Successful Priority Setting in Low and Middle Income Countries: A Framework for Evaluation

Abstract

Priority setting remains a big challenge for health managers and planners, yet there is paucity of literature on evaluating priority setting. The purpose of this paper is to present a framework for evaluating priority setting in low and middle income countries. We conducted a qualitative study involving a review of literature and Delphi interviews with respondents knowledgeable of priority setting in low and middle income countries. Respondents were asked to identify the measures of successful priority setting in low and middle income countries. Responses were grouped as: immediate internal or external/delayed internal or external. We also identified some pre-requisites for successful priority setting. The immediate internal measures included increased efficiency in decision making, improved quality of decisions and fairer priority setting. Immediate External measures included-improved public understanding and acceptance of decisions, increased public participation, increased trust. Delayed Internal measures included increased satisfaction, understanding, compliance, balanced budget, achievement of organization goals, and improved internal accountability. Delayed External measures include impact on policy and practice, improved population health and reduction of health inequalities, achievement of health system goals and strengthening of health care systems. Identified pre-requisites for successful priority setting included; the presence of credible priority setting institutions, incentives for participation and implementation and resources, capacity and political will to implement. These would be augmented in a conducive political, social and economic context. This framework, although not exhaustive, provides a practical basis for planning and evaluating priority setting in low and middle income countries.

Research for better health: the Panamanian priority-setting experience and the need for a new process

“…According to the World Health Organization, a health research prioritization process is defined as a scheme to build consensus on a set of research issues that require urgent attention [20]. A priority is defined as an element or condition judged to be more important than another, which involves an exercise in “judgment” and the use of “values” that sustain the quality of a priority [21].…”

“…Simultaneously, there is a local context and a series of criteria, such as benefits, evidence, cost-efficiency, equity, and severity, which compete in order to establish this judgment. Finally, stakeholders, who act individually in representation of pluralist society, make decisions by consensus, making an ethical framework necessary to sustain the legitimacy of the prioritization process [2,20]. This group of stakeholders includes individuals from the governmental sector, non-governmental organizations, the private sector, academia, health service providers, and healthcare recipients.…”

High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context

“…These authors suggested that their research was an "initial attempt to evaluate priority setting decisions in a specific context" and that "future research is required to determine the best combination of components" -building on this work, we have adapted many of their dimensions into our model of high performance. Kapiriri and Martin (2009) Canada could serve at a minimum as a starting point for discussion in other settings as well.…”

Multicriteria Decision Analysis for Including Health Interventions in the Universal Health Coverage Benefit Package in Thailand

“…Fifth, the framework of A4R was purposively selected to evaluate the prioritization process of the project. There are, however, other evaluation tools that can be applied for assessing the resource allocation process such as a framework of internal and external parameters for evaluating successful priority setting in low-and middle-income countries [33] and a checklist for assessing nine common themes of good practice for health research priority setting [34]. It is noteworthy that decision making in itself is a dynamic process, and some interventions' performance on some criteria used for example, severity of disease, effectiveness of interventions, or economic impact of household expenditure, is likely to change over time.…”