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:

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

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.

The following checklist of questions can help to guide considerations of the potential impacts on equity:

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:



This page was last updated November 2011.