Building Institutions For Smarter Spending

Priority setting can be undertaken on many other levels when a decision is needed on health care interventions.

Health Interventions 

These are activities that reframe those with health dangers or encourage behavior that improves physical and mental health. These interventions are normally alienated to public health promotion programs. Health interventions can be undertaken by:

• Families
• Administrative organizations
• Health departments
• Private organizations etc Goldberg, J. (2011).

A good example of these interventions are matters such as behavioral interventions to stop people from smoking, reducing caloric intake, visiting physicians for cholesterol and hypertension screening and exercising regularly.

In carrying out health interventions priority setting is mandatory to determine which intervention should be carried out first depending on various unique factors to the health situation Mubyazi, G. (2007).

Priority Setting Implementers

Many actors are involved when it comes to priority setting on which health intervention to be undertaken first. These actors have a great influence on health priorities and they range from governments to private organizations. Some of these implementers are:

• Foundations
• Governments
• Private donors
• Stakeholders
• Companies and Non-profit organizations Kenny, N. (2008).

Factors that Influence Priority Setting

There are various factors that influence the setting of priorities, these factors interdepend on each other and impact each other when priorities are being made Clark, S. (2012). These factors are listed below:

1. Data comparison

This involves the use of epidemiological and comparative data to identify those health needs which should be prioritized. Examples of this kind of data is mortality statistics, morbidity statistics, hospital admission records, indicators of socio economic disadvantage and measures of community health and wellbeing McDonald, J. (2011). There are some objective methods to health research prioritization founded on the burden of disease data. In research priority setting data is required for example data needed to help in the discussion of research priorities. 

2. Addressing pre-existing / background / non-modifiable risk factors (such as social determinants of health) Identifying the scale of the problem

3. Aligning the priority with governments’ priorities and targets

The government is a major actor in priority setting in every society health priorities should be set in a way that they are allied to the goals and policies of relevant jurisdictions.

4. Leveraging off Other Concurrent Initiatives

Health priorities should complement and leverage off plans that are being affected by other agencies.

5. Assessing the financial cost

Making priorities on which research to carry out is mandatory in order to maximize the effect of investments particularly in resource strained places. Resources should be allocated based on certain principles as shown in (table 2) Persad, G. (2009).

6. The potential to produce Improvement

The health program prioritized must show the possibility of creating an enhancement on the current situation.

7. Maintaining Progress with Existing Community Health Plan Initiatives

Health priorities must be aligned to the plans for community health and must be responsive to changes in these plans.

8. Consumer Action and Voice

Since consumers are the actual target of the health program, their voice is important and should be put into consideration in priority setting McDonald, J. (2011).

9. Legitimacy

The projects being allocated resources and the process of allocation should all be legitimate and transparent Persad, G. (2009).

10. Assessing the Scale of the Problem

This is the process of identifying the number of people who are indirectly and directly affected by a certain problem. The scale of the problem is measured by the number of people affected by the problem. Demographical and epidemiological data can be used to management this scale, a decision on priority setting is made based on this scale.

11. Assessing the Financial Cost of not Addressing the Problem

The financial cost of not addressing a problem should be put into perspective since it can be costly leaving certain problems unresolved.

12. Potential to produce improvement

The possibility of a certain health intervention strategy to bring development must be considered and preference be given to the strategy that has the highest potential of bringing a positive change.

13. Strength of evidence base

This is very important in primary health care, nowadays evaluation is becoming mandatory before funding is given out to implement projects.

14. Available Resources to Resolve the Problems

When setting health priorities current and future resources should be assessed to ensure they are sufficient to address the existing problem. 

15. Impact of The Problem

The effects of a health problem such as environmental, social and economic should be considered using terms such as social costs of the problem such as stigma, financial cost of the problem to the health system and effects on the people’s quality of life Carter, R (2008).

16. Moving Upstream to target social determinants of Health

Social factors of health should be addressed by primary health. Priority setting in primary health must be focused on upstream determinants such as transport, education, housing and employment.

17. Considering the Values of All Members

The priorities of all members including stakeholders and donors should be considered to ensure fairness in priority setting.

2.1 Common Themes for Good Practice in Health Research Priority Setting

Priority Setting in Research

Health research is a vital factor in health globally, governments and organizations have invested heavily in research to improve health practices. There is increased demand for coordination of health research at an international level Viergever, R. (2010). The research themes for good health research priority setting practice have been categorized into three as follows:

Preparatory Work

18. Context

There is a myriad of factors that are considered when setting up priorities such as the particular exercise being assumed, the research health and political setting in a country and practical deliberations about existing resources. The first step which should be implemented especially in setting health research priorities is identifying the available resources for the research both time, financial and human resources amid coming up with the research objectives. The target beneficiaries and intended audience for the research should also be identified. The principles guiding the exercise should be outline whether the priority should be equitable, cost effective or be in consideration of both. External demands such as commercial and political demands for the practice should be put into perspective and if they exist they must be resolved in a genuine and fair manner Goddard, R. (2007).  

19. Use of a Comprehensive Approach

There are a couple of complete methods to priority setting in health research. These methods are considered comprehensive because of the fact that they are detailed and provide procedural guidance for the whole priority setting process. Some of the most used Comprehensive approaches are:

• Essential National Health Research (ENHR)

This approach provides guidance on the whole priority setting process on a national level.

• The COHRED

Focusses on setting up health priorities for the national level.

• 3 D Combined Approach Matrix (CAM)

This approach emphasizes on an organized collection of info on priority setting.

