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Table 3 Summary of evaluation findings for each parameter of the Kapiriri & Martin framework

From: The unfunded priorities: an evaluation of priority setting for noncommunicable disease control in Uganda

 

Parameters of successful priority setting

Key findings

Contextual factors

Conducive political, economic, social and cultural context

Contextual factors had both positive (e.g. UN High level meeting) and negative (e.g. staff turnover in the MOH) influences on the process

Pre-requisites

Political will

Political will documented in the policies, but inadequate resources to support successful PS from the outset. Ministry of Health seen as having a legitimate and credible role to set priorities. No evidence of incentives to set priorities for NCDs

Resources

Legitimate and Credible institutions

Incentives

The Priority setting process

Successful process

Stakeholder participation

Wide stakeholder involvement but major players (e.g. DAPs) were able to exert influence on the process and the selection of priorities

Use of clear priority setting process/tool/methods

The NHP and HSSP provided the framework for priority setting and defined the process.

Use of explicit relevant priority setting criteria

Consistency among stakeholders in the criteria identified as being most relevant for establishing national health priorities but lack of a defined process to systematically assess all relevant criteria.

Use of evidence

There was a commitment to evidence-informed priority-setting demonstrated by the use of existing data in the process, the identification of data gaps and priority given to addressing the data gaps.

Reflection of public values

Publicity of priorities and criteria

The decisions about what interventions to prioritize and the criteria used to make these decisions were not publicized

Functional mechanisms for appeal and enforcement of the decision

There were no reported appeals. There were no documented mechanisms to ensure adherence to the conditions of a fair process

Efficiency of the priority setting process

The quality of decisions was improving but the probability of implementing the identified NCD objectives did not improve

Dissentions

Calls for increased funding and more equitable funding for NCDs in the media.

Public understanding and confidence in the process

Allocation of resources according to priorities

NCDs were identified as a priority area in the NHPs and HSSPs, but there was an ongoing challenge of insufficient resