Title Health Priority-Setting For Overseas Development Assistance in Low-Income and Middle-Income Countries: A Comparative Case Study of Ethiopia, Nigeria and Tanzania

Background Priority setting process for the health care sector in low- and middle-income countries involves multiple agencies, each with their unique power, decision-making and funding mechanisms. Methods This paper developed and applied a new framework to analyze priority setting processes in Ethiopia, Nigeria, and Tanzania, from a scoping review of literature. Interviews were then conducted using a pre-determined interview guide developed by the research team. Transcripts were reviewed and coded based on the framework to identify what principles, players, processes, and products were considered during priority setting. Those elements were further used to identify where the potential capacity of local decision-makers could be harnessed. Results a framework was developed based on 40 articles selected from 6860 distinct search records. 21 interviews were conducted in three case countries from 12 institutions. Transcripts or meeting notes were analyzed to identify common practices and specific challenges faced by each country. We found that multiple stakeholders working around one national plan was the preferred approach used for priority setting in the countries studied. Conclusions Priority setting process can be further strengthened through better use of analytical tools, such as the one described in our study, to enhance local ownership and improve aid effectiveness.

Stakeholder perceptions of current practices and challenges in priority setting for non-communicable disease control in Kenya: a qualitative study

ObjectiveTo explore the stakeholders’ perceptions of current practices and challenges in priority setting for non-communicable disease (NCD) control in Kenya.DesignA qualitative study approach conducted within a 1-day stakeholder workshop that followed a deliberative dialogue process.SettingStudy was conducted within a 1-day stakeholder workshop that was held in October 2019 in Nairobi, Kenya.ParticipantsStakeholders who currently participate in the national level policymaking process for health in Kenya.Outcome measurePriority setting process for NCD control in Kenya.ResultsDonor funding was identified as a key factor that informed the priority setting process for NCD control. Misalignment between donors’ priorities and the country’s priorities for NCD control was seen as a hindrance to the process. It was identified that there was minimal utilisation of context-specific evidence from locally conducted research. Additional factors seen to inform the priority setting process included political leadership, government policies and budget allocation for NCDs, stakeholder engagement, media, people’s cultural and religious beliefs.ConclusionThere is an urgent need for development aid partners to align their priorities to the specific NCD control priority areas that exist in the countries that they extend aid to. Additionally, context-specific scientific evidence on effective local interventions for NCD control is required to inform areas of priority in Kenya and other low-income and middle-income countries. Further research is needed to develop best practice guidelines and tools for the creation of national-level priority setting frameworks that are responsive to the identified factors that inform the priority setting process for NCD control.

Ayushman Bharat and Universal Health Coverage in India: Is our approach ethical?

The Ayushman Bharat Mission with its two inter-linked components, namely Health and Wellness centres and the Pradhan Mantri Jan Arogya Yojana, has been proposed as India’s prime instrument for achieving universal health coverage. The insurance component of the mission has received priority over the primary healthcare component. Apart from efficiency reasons, there are strong ethical grounds to prioritize the primary care component over its insurance counterpart. There is also a need to consider the ethical dimensions of publicly financed health insurance in India. A robust priority setting process should guide the roll-out of universal health coverage. This is particularly crucial since a large scale expansion of PMJAY to the non-poor population is being currently envisaged by the government.

Prioritization of Investments and Disinvestments in Healthcare

The chapter looks at the key concepts and issues involved in the prioritization of resources for investments and disinvestments in health services. It describes a framework for understanding what needs to be achieved in this arena. It describes three core components that underpin a coherent approach to prioritization (guiding principles, a tool to help gather and sift through the information, and coherent decision-making processes). The pragmatic overview emphasizes that the processes involved in prioritization matter, and that to do this consistently and with transparency for ethical reasons, as well as to make the task more manageable, is important. An example of a prioritization tool and guiding principles are given. Some ethical considerations in this arena are also discussed. In day-to-day work, many of the issues in this arena can be facilitated by applying the principles, even if a full blown priority setting process is not needed.