• The Child Health and Nutrition Research Initiative (CHNRI)

Offers an organized algorithm on priority setting.

Inclusiveness

The involvement of stakeholders is a major part of health research priority setting. Stakeholders which need to be involved in priority setting should be identified, why their views are essential and the part they should play recognized.  In the process of involving stakeholders, factors such as gender and regional balance must be considered to ensure equity. The following groups of people could be potentially involved:

• Private sector
• Donors
• The public

In the process of priority setting conflicts may come up thus there is a need to come up with a legitimate process to solve conflicts. There should be a strong leadership such as in the form of an advisory committee or an executive committee. 

21. Information Gathering

Priority setting on research should be well informed with credible and good sources of information

22. Planning for Implementation

In planning for implementations those involved should consider the target group, the stakeholders needed. The individuals involved in the research should be competent enough to see it through to the implementation stage.

23. Methods of Deciding on Priorities

There are many approaches used in determining priority setting, they are categorized into two metric approaches and consensus approaches. Metric methods involve the use of algorithms that lead to the combining of individual positions of research options while consensus methods involve using group consensus to decide on priorities.

After Priorities have Been Set

24. Evaluation

Priorities which were set in the past in health research priority setting should be reviewed from time to time to ensure that they are updated to retain effectiveness.

25. Transparency

The whole process of priority setting in health research priority setting must be transparent, this is crucial especially as it encourages donors and stakeholders to contribute fully to the research process Viergever, R. (2010).

Categorization of Priority Setting Research Themes table

Checklist for Health Research Priority Setting (Table 1) Viergever, R. (2010).

Introductory work

1.Setting Chooses which comparative factors strengthen the process.

2.Use of a complete approach This provides organized, step by step and detailed guidance for health research priority settings.

3.Comprehensiveness Resolves who must be convoluted in setting the health research urgencies and the reason why.

4.Gathering Information Decides on what information should be collected.

5.Implimantation Planning Create strategies for conversion of the urgencies to the real research

Inference on priorities

6.Criteria Choose appropriate criteria to concentrate discussion around setting urgencies

7.Priority deciding Methods The method on deciding on urgencies is chosen.

After urgencies have been decided

8.Evaluation It defines how and when evaluation of the established priorities and the priority setting process will take place.

9.Transparency Write a clear report that deliberates on the method used.

Conclusion

Priority setting is essential in determining which health intervention to be commenced first. Parties involved in priority setting such as the government, foundations and private donors should ensure that they decide carefully and professionally since they have high influence on health priorities. There is no particular approach for priority setting which fits all exercises. Every exercise has its own unique tactic therefore common themes for good practices should be recognized and utilized in priority setting. Priority setting remains a collaborative exercise that requires transparency, information and commitment.

References

Baltussen, R. M. P. M., Ten Asbroek, A. H. A., Koolman, X., Shrestha, N., Bhattarai, P., & Niessen, L. W. (2007). Priority setting using multiple criteria: should a lung health programme be implemented in Nepal?. Health policy and planning, 22(3), 178-185.

Mitton, C., Smith, N., Peacock, S., Evoy, B., & Abelson, J. (2009). Public participation in health care priority setting: a scoping review. Health policy, 91(3), 219-228.

Goldberg, D. S., & McGee, S. J. (2011). Pain as a global public health priority. BMC public health, 11(1), 770.

Persad, G., Wertheimer, A., & Emanuel, E. J. (2009). Principles for allocation of scarce medical interventions. The Lancet, 373(9661), 423-431.

McDonald, J., & Ollerenshaw, A. (2011). Priority setting in primary health care: a framework for local catchments. Rural Remote Health, 11(2), 1714.

Viergever, R. F., Olifson, S., Ghaffar, A., & Terry, R. F. (2010). A checklist for health research priority setting: nine common themes of good practice. Health research policy and systems, 8(1), 36.

Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and implementation of public health interventions. Annual review of public health, 31, 399-418.

Clark, S., & Weale, A. (2012). Social values in health priority setting: a conceptual framework. Journal of health organization and management, 26(3), 293-316.

Noorani, H. Z., Husereau, D. R., Boudreau, R., & Skidmore, B. (2007). Priority setting for health technology assessments: a systematic review of current practical approaches. International journal of technology assessment in health care, 23(3), 310-315.

Kenny, N., & Joffres, C. (2008). An ethical analysis of international health priority-setting. Health Care Analysis, 16(2), 145-160.

Mubyazi, G. M., Mushi, A., Kamugisha, M., Massaga, J., Mdira, K. Y., Segeja, M., & Njunwa, K. J. (2007). Community views on health sector reform and their participation in health priority setting: case of Lushoto and Muheza districts, Tanzania. Journal of public health, 29(2), 147-156.

Menon, D., & Stafinski, T. (2008). Engaging the public in priority?setting for health technology assessment: findings from a citizens’ jury. Health Expectations, 11(3), 282-293.

Barclay-Goddard, R., Epstein, J. D., & Mayo, N. E. (2009). Response shift: a brief overview and proposed research priorities. Quality of Life Research, 18(3), 335-346.

Glassman, A., & Chalkidou, K. (2012). Priority-setting in health: building institutions for smarter public spending. Washington, DC: Center for Global Development.

Carter, R., Vos, T., Moodie, M., Haby, M., Magnus, A., & Mihalopoulos, C. (2008). Priority setting in health: origins, description and application of the Australian Assessing Cost–Effectiveness initiative. Expert review of pharmacoeconomics & outcomes research, 8(6), 593-617.