Making fair choices on the path to universal health coverage

Ottersen, Trygve; Norheim, Ole Frithjof

doi:10.2471/blt.14.139139

Cited by 157 publications

(86 citation statements)

References 2 publications

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“…Ideally, countries should work towards the development of more generic centrally-led institutionalized processes, which would then be used at decentralised level as guidance for priority setting. 24,25 We see our work as a stepping stone towards such institutionalized processes, by spelling out important principles, documenting the initial experiences, and thereby creating awareness about its potential and limitations. In this context, we applaud the pioneering work of the International Decision Support Initiative (iDSI), which provides policy-makers at sub-national, national, regional, and international levels with technical support in coordinating priority setting as a means towards achieving UHC.…”

Section: Development Of Evidence-informed Deliberative Processesmentioning

confidence: 99%

Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness

Baltussen¹,

Jansen²,

Mikkelsen³

et al. 2016

Int J Health Policy Manag

116

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Priority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs) in their strive for universal health coverage (UHC). However, present initiatives on priority setting are mainly geared towards the development of more cost-effectiveness information, and this evidence does not sufficiently support countries to make optimal choices. The reason is that priority setting is in reality a value-laden political process in which multiple criteria beyond cost-effectiveness are important, and stakeholders often justifiably disagree about the relative importance of these criteria. Here, we propose the use of ‘evidence-informed deliberative processes’ as an approach that does explicitly recognise priority setting as a political process and an intrinsically complex task. In these processes, deliberation between stakeholders is crucial to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. Such processes then result in the use of a broader range of explicit criteria that can be seen as the product of both international learning (‘core’ criteria, which include eg, cost-effectiveness, priority to the worse off, and financial protection) and learning among local stakeholders (‘contextual’ criteria). We believe that, with these evidence-informed deliberative processes in place, priority setting can provide a more meaningful contribution to achieving UHC.

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Section: Development Of Evidence-informed Deliberative Processesmentioning

confidence: 99%

Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness

Baltussen¹,

Jansen²,

Mikkelsen³

et al. 2016

Int J Health Policy Manag

116

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“…[19][20][21][22] Furthermore, there are reported cases where evidence has been disregarded by decision-makers whose priorities lie elsewhere. 1,[22][23][24] Evidence is thought to be key to improving the quality of priority setting and resource allocation decisions. 25 Since it is often considered to be objective, evidence is thought to provide means through which personal interests and values which may have undue influence on priority setting, can be mitigated.…”

Section: Introductionmentioning

confidence: 99%

“…25 Since it is often considered to be objective, evidence is thought to provide means through which personal interests and values which may have undue influence on priority setting, can be mitigated. 4,[24][25][26][27][28] However, there is a paucity of literature on how low-income country decision-makers define, access and use evidence when identifying healthcare priorities. To date most of the literature on the use of evidence in LICs has focused on policy-making [1][2][3][9][10][11] and not specifically on priority setting -which is a critical component of the health policy-making cycle.…”

Section: Introductionmentioning

confidence: 99%

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

Kapiriri

2020

Int J Health Policy Manag

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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.

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“…Doing so will enable them to identify appropriate and priority interventions that need to be addressed rst. Consequently, less priority services will be covered after making sure that the high priority services are reaching every population group without signi cant nancial hardship [13].…”

Section: Introductionmentioning

confidence: 99%

Socio-economic Determinants of Maternal Healthcare Utilization in Addis Ababa

Mossie

Sandy

2020

Preprint

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Background Despite progresses over the last two decades, Ethiopia is one of the countries in the world with significant number of maternal deaths and service use for antenatal, labour and childbirth is low. This study intended to identify the underlying causes of low coverage of maternal health services in Addis Ababa. Methods We conducted a comparative cross-sectional study in Addis Ababa in July 2017. A three stage sampling technique was applied to select the study population. The first step was to select study Ketenas using simple random sampling. The villages within the Ketenas were then identified, which led to the second stage of the sampling process. In the third stage, a fixed number of 20 households per village were selected with an equal probability random selection from the newly created household listing. All women aged 18–49 years who gave birth one year preceding the date of data collection were then invited to a face-to-face interview. Both multiple linear regression and logistic regression were applied to estimate crude and adjusted associations. Results Less than 45.0% of women from the poorest households received all the recommended ANC contacts at the right time, while 71.4% of women from richest households received all the recommended contacts at the right time. The majority of women from poorest households gave birth at health centres (66.2%), followed by public hospitals (30.9%). The largest proportion of women from richest households gave birth at private hospitals (46.1%), followed by public hospitals (16.1%). Meanwhile, only 52.5% of women with primary education had all the recommended ANC contacts, while 78.5% of women who completed tertiary education had all the recommended ANC contacts (p < 0.001). Women from richest households were less likely to face multiple barriers to use maternal health services as compared to women from poorest households (OR = 0.57, p = 0.032). Conclusion There is a huge inequality in maternal healthcare coverage in Addis Ababa. To achieve universal maternal health coverage, affordability of the service is not adequate although it is one of the requirements. Other underlining social determinants deserve the attention of policy makers and program designers.

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Making fair choices on the path to universal health coverage

Cited by 157 publications

References 2 publications

Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness

Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness

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

Socio-economic Determinants of Maternal Healthcare Utilization in Addis Ababa

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