医療システムと政策研究

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One Health Sectors Similar Criteria for Priority Setting: A Comparative Analysis of Criteria Used for Priority Setting in Six National Health Programs and Those Used across the Health Sector

Lydia Kapiriri and Nicoda Foster

Background: Scarcity of resources is often a barrier to the provision of interventions that are responsive to people’s health needs. Consequently, health system decision-makers and administrators are faced with questions about the most efficient way to determine priorities and allocate resources for the best results. Using explicit criteria has been highlighted as an efficient way to distribute resources that align with health system priorities. This study aimed to explore national level priority setting in Uganda based on six cases: HIV, New Technologies - focusing on new vaccines (NT), Maternal, neonatal and child health (MNCH), Noncommunicable diseases (NCD), Emergencies and Health Systems Strengthening.

Methods: Semi-structured interviews were conducted with 57 Ugandan health policy makers between 2013 and 2015. Interviewees were identified through a mix of purposive and snowball sampling approaches. Respondents were asked about the pre-requisites for good priority setting as well as priority setting context, processes, implementation, outcome and impact. Initial analysis involved three researchers reading and coding two similar transcripts; the agreed on codes were then used to code the rest of the interviews. Criteria emerged as a main theme, which was further analyzed and forms the basis of this manuscript.

Results: A total of 20 criteria emerged from the semistructured interviews, 11 of which were mentioned by Ugandan health policy makers as key considerations in decision-making for two or more of the cases reviewed. Many of the overlapping criteria across all six cases are consistent with criteria articulated in the literature.

Conclusion: Different programs within the health sector apply different criteria when setting priorities within their respective programs. While some of these criteria overlap with those in the health policy, most of the criteria are program specific. Promoting the use of explicit criteria in decision-making can be an effective tool in ensuring the equitable allocation of resources.