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ESSAYS ON RESEARCH -- EVIDENCE-BASED PRIORITY SETTING FOR HEALTH CARE AND RESEARCH

Wednesday, 19th of June 2013

• ESSAYS ON RESEARCH -- EVIDENCE-BASED PRIORITY SETTING FOR HEALTH CARE AND RESEARCH

Citation: Rudan I, Kapiriri L, Tomlinson M, Balliet M, Cohen B, et al. (2010) Evidence-Based Priority Setting for Health Care and Research: Tools to Support Policy in Maternal, Neonatal, and Child Health in Africa. PLoS Med 7(7): e1000308. doi:10.1371/journal.pmed.1000308

Published: July 13, 2010

Copyright: © 2010 Rudan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The authors received no specific funding for this article.

Competing interests: IR, LK, MT, and MC have all been involved in the development and implementation of the CHNRI methodology. IR and MC have been consultants of Child Health and Nutrition Research Initiative of the Global Forum of Health Research while developing the CHNRI methodology. The other coauthors have no competing interests to declare.

Abbreviations: CAM, Combined Approach Matrix; CHNRI, Child Health and Nutrition Research Initiative; CHOICE, Choosing Interventions that are Cost-Effective; COHRED, Council on Health Research for Development; DALY, disability-adjusted life year; DCPP, Disease Control Priorities Project; EHCP, Essential Health Care Package; ENHR, Essential National Health Research; LiST, Lives Saved Tool; MBB, Marginal Budgeting for Bottlenecks; WHO, World Health organization

Provenance: Commissioned; externally peer reviewed.

This paper is part of a PLoS Medicine series on maternal, neonatal, and child health in Africa

Extract below; full text is at  http://www.ploscollections.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000308

Priority Setting—Implicit or Explicit?

Priority setting is required in every health care system. It guides investments in health care and health research, and respects resource constraints. It happens continuously, with or without appropriate tools or processes. Although priority-setting decisions have been described as difficult, value laden, and political, only a few research groups are focused on advancing the theory of priority setting and the development and validation of priority setting tools [1]–[4]. These groups advocate the use of their tools, but their work is often not widely recognized, especially among the policy makers in developing countries, where these tools would be most helpful [2].

Our primary objective in this essay is to present the available tools for priority setting that could be used by policy makers in low-resource settings. We also provide an assessment of the applicability and strengths of different tools in the context of maternal and child health in sub-Saharan Africa.

The analyses of investments in neglected diseases showed that they lack transparent priority-setting processes [2]. This persisting situation results in remarkable levels of inequity between investments in different health priorities [1]–[6]. Therefore, our secondary objective is to advocate for the use of the tools that could lead to more rational priority setting in sub-Saharan Africa. An optimal tool should be able to draw on the best local evidence and guide policy makers and governments to identify, prioritize, and implement evidence-based health interventions for scale-up and delivery.

Priority Setting in Low-Resource Settings—Mixed Evidence

Although there is currently insufficient evidence that the use of priority-setting tools improves health outcomes and reverses existing inequities, we have ample evidence that the lack of a rational and transparent process generates inequity and stagnation in mortality levels [5],[6]. Recently, Youngkong et al. conducted a systematic review of empirical studies on health care priority setting in low-income countries (Table 1) [7]. The review found that policy makers in developing countries rarely consider using the available priority-setting tools, but also that the available tools lack credibility for priority setting in low-resource settings [7],[8]. This is mainly because it is not easy to validate the tools or to link their output with concrete follow-up actions and policy development [9]. Indeed, it is difficult to prove beyond all doubt that investments in health care or health research are valuable to society when compared to alternative investments such as infrastructure or the economy.