Decide's Sunset: a proud and bittersweet message for the end of the Decide Hub

Dear Members and Followers,


I sincerely hope this message finds you all well, healthy and still full of energy despite turning the page of another hectic year!


To paraphrase Charles Dickens, has it been “the best of years and the worst of years”? Well, Decide proved more than busy, and quite successful.


So let us look back and appraise what our young health decision hub managed to achieve over 2023 and more broadly over the last three years:


A unique positioning leading to hands-on products

hands on 

As you know, your Decide Hub’s business model relies on the design of operational tools that health decision makers can use to secure value for money across their policies and projects, in the fields of HTA, priority setting, contracting, capital investment and predictive modelling.


Based on data, analytics and knowledge, our operational tools offer actual country use and strive to make a difference.


Decide is the global hub for value for money and showcases how it’s done through the tools it designed and made available!


So, what happened after the design and implementation of the Cost-Effective Data Across Settings (CEDAS) tool? This first collaborative matrix – with more than 20 participating organizations- allowed the breadth and depth of the health economics ecosystem to co-create a unique pathway for decision makers to navigate datasets, tools and methods.


We also finalized the minimum viable product (MVP) of Bolster!, or the first step of the scenario generating “video game” for policymakers to visualize the consequences of their health system transformation options.


Partnering with The Royal Institute of Tropical Medicine of The Netherlands (KIT), the University of Sheffield and Triangulate Health Ltd, Decide managed to create an interoperable analytical platform that harvests all relevant data pertaining to PHC (starting with maternal and child health) and project effects of changes in health systems delivery.


The proof of concept now awaits further funding to build up the algorithm that will build scenarios, and expands to a wider spectrum of diseases as well as other policy sectors.


As agreed last year and with the support of our funders the Bill and Melinda Gates Foundation, 2023 was a special year for your Decide Hub, with a single focus on the finalization and country use cases of another one of our exciting tools, and arguably the most impactful: the capital investment in health tool.


Capital Assets Solutions for Health: CASH is king!

cash king 

The capital investment in health tool, known as the Capital Assets Solutions in Health (CASH) tool is a unique instrument enabling health stewards to optimize their health infrastructure projects across the life cycle.


Designed with the support of Decide board members CEB and HOPE as well as WHO, national decision makers and health infrastructure experts, CASH is as of the end of this year:


- In effective use in 7 countries

- Lined up to be used in 15 more countries in 2024

- At the centre of the PHC facility management guide produced by WHO EMRO

- The subject of a training module for the WHO Academy


CASH is used not only for hospitals or health centres but for all types of health capital assets: laboratories, waste management systems, energy production units, oxygen production plants, warehouses or ancillary units for instance.


CASH is also the overall framework that empowers WHO to provide an unprecedented integrated offering. It covers all phases of a capital asset life cycle:


- Pre-feasibility and feasibility studies,

- Planning and design phases,

- construction and commissioning,

- Operations and maintenance

- End of cycle management (recycling, disinvestment, sale or reallocation for instance).

- Overall Project Management


Moreover, additional modules are being designed and progressively rolled out. Those include: capital and operational expenditure matrices, ancillary services, skill mix required, full legal analysis, contracting models, facility management or appraisal report….There are already 14 modules in development to help with specialized phases, component or types of capital investment projects in the health sector.


CASH is now at the heart of WHO’s health infrastructure investment dynamics and leverages collaborations with different parts of the organization to build an integrated offering advising health decision makers on their capital assets optimization.


Investment planning, accessibility, planning, design and architecture, energy performance of climate change and net zero targets, as well as facility standardization all complement CASH to make a thriving skill mix to guide and support health stewards in their infrastructure projects.


This is the first comprehensive capital investment and infrastructure tool in the health sector and a net contribution to health systems transformation.


A successful “matching tool”!


Driven by the constant goal of fostering collaboration, Decide undertook to create different innovative ways to bring skill mix and collaboration opportunities together.


This broker role was best embodied in the matching tool”, a truly valuable online tool available on the Decide web platform enabling project owners to look for adequate expertise, while individual experts can publish their profiles and look for suitable projects. A shortlist of “matches” is established by the tool and contact then allowed. 


The matching tool proved successful for Brazil, Ethiopia and other countries where decision makers and experts could meet and co-create solutions to deliver value for money in the context of health systems transformation.


Brokering insight: Decide’s credentials


You are aware of the hundreds of news, events, as well as the many blog entries that populate the web platform. A trademark from our Decide Hub, these nuggets of news and analytics proposed thematic summaries, analyses and forecasts in areas such as HTA, health economics, contracting, Public-Private Partnerships and capital investment.


It is worth remembering that several institutions approached Decide (amongst which York University, CGD and WHO’s Barcelona Office for Health Financing) to have their blogs published on our platform.


These products added significant value to the visibility as well as credibility of the Hub, and led to increasing participation of networks, authors and contributors to the stream of information regularly praised by platform users or members of our ecosystem who praised the work of Decide.


Growth of a vibrant ecosystem


Decide was originally set up to encourage more collaborations across working themes. Its interactive web platform, its co-organization of the international conference on priority setting in health or its thematic working groups have all significantly contributed to responding to these objectives.


An additional achievement was reached with the spontaneous requests of three communities to be hosted by the Decide Hub: the CMCC, the Fair Pricing Forum and the country-led CAPACITI initiative.


- The Covid-19 Multi-Model Consortium (CMCC):

- The WHO Fair Pricing Forum:

- The Country-led Assessment for Prioritization on Immunization (CAPACITI) project:


The CAPACITI community exemplifies how the technical support brought by Decide led to country teams such as Ethiopia to develop their own approach, strategy and tools to respond to population’s needs.


Finally, Decide also helped its sister networks and created bonds across working themes. Illustrative of this is the support brought to the Health Data Collaborative (HDC) network in routine information systems strengthening.


Similarly, Decide shared insight with P4H, the health financing network or the Governance collaborative, three global health networks based at WHO and complementing each other to help the health community address health systems transformation.


Decide’s footprint: where do we go from here?


Decide’s footprint therefore incorporates the design and operationalization of practical tools for countries, the facilitation of collaborative spaces for its ecosystem in the field of value for money, as well as the brokering of data, analytics and knowledge to help decision makers.


Bolstering innovation co-production between organizations and experts across its fields of activities, Decide certainly achieved the objectives set out by its terms of reference, thanks to the relentless support of its Board members.


It is therefore a proud and bittersweet farewell, as the time has come to close the Decide chapter as its funding reached its closure.


The Health Decision Hub has served its purpose and leaves its ecosystem in a dynamic position to better collaborate then ever:


- HTA transferability and priority setting, under the impulsion of WHO’s Health Economics team will carry on creating innovative products and guidance for health stewards, with the support of INAHTA and HTAI


- Capital investment in health is thriving, and at the heart of a multitude of projects which will still require the inputs of the CEB and HOPE as well as partnering with multilateral investors and national as well as regional decision makers. In fact, your Decide Hub Facilitator is now the Health Infrastructure Focal Point of the WHO UHL Division, working on the use of the CASH tool


- Continuous flows of information, knowledge and insights are now shared more substantially throughout the value for money ecosystem, with a wide range of stakeholders in the habit of working together thanks to Decide


Decide will remain a unique endeavour, one which owes a debt of gratitude to your immense support, participation and commitment.


The reward we all share is having contributed to such an excited collaboration yielding operational, effective and enduring results.


Looking forward to staying in touch with you


With infinite thanks and best wishes


Dr Gwen Dhaene

flamingo sketches 


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