Brooke expressed several concems and goals to the OTA during the home health session. She is feeling somewhat depressed and lonely being "confined" to her apartment and neighborhood. She would like to get out into the community more and to expand her life. She and her partner are seriously discussing having a child, but she's also thinking about going back to school for a degree in teaching. She misses the challenge of climbing and wants to get back into sports. What would be the priorities of your intervention? Why?

 

Answer:

In the context of an explicit prioritization exercise, cost-effectiveness information can be used for two different purposes. The first is to look for missed opportunities in terms of interventions that could generate reasonable returns for the investment made, but are not currently included in the package. The second is to provide the evidence needed to counter political pressures to add interventions that generate relatively low benefits relative to their cost. The relevance of time constraints varies between two types of situations. In the first case, cost-effectiveness analysis can be conducted without rigid time pressures, while in the second situation, information has to be produced quickly enough to guide impending decisions that often arise from other stakeholders. Given these dynamics, it is usually difficult to complete cost-effectiveness analyses quickly enough to respond to the pressures faced to add specific interventions. The exception is a scenario where there is an institutionalized requirement to demonstrate the cost-effectiveness outcome ante.

Rational prioritization can also guide long-term organizational change in strategic areas such as capacity building. Cost-effectiveness analysis and priority setting in general highlight valuable opportunities for strengthening health systems. Capacity constraints and organizational issues, particularly the availability of human and physical resources, can limit coverage expansion plans for cost-effective interventions. Evidence and consensus on the interventions that should be provided by the health system can exert strong pressure to identify constraints to their implementation, to achieve greater coordination among government agencies, and to allocate resources to new services. In short, they can help bring about needed changes that would otherwise have been too slow and difficult to promote. Similarly, the explicit formulation of packages helps to improve the compatibility of instruments for regulating provision that were traditionally uncoordinated. These include master plans for new infrastructure, guidelines and protocols for new interventions, certification and accreditation procedures for programs seeking quality assurance, and formulary lists for pharmaceuticals, equipment and other therapeutic supplies.