75
levels, improvements in health led to greater aggregate income (Bloom et al. 2001). Further research by the same authors found that each extra year of life expectancy raised a country’s GDP per person by around 4% in the long run (Bloom et al. 2004). Given the evidence from the past and from other countries, then, the Indian government’s pledge to increase its investment in health will be justifiable, on economic as well as humanitarian grounds. However, as we have seen, the amount invested is still lower than the amount pledged; and the scale of need is always certain to be far greater than the available resources. Each additional 1% of GDP, even allowing for growth, is still a relatively modest sum per capita, around Rs 320 (US$ 8) each per year. How can the government make sure that it uses these very limited amounts of money effectively? Clearly, it will be essential to set priorities. In the discussion that follows, we examine what kinds of criteria might be used.
4.3 Rational approaches to setting priorities Many factors can influence governments’ decisions about how to prioritise their health spending. Often, the power of a political lobby, a pressure group, or the medical profession can be significant. Skewed priorities can result in governments’ investing heavily in facilities that will be used only by a wealthy minority, while neglecting basic public health tools, such as child immunisation. Almost all countries can point to expensive mistakes in the allocation of their health resources – such as high-profile, high-specification hospitals that are opened proudly by politicians but remain inaccessible to the majority in need of basic, essential services. Governments have a responsibility to spend their taxpayers’ money carefully, using independently monitored evidence on what works and how best to organise the delivery of services. To achieve the goal of improving health on a limited budget, rational criteria should guide the decisions. Since the 1990s, mainly as a result of initiatives such as the Disease Control Priorities Project, health policy researchers in many countries have made systematic efforts to identify such criteria. As discussed in the Introduction to this report, the DCPP was set up to review, generate, and disseminate information on how to improve