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Health Care Analysis

, Volume 15, Issue 3, pp 159–167 | Cite as

A Strategy to Improve Priority Setting in Developing Countries

  • Lydia KapiririEmail author
  • Douglas K. Martin
Original Article

Abstract

Because the demand for health services outstrips the available resources, priority setting is one of the most difficult issues faced by health policy makers, particularly those in developing countries. Priority setting in developing countries is fraught with uncertainty due to lack of credible information, weak priority setting institutions, and unclear priority setting processes. Efforts to improve priority setting in these contexts have focused on providing information and tools. In this paper we argue that priority setting is a value laden and political process, and although important, the available information and tools are not sufficient to address the priority setting challenges in developing countries. Additional complementary efforts are required. Hence, a strategy to improve priority setting in developing countries should also include: (i) capturing current priority setting practices, (ii) improving the legitimacy and capacity of institutions that set priorities, and (iii) developing fair priority setting processes.

Keywords

Developing countries Improvement strategies Priority setting 

References

  1. 1.
    Singer PA (2000) Recent advances in medical ethics. Br Med J 321:282–285CrossRefGoogle Scholar
  2. 2.
    Bryant JH (2000) Health priority dilemmas in developing countries. In: Coulter A, Ham C (eds) The global challenge of health care rationing. Open University Press, Philadelphia, pp 63–73Google Scholar
  3. 3.
    Klein R (1998) Puzzling out priorities. Why we must acknowledge that rationing is a political process. Br Med J 317:959–960Google Scholar
  4. 4.
    Buse K. (1999) Keeping a tight grip on the reigns: donor control over aid coordination and management in Bangladesh. Health Policy Plan 14(3):219–228PubMedCrossRefGoogle Scholar
  5. 5.
    Klein R, Williams A (2000) Setting priorities: what is holding us back—inadequate information or inadequate institutions? In: Coulter A, Ham C (eds) The global challenge of health care rationing. Open University Press, Philadelphia, pp 15–26Google Scholar
  6. 6.
    Wikler D (2003) Why prioritize when there isn’t enough money? Cost Effectiveness Res Allocation 1(1):5–7CrossRefGoogle Scholar
  7. 7.
    http://www.who.int/countries/en/Accessed on January, 21st 2006Google Scholar
  8. 8.
    Steen HS, Jareg P, Olsen IT (2001) Providing a core set of health interventions for the poor. Towards developing a framework for reviewing and planning—a systemic approach. Background document. Oslo: Centre for health and social development. Unpublished ReportGoogle Scholar
  9. 9.
    Holm S (2000) The second phase of priority setting. Goodbye to simple solutions. Br Med J 317(7164):1000–1002.Google Scholar
  10. 10.
    Haudemaekers R, Dekkers W (2003) Justice and solidarity in priority setting in health care. Health care Anal. 11(4):325–343CrossRefGoogle Scholar
  11. 11.
    http://www.who.int/choice/description/en/Accessed on January 21st 2006Google Scholar
  12. 12.
    Kapiriri L, Arnesen T, Norheim OF (2004) Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda. Cost Effectiveness Resour Allocation 2(1):1–11CrossRefGoogle Scholar
  13. 13.
    Kapiriri L, Norheim OF (2004) Criteria for priority setting in health care in Uganda: exploration of stakeholders’ values. Bull World Health Organ 82:172–179PubMedGoogle Scholar
  14. 14.
    Kapiriri L, Norheim OF, Heggenhougen K (2003a) Using the burden of disease information for health planning in developing countries: experiences from Uganda. Soc Sci Med 56(12):2433–2441PubMedCrossRefGoogle Scholar
  15. 15.
    Kapiriri L, Norheim OF, Heggenhougen K (2003b) Public participation in health planning and priority setting at the district level in Uganda. Health policy plan 18(2):205–213PubMedCrossRefGoogle Scholar
  16. 16.
    Evans DB, Adam T (2005) Achieving the millennium development goals for health: Evaluation of current strategies and future priorities for improving health in developing countries. BMJ, doi:10.1136/BMJ.38658.561123.7CGoogle Scholar
  17. 17.
    Kleinman A (March 1999) Ethics and Experience: An Anthropological Approach to Health Equity. Harvard Center for Population and Development Studies Working Paper Series 99.04, pp 6. Harvard University, Boston. Unpublished documentGoogle Scholar
