Health sector priority setting at meso-level in lower and middle income countries: lessons learned, available options and suggested steps

Hipgrave, David B., Bolsewicz Alderman, Katarzyna, Anderson, Ian and Jimenez Soto, Eliana (2014) Health sector priority setting at meso-level in lower and middle income countries: lessons learned, available options and suggested steps. Social Science and Medicine, 102 190-200. doi:10.1016/j.socscimed.2013.11.056

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Author Hipgrave, David B.
Bolsewicz Alderman, Katarzyna
Anderson, Ian
Jimenez Soto, Eliana
Title Health sector priority setting at meso-level in lower and middle income countries: lessons learned, available options and suggested steps
Journal name Social Science and Medicine   Check publisher's open access policy
ISSN 0277-9536
Publication date 2014-02-01
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.socscimed.2013.11.056
Volume 102
Start page 190
End page 200
Total pages 11
Place of publication Kidlington, Oxford, United Kingdom
Publisher Pergamon
Language eng
Formatted abstract
• Priority-setting for health resources in LMICs is difficult; related evidence is scant.
• It mostly focuses on technocratic issues and ignores the local capacity and context.
• Systems and contextual issues in LMICs often render meso-level plans ineffective.
• If not addressed, even successful priority-setting processes will have limited impact.

Setting priority for health programming and budget allocation is an important issue, but there is little consensus on related processes. It is particularly relevant in low resource settings and at province- and district- or “meso-level”, where contextual influences may be greater, information scarce and capacity lower. Although recent changes in disease epidemiology and health financing suggest even greater need to allocate resources effectively, the literature is relatively silent on evidence-based priority-setting in low and middle income countries (LMICs). We conducted a comprehensive review of the peer-reviewed and grey literature on health resource priority-setting in LMICs, focussing on meso-level and the evidence-based priority-setting processes (PSPs) piloted or suggested there. Our objective was to assess PSPs according to whether they have influenced resource allocation and impacted the outcome indicators prioritised. An exhaustive search of the peer-reviewed and grey literature published in the last decade yielded 57 background articles and 75 reports related to priority-setting at meso-level in LMICs. Although proponents of certain PSPs still advocate their use, other experts instead suggest broader elements to guide priority-setting. We conclude that currently no process can be confidently recommended for such settings. We also assessed the common reasons for failure at all levels of priority-setting and concluded further that local authorities should additionally consider contextual and systems limitations likely to prevent a satisfactory process and outcomes, particularly at meso-level. Recent literature proposes a list of related attributes and warning signs, and facilitated our preparation of a simple decision-tree or roadmap to help determine whether or not health systems issues should be improved in parallel to support for needed priority-setting; what elements of the PSP need improving; monitoring, and evaluation. Health priority-setting at meso-level in LMICs can involve common processes, but will often require additional attention to local health systems.
Keyword Priority-setting
Lower- and middle-income countries (LMICs)
Health systems
Resource allocation
Evidence-based policy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online: 10 December 2013.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Public Health Publications
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Citation counts: TR Web of Science Citation Count  Cited 17 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 15 times in Scopus Article | Citations
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Created: Sat, 15 Feb 2014, 02:37:33 EST by Eliana Jimenez Soto on behalf of School of Public Health