A CRITICAL-REVIEW OF PRIORITY SETTING IN THE HEALTH SECTOR - THE METHODOLOGY OF THE 1993-WORLD-DEVELOPMENT-REPORT

The 1993 World Development Report, investing in Health, suggests polic ies to assist governments of developing countries in improving the hea lth of their populations. A new methodology to improve government spen ding is introduced. Epidemiological and economic analyses form the bas is for a global priority setting exercise, leading to a recommended es sential public health and clinical services package for low-and middle -income countries, Ministries of Health in many countries have express ed an interest in designing a national package of essential health ser vices, using the methodology. Given the apparent importance attached t o the study and its far reaching potential consequences, this article provides an overview of the method, the main issues and problems in es timating the burden of disease as well as the cost-effectiveness of in terventions. Strengths and weaknesses in the databases, value judgemen ts and assumptions are identified, leading to a critical analysis of t he validity of the priority setting exercise on the global level.