briefs
should consider the following questions:
- What are the most important costs, including the costs of
implementing and sustaining the option?
- What information is there about those costs, either from
systematic reviews or other sources, for example economic analyses
(see Box 4.4)?12
- Is there important uncertainty about medium- to long-term
costs?
- Is there important uncertainty about the applicability of any
reported costs?
A
worksheet,
Workshop materials and a
PowerPoint presentation on making judgements about costs and
cost effectiveness are provided in the ‘Additional resources’ section of
this guide. Further guidance on finding and using research evidence
about resource use and costs can be found in the SUPPORT
Tool which is also available in the ‘Additional resources’.
Judgements about impacts on equity
In addition to considering the overall impacts of options,
policy brief authors should also consider potential impacts on
equity. This can be done by examining the findings of a review and
considering the possible differential effects of interventions on
disadvantaged populations. Potential impacts on equity of an option
should be evaluated in relation to factors likely to be associated
with disadvantage. These might include economic status, employment
or occupation, education, place of residence, gender and ethnicity
(Box 4.5).
Box 4.5 Factors likely to be
associated with disadvantage
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You should consider the possibility of an intervention having
different effects in disadvantaged populations whenever there is an
association between the mechanism of action of the option and
particular characteristics. For example:
-
Economic status:
low-income populations are more likely to be responsive to changes
in the prices of goods and services. Because they have less
disposable income, tobacco tax increases, for example, could make
such populations more likely to quit. But they would also be made
more vulnerable as a result of having to spend more money on
tobacco if they did not quit smoking
-
Employment or
occupation: employer-funded insurance schemes may result in
differences in coverage, with less coverage being likely for those
who are unemployed, self-employed or employed in small
companies
-
Education: school-based
programmes would be expected to differentially affect those who
attend versus those who do not attend schools. Information
campaigns that rely on printed materials to improve the utilisation
of health services might have differential impacts on illiterate or
less-educated populations
-
Place of residence:
access to care is commonly more difficult in rural areas. Any
strategy, therefore, that does not take into account the need to
improve the delivery of effective clinical or public health
interventions is likely to be less effective in rural areas
-
Gender: strategies for
involving stakeholders in priority setting may affect women and men
differently, resulting in priorities that may have different
impacts on women and men
-
Ethnicity: ethnic groups
(e.g. those groups who consider themselves, or are considered by
others, to share common characteristics which differentiate them
from other groups in society) may have beliefs and attitudes
relating to the acceptability of a particular policy or programme.
Delivery strategies that do not take these perspectives into
account are likely to be less effective amongst ethnic groups where
an otherwise effective policy or programme might not be readily
accepted.
These examples were adapted from the SUPPORT tool
for taking equity into consideration. The acronym PROGRESS is
sometimes used as a mnemonic for factors that can be associated
with health inequities.* PROGRESS stands for place of residence,
religion, occupation, gender, race/ethnicity, education,
socioeconomic status, and social networks and capital.
*Evans T, Brown H. Road traffic crashes: operationalizing equity in
the context of health sector reform. International Journal of
Injury Control and Safety Promotion 2003; 10:11-12.
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The following checklist of questions can help to guide
considerations of the potential impacts on equity:
- Are there plausible reasons for anticipating differences in the
relative effectiveness of the option for disadvantaged groups or
settings?
- Are there likely to be different baseline conditions across
groups or settings such that the absolute effectiveness of the
option would be different, and the problem more or less important,
for disadvantaged groups or settings?
- Are there important considerations that should be made when
implementing the option in order to ensure that inequities are
reduced, if possible, and that they are not increased?
More guidance on how equity should be taken into consideration
when assessing the findings of a systematic review can be found in
a SUPPORT
tool located in the ‘Additional resources’
section. A
worksheet, workshop
materials and a
PowerPoint presentation on making judgements about equity are
also available in the ‘Additional resources’ section of
this guide.
Judgements about the need for monitoring and evaluation
There is often uncertainty about the effects and
cost-effectiveness of interventions, therefore the authors of
policy briefs should also address the need for monitoring and
evaluation of each option. See
SURE Guide 6.
Monitoring and Evaluation. Questions to consider
include:
- Is monitoring necessary?
- If monitoring is necessary, what should be measured?
- Is an impact evaluation necessary?
- If an impact evaluation is necessary, what should be evaluated
and how?
This page was last updated November 2011.