Does the Narrative About the Use of Evidence in Priority Setting Vary Across Health Programs Within the Health Sector: A Case Study of 6 Programs in a Low-Income National Healthcare System

Abstract

Background: There is a growing body of literature on evidence-informed priority setting. However, the literature on the use of evidence when setting healthcare priorities in low-income countries (LICs), tends to treat the healthcare system (HCS) as a single unit, despite the existence of multiple programs within the HCS, some of which are donor supported. Objectives: (i) To examine how Ugandan health policy-makers define and attribute value to the different types of evidence; (ii) Based on 6 health programs (HIV, maternal, newborn and child health [MNCH], vaccines, emergencies, health systems, and non- communicable diseases [NCDs]) to discuss the policy-makers’ reported access to and use of evidence in priority setting across the 6 health programs in Uganda; and (iii) To identify the challenges related to the access to and use of evidence. Methods: This was a qualitative study based on in-depth key informant interviews with 60 national level (working in 6 different health programs) and 27 sub-national (district) level policy-makers. Data were analysed used a modified thematic approach. Results: While all respondents recognized and endeavored to use evidence when setting healthcare priorities across the 6 programs and in the districts; more national level respondents tended to value quantitative evidence, while more district level respondents tended to value qualitative evidence from the community. Challenges to the use of evidence included access, quality, and competing values. Respondents from highly politicized and donor supported programs such as vaccines, HIV and maternal neonatal and child health were more likely to report that they had access to, and consistently used evidence in priority setting. Conclusion: This study highlighted differences in the perceptions, access to, and use of evidence in priority setting in the different programs within a single HCS. The strong infrastructure in place to support for the access to and use of evidence in the politicized and donor supported programs should be leveraged to support the availability and use of evidence in the relatively under-resourced programs. Further research could explore the impact of unequal availability of evidence on priority setting between health programs within the HCS.

Health Research Priority Setting in Uganda: A Qualitative Study Describing and Evaluating the Processes

“…Systematic evaluation and publicizing the ndings would examine the degree to which the research that is implemented in a country aligns with the national health research priorities and the health strategic plan. Evaluation would not only support focused allocation of health research funding, but also ensure that there is a synergy between health research and health policy and practice (26,27).…”

A Framework for Criteria Weighting in a Sustainable River Basin

“…However, what is found as 'evidence' for one person may not be regarded as appropriate evidence by another, including subjective terms. In their responses, respondents focused on the aspects of evidence that they value most [12] (Kapiriri, 2020).…”

Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review

“…We found several papers on understanding the research uptake context (41, 52, 63, 68-92, 94-114, 116, 137) . This included understanding of the political dimension and interest (5,30,41,66,67,72,76,79,83,88,89,93,98,99,109,(117)(118)(119)(120)(121)(122)(123)(124)(125)(127)(128)(129)(130) , lack of political will (41,52,63,107,112,131,132) , political commitment (69, 84, 104-106, 109, 122, 130, 132-136, 138, 139) , leadership (70,77,97,131,(135)(136)(137)(140)(141)(142) , and health policy research priority setting (30, 69-71, 75, 77, 80, 84, 98, 106, 107, 109, 130, 134, 138, 139, 143-150) .…”

“…Recognizing the domains (process, content and outcome) of health policymaking is important so that useable evidence to inform policies and practices in local context is generated (71, 82, 90-92, 94, 95) . Understanding the actual context in terms of political environment will enable actual use of evidence (70,76,77,100,137) , encourage institutional budgetary allocations for research (73,78) , health research and policy priority setting (70,76,79) , and support scale up for societal bene t (71, 72, 74-76, 80, 85, 96-101, 104) . Conversely, lack of credible context-speci c health evidence (75,86,102,103) , weak local evidence, misunderstanding of decision-makers, lack of consideration of sociocultural or religious practices (52,63,(105)(106)(107)(108)(109) , and weak involvement of advocacy coalitions, and evidence generators (110) have limited the translation of evidence into policy and practice.…”