Economic Evaluation in Low- and Middle-Income Countries Facing Aid Transition, Financing Volatility and Health-System Transformation

Health systems worldwide face growing pressure to do more with limited resources, and the pace of new technology are straining budgets and forcing hard choices about what to fund, for whom, and at what cost. In low- and middle-income countries, these pressures are compounded by aid transition and financing volatility, as shrinking or shifting donor support forces governments to rethink how they fund and prioritise care.Economic evaluation is one of the main tools available for making these decisions, but no single method captures the full picture. Cost-effectiveness analysis is the most established approach, while cost-utility, cost-benefit, and budget impact analyses each answer different questions for different decision-makers. As health systems move from single-technology decisions to system-wide reform, portfolio management, and disinvestment, this toolkit needs to broaden alongside them.Three pressures make this urgent. Financing volatility means countries increasingly need to evaluate a portfolio of services and programmes rather than a single product, often on compressed timelines and with little methodological guidance for managing disinvestment or transition financing. Health-system transformation, through integrated service delivery, workforce redesign, and new purchasing arrangements, is poorly captured by cost-effectiveness ratios built for one technology at a time. And distributional consequences need to be built into the analysis from the outset, rather than treated as a footnote to an efficiency calculation.This Research Topic brings together methodological, empirical, and policy work that helps decision-makers in low- and middle-income countries evaluate resource allocation under these conditions. We're particularly interested in how donor priorities, earmarking, and commissioning arrangements shape the assumptions built into an evaluation, and in work that makes distributional trade-offs explicit rather than incidental. Contributions led by or co-authored with researchers based in low- and middle-income countries are especially welcome.We welcome original research, systematic reviews, methodological papers, and policy analyses on themes including, but not limited to:• Aid transition and donor influence, including how earmarking and commissioning arrangements shape the perspective, comparator, time horizon, or threshold used in an evaluation, and how countries plan for sustainability once donor funding ends.• Evaluation under financing volatility, including portfolio and disinvestment analysis, constrained optimisation, and budget impact or fiscal space analysis when budgets are shrinking or unpredictable.• Economic evaluation of health-system transformation, covering integrated service delivery, workforce redesign, and reforms to purchasing or benefit packages.• Equity in resource allocation, including distributional and extended cost-effectiveness analysis, financial protection, and allocation across regions or population groups.• Methods and reporting quality, including model transparency, replicability, conflict-of-interest disclosure, and how far existing reporting standards fit donor-funded analyses. Topic editors: Saima Arif, Charles C. Ezenduka, Masoud Behzadifar Source: https://www.frontiersin.org/research-topics/85712/economic-evaluation-in-low--and-middle-income-countries-facing-aid-transition-financing-volatility-and-health-system-transformation