Qualitative evaluation of the use of modelling in resource allocation decisions for HIV and TB

IntroductionGlobally, resources for health spending, including HIV and tuberculosis (TB), are constrained, and a substantial gap exists between spending and estimated needs. Optima is an allocative efficiency modeling tool that has been used since 2010 in over 50 settings to generate evidence for country-level HIV and TB resource allocation decisions. This evaluation assessed the utilization of modeling to inform financing priorities from the perspective of country stakeholders and their international partners. MethodsIn October-December 2021, the World Bank and Burnet Institute led 16 semi-structured small-group virtual interviews with 54 representatives from national governments and international health and funding organizations. Interviews probed participants roles and satisfaction with Optima analyses and how model findings have had been used and impacted resource allocation. Interviewed stakeholders represented nine countries and 11 different disease program-country contexts with prior Optima modeling analyses. Interview notes were thematically analyzed to assess factors influencing the utilization of modeling evidence in health policy and outcomes. ResultsCommon influences on utilization of Optima findings encompassed the perceived validity of findings, health system financing mechanisms, the extent of stakeholder participation in the modeling process, engagement of funding organization, socio-political context, and timeliness of the analysis. Utilizing workshops can facilitate effective stakeholder engagement and collaboration. Model findings were often used conceptually to localize global evidence and facilitate discussion. Secondary outputs included informing strategic and financial planning, funding advocacy, grant proposals, and influencing investment shifts. ConclusionAllocative efficiency modeling has supported evidence-informed decision making in numerous contexts and enhanced the conceptual and practical understanding of allocative efficiency. Most immediately, greater involvement of country stakeholders in modeling studies and timing studies to key strategic and financial planning decisions may increase the impact on decision making. Better consideration for integrated disease modeling, equity goals, and financing constraints may improve relevance and utilization of modeling findings.