  18. 18.
    Fraser DW (2000) Overlooked opportunities for investing in health research and development. Bull World Health Organ 78(8):1054–1061PubMedGoogle Scholar
  19. 19.
    Martin DK, Singer PA (2003) A strategy to improve priority setting in health care institutions. Health Care Anal 11(1):59–68PubMedCrossRefGoogle Scholar
  20. 20.
    Ham C, Roberts G (2003) Reasonable Rationing: International Experience of Priority Setting in Health Care. Open University Press, Maidenhead, UK, p 156Google Scholar
  21. 21.
    Mielke J, Martin DK, Singer PA (2003) Priority setting in a hospital critical care unit: Qualitative case study. Crit Care Med 31(12):2809–2811CrossRefGoogle Scholar
  22. 22.
    Singer PA, Martin DK, Giacomini M, Purdy L (2000) Priority Setting for New Technologies in Medicine: A Qualitative Case Study. Br Med J 321:1316–1318CrossRefGoogle Scholar
  23. 23.
    Martin DK, Shulman K, Santiago-Sorrell P, Singer PA (2003) Priority Setting and Hospital Strategic Planning: A Qualitative Case Study. J Health Serv Res Policy 8:197–201PubMedCrossRefGoogle Scholar
  24. 24.
    Madden S, Martin DK, Downey S, Singer PA (2005) Hospital Priority Setting with an Appeals Process: A qualitative case study and evaluation. Health Policy 73:10–20PubMedGoogle Scholar
  25. 25.
    Walton NA, Martin DK, Peter EH, Pringle DM, Singer PA (2006) Priority setting and cardiac surgery: A qualitative case study. Health Policy (in press)Google Scholar
  26. 26.
    Gibson JL, Martin DK, Singer PA (2005) Evidence, Economics and Ethics: Resource Allocation in Health Services Organizations. Health Care Q 8:50–59Google Scholar
  27. 27.
    Daniels N, Sabin JE (2002) Setting limits fairly: Can we learn to share medical resources? Oxford University Press, Oxford, NY, pp 26–28Google Scholar
  28. 28.
    Daniels N, Bryant J, Castano RA (2000) Benchmarks of fairness for health care reform: A policy tool for developing countries. Bull World Health Organ 78(6):740–750PubMedGoogle Scholar
  29. 29.
    Good MJ (1995) Cultural studies of biomedicine: An agenda for research. Soc Sci Med 41:4461–73CrossRefGoogle Scholar
  30. 30.
    O’Dempsey TJ, Munslow B. Globalisation (2006) Complex humanitarian emergencies and health. Ann Trop Med Parasitol 100(5–6):501–515PubMedCrossRefGoogle Scholar
  31. 31.
    Waddington C (2004) Does earmarked donor funding make it more or less likely that developing countries will allocate their resources towards programs that yield the greatest health benefits? Bull World Health Organ 82(9)703–706PubMedGoogle Scholar
  32. 32.
    Sundewall J, Sahlin-Andersson K (2006) Translations of health sector SWAPs- A comparative study of health sector development cooperation in Uganda, Zambia and Bangladesh. Health Policy 76:277–287PubMedCrossRefGoogle Scholar
  33. 33.
    Benatar SR (2003) Priority setting: learning to make tough decisions; the costs of trying to provide modern medical care for all who could potentially benefit exceed the capacity of most countries. J Neurol Neurosurg Psychiatry. 74(9):1185–1186PubMedCrossRefGoogle Scholar
  34. 34.
    Hauck K, Smith PC, Goddard M (November 2003) The Economics of Priority Setting for Health Care: A Literature Review. HNP Discussion Paper. World Bank, Washington DC. Unpublished paperGoogle Scholar
  35. 35.
    Terry LM (2004) An integrated approach to resource allocation. Health Care Anal 12(2):171–180PubMedCrossRefGoogle Scholar
  36. 36.
    Rawls J (1993) Political liberalism. University Press. New York, ColumbiaGoogle Scholar
  37. 37.
    Hasman A (2003) Eliciting Reasons: Empirical methods in priority setting. Health Care Anal 11(1):41–58PubMedCrossRefGoogle Scholar
  38. 38.
    Hasman A, Holm S (2005) Accountability for Reasonableness: Opening the Black Box of Process. Health Care Anal 13(4):261–273PubMedCrossRefGoogle Scholar
  39. 39.
    Mechanic D (1995) Dilemmas in rationing health care services: the case for implicit rationing. Br Med J 310:1655–1657Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Research Associate, University of Toronto Joint Centre for BioethicsTorontoCanada
  2. 2.Associate Professor, Department of Health PolicyManagement and Evaluation, and the Joint Centre for Bioethics, University of TorontoTorontoCanada

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