Randomised controlled trials are rarely feasible for evaluating large-scale health policies like national insurance schemes or sugar taxes, so researchers in Brazil, Indonesia, and South Africa will instead use quasi-experimental methods—such as synthetic control groups—to assess what works, for whom, and at what cost. This matters because a major evidence gap exists around system-level and population-level interventions that could have large impacts on population health in low- and middle-income countries. Without rigorous evaluation, policymakers lack reliable guidance on which policies deliver real health gains and value for money. If successful, the research will produce concrete evidence on the health and economic effects of policies such as universal health coverage or taxes on unhealthy foods. This could directly inform government decisions in partner countries and beyond, helping to allocate scarce resources more effectively. The work also combines under-exploited data with state-of-the-art econometric methods, offering a low-cost way to generate actionable insights where traditional trials cannot go.
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A - C The proposed programme of work aligns both with the University of York’s (UoY) strategy 2015-2020 ‘to be a world leader in research’ and the specific ambition to encourage international research activity - and builds on two of its themes: ‘Health and Wellbeing’ and ‘Justice and Equality’. UoY has entered into an ambitious engagement with ODA-compliant research, aiming to leave a legacy for the University, research in the UK and our partners in the global South. CHE has a team of 50 health economists representing the full breadth of the discipline. Its joint submission with related health groups at UoY to the REF 2014 was ranked top in the country for research environment. While CHE is regarded as one of the leading health economics institutions worldwide [1], most of its research has focussed on high-income health systems (esp. the UK NHS). This proposal is part of CHE’s aim to use health economics to inform policies in LMICs. CHE has an excellent track record in the core domains of GHE2 (econometric analysis and economic evaluation) with demonstrable impact for over 30 years. The UoY is committed to ensuring the success of the proposed Group and has agreed to support it with funding a 3-year full-time Grade 6 research fellow position. The UoY has been investing in supporting International Development research; the International Development Network provides a vehicle to access extended networks of expertise in research programmes in partnership with ODA-recipient countries. Early successes include GCRF funding on leishmaniasis and MRC funding on tobacco control. CHE itself has existing successful international projects in disease modelling/economic evaluation and is seeking to build upon these with GCRF funding (e.g. Thanzi la Onse [TLO] proposal to RCUK), targeting South and East Africa, but these do not have GHE2’s focus on impact evaluation using secondary data. Together, TLO and GHE2 represent the breadth of CHE’s research in global health covering major thematic areas in health economics and building a solid basis on which to sustain further growth. D RCTs are the gold standard of evaluative techniques but randomisation is seldom feasible for evaluating larger-scale interventions that go beyond patient-level, disease-specific interventions [2-4]. This has left a major evidence gap around types of interventions that could have large population health impacts: (1) Health system-level e.g. universal health insurance, and (2) Population-level interventions e.g. taxes on unhealthy foods (See Additional Information). The key objective of GHE2 is to contribute to filling the evidence gap on ‘what works, for whom and at what cost’ in terms of system- and population-level interventions in LMICs. We will do this by conducting country-specific case studies led by researchers in partner countries (Brazil, Indonesia, South Africa) on a set of system- and population-level interventions selected on the basis of pressing national policy needs, their relevance for policymaking beyond the country itself, and the availability of suitable data for evaluation. The case studies focus on quasi-experimental research designs [5] relevant to situations where RCTs are less feasible and that address key limitations of RCTs (e.g. external validity) [4]. Combining existing, under-exploited data with rigorous empirical impact evaluation methods provides evidence to inform policymaking at comparatively low cost. State-of-the-art approaches, e.g. panel instrumental variables and synthetic control methods, will be adopted to assess average population health impacts and distributional impacts, capturing effects across different socioeconomic groups. An integral part of this work will be theory-based logic models of the key causal pathways; identifying the key active ingredients and contextual factors of the intervention [6-7]. There is also a major gap in assessing the value-for-money of the above policies [8-9]. While economic
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