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A Strategy to Improve Priority Setting in Developing Countries

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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.

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References

  1. Singer PA (2000) Recent advances in medical ethics. Br Med J 321:282–285

    Article  CAS  Google Scholar 

  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 63–73

    Google Scholar 

  3. Klein R (1998) Puzzling out priorities. Why we must acknowledge that rationing is a political process. Br Med J 317:959–960

    CAS  Google Scholar 

  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):219–228

    Article  PubMed  CAS  Google Scholar 

  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 15–26

    Google Scholar 

  6. Wikler D (2003) Why prioritize when there isn’t enough money? Cost Effectiveness Res Allocation 1(1):5–7

    Article  Google Scholar 

  7. http://www.who.int/countries/en/Accessed on January, 21st 2006

  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 Report

  9. Holm S (2000) The second phase of priority setting. Goodbye to simple solutions. Br Med J 317(7164):1000–1002.

    Google Scholar 

  10. Haudemaekers R, Dekkers W (2003) Justice and solidarity in priority setting in health care. Health care Anal. 11(4):325–343

    Article  Google Scholar 

  11. http://www.who.int/choice/description/en/Accessed on January 21st 2006

  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):1–11

    Article  Google Scholar 

  13. Kapiriri L, Norheim OF (2004) Criteria for priority setting in health care in Uganda: exploration of stakeholders’ values. Bull World Health Organ 82:172–179

    PubMed  Google Scholar 

  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):2433–2441

    Article  PubMed  Google Scholar 

  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):205–213

    Article  PubMed  Google Scholar 

  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.38658.561123.7C

  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 document

  18. Fraser DW (2000) Overlooked opportunities for investing in health research and development. Bull World Health Organ 78(8):1054–1061

    PubMed  CAS  Google Scholar 

  19. Martin DK, Singer PA (2003) A strategy to improve priority setting in health care institutions. Health Care Anal 11(1):59–68

    Article  PubMed  Google Scholar 

  20. Ham C, Roberts G (2003) Reasonable Rationing: International Experience of Priority Setting in Health Care. Open University Press, Maidenhead, UK, p 156

    Google Scholar 

  21. Mielke J, Martin DK, Singer PA (2003) Priority setting in a hospital critical care unit: Qualitative case study. Crit Care Med 31(12):2809–2811

    Article  Google Scholar 

  22. Singer PA, Martin DK, Giacomini M, Purdy L (2000) Priority Setting for New Technologies in Medicine: A Qualitative Case Study. Br Med J 321:1316–1318

    Article  CAS  Google Scholar 

  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 8:197–201

    Article  PubMed  Google Scholar 

  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 73:10–20

    PubMed  Google Scholar 

  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)

  26. Gibson JL, Martin DK, Singer PA (2005) Evidence, Economics and Ethics: Resource Allocation in Health Services Organizations. Health Care Q 8:50–59

    Google Scholar 

  27. Daniels N, Sabin JE (2002) Setting limits fairly: Can we learn to share medical resources? Oxford University Press, Oxford, NY, pp 26–28

    Google Scholar 

  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):740–750

    PubMed  CAS  Google Scholar 

  29. Good MJ (1995) Cultural studies of biomedicine: An agenda for research. Soc Sci Med 41:4461–73

    Article  Google Scholar 

  30. O’Dempsey TJ, Munslow B. Globalisation (2006) Complex humanitarian emergencies and health. Ann Trop Med Parasitol 100(5–6):501–515

    Article  PubMed  CAS  Google Scholar 

  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)703–706

    PubMed  Google Scholar 

  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 76:277–287

    Article  PubMed  Google Scholar 

  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):1185–1186

    Article  PubMed  CAS  Google Scholar 

  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 paper

  35. Terry LM (2004) An integrated approach to resource allocation. Health Care Anal 12(2):171–180

    Article  PubMed  Google Scholar 

  36. Rawls J (1993) Political liberalism. University Press. New York, Columbia

    Google Scholar 

  37. Hasman A (2003) Eliciting Reasons: Empirical methods in priority setting. Health Care Anal 11(1):41–58

    Article  PubMed  Google Scholar 

  38. Hasman A, Holm S (2005) Accountability for Reasonableness: Opening the Black Box of Process. Health Care Anal 13(4):261–273

    Article  PubMed  Google Scholar 

  39. Mechanic D (1995) Dilemmas in rationing health care services: the case for implicit rationing. Br Med J 310:1655–1657

    CAS  Google Scholar 

Download references

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Correspondence to Lydia Kapiriri.

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Kapiriri, L., Martin, D.K. A Strategy to Improve Priority Setting in Developing Countries. Health Care Anal 15, 159–167 (2007). https://doi.org/10.1007/s10728-006-0037-1

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