Hospital Managers’ Perceptions Regarding Setting Healthcare Priorities in Kuwait

BACKGROUND & OBJECTIVE: In view of the budget limitations resulting from the downturn in the Kuwaiti economy, it is crucial to evaluate the process of priority setting within the health system to identify strengths and weaknesses of this process within both the public and private sectors. Once the weak points are identified, policy makers can work with hospital administration staff to upgrade the process with the aim of utilising health resources more efficiently. The purpose of this study is to give decision makers some insight on the perspective of hospital managers regarding the current process of priority setting, and suggest ways to improve this process. Additionally, this study will provide the opinions of hospital managers in questioning the effect of certain healthcare policies, currently given top priority, on healthcare system efficiency. The views of the hospital managers interviewed indicate their preferences in priority setting and the changes in health spending they believe are required. METHODS: A qualitative study was conducted using semi-structured, face-to-face interviews with 14 managers from public and private hospitals in Kuwait. Content analysis was used to produce major themes and sub-themes from the interview transcripts. RESULTS: While several similarities and differences in the priority-setting process between the public and private sectors were apparent, the main strength in the process that most managers from both sectors mentioned, was that it was simple, systematic, comprehensive and democratic. The several weaknesses of the process include it not being evidence-based due to the lack of accurate and up-to-date data. Also, the discrepancy between the official statements made and the actual practices of health decision makers in the country demonstrate the confusion around the priority-setting process. Most respondents, from both sectors, thought that the availability of a clear and well-communicated national health strategic plan would facilitate the necessary modifications in legislative, structural and administrative strategies to streamline the processes of allocating resources and setting priorities. For example, most respondents believed that the disadvantages of the costly practice of sending patients abroad for treatment and its effect on resource allocation outweighed its advantages. Further, the managers from both sectors had different perceptions regarding the policy of private health insurance for retirees. These two policies, according to some hospital managers, added strain to the health budget and undermined trust in the public-health sector. CONCLUSION: This study examined the perspective of hospital managers regarding the process of healthcare priority setting in Kuwait, and ways to improve it. Priority setting could be improved by having a better understanding of its strengths and weaknesses. The study concludes that health decision makers should remain responsible for accepting and implementing evidence-based, systematic processes of resource allocation. Additionally, continuous monitoring and evaluation of the impact of health policies will be required to improve overall health outcomes.        

What Really Sets Priorities?

The practice of priority-setting in global health has evolved to include both helpful strengths and extraordinary weaknesses. This chapter explores how context and methods shape the priority-setting process and influence its outcomes through an historical analysis of four cases of decision-making about cholera and diarrheal diseases: in Jamaica in 1850, in London in 1866, by multilateral development agencies in the 1980s, and by Gavi, the Vaccine Alliance in 2006. The chapter focuses on the nature of the state–citizen relationship, the type of evidence used, the methods of analysis employed, and the identity of those whose judgment is applied to explain variation in decision-making. Analyzing these examples suggests that priority-setting has evolved to become a narrow exercise incapable of reckoning broader problems, ill suited to assessing comprehensive solutions, and unlikely to contribute to the development of state capacity. Taken together, these findings argue for rethinking priority-setting methods to better account for a wider range of problems, more participatory processes, and more comprehensive solutions.

Methodology and criteria for setting national health research priorities in Bhutan: a workshop report

The Bhutanese health system is committed to providing health services for all citizens and is interested in strengthening the country’s health research capacity. The objectives of this workshop were to understand the range of health research activities in Bhutan; to formulate a prioritized research agenda for the Ministry of Health (MoH); to share challenges, gaps and opportunities in health research; and to provide insights for future prioritization exercises. The MoH partnered with Khesar Gyalpo University of Medical University of Bhutan and USA-based facilitators to develop and pilot a methodology for health research priority setting. The Bhutan priority setting process was adapted from the Combined Approach Matrix and the Essential National Health Research methods. The methodology proved successful in the systematic creation of a list of health research priorities. Future priority setting processes will build on this workshop, continuing to refine and strengthen the priority setting process in Bhutan.

Selecting topic areas for developing quality standards in a resource-limited setting

Variation in practices of and access to health promotion and disease prevention (P&P) across geographical areas have been studied in Thailand as well as other healthcare settings. The implementation of quality standards (QS)—a concise set of evidence-informed quality statements designed to drive and measure priority quality improvements—can be an option to solve the problem. This paper aims to provide an overview of the priority setting process of topic areas for developing QS and describes the criteria used. Topic selection consisted of an iterative process involving several steps and relevant stakeholders. Review of existing documents on the principles and criteria used for prioritising health technology assessment topics were performed. Problems with healthcare services were reviewed, and stakeholder consultation meetings were conducted to discuss current problems and comment on the proposed prioritisation criteria. Topics were then prioritised based on both empirical evidence derived from literature review and stakeholders’ experiences through a deliberative process. Preterm birth, pre-eclampsia and postpartum haemorrhage were selected. The three health problems had significant disease burden; were prevalent among pregnant women in Thailand; led to high mortality and morbidity in mothers and children and caused variation in the practices and service uptake at health facilities. Having agreed-on criteria is one of the important elements of the priority setting process. The criteria should be discussed and refined with various stakeholders. Moreover, key stakeholders, especially the implementers of QS initiative, should be engaged in a constructive way and should be encouraged to actively participate and contribute significantly in the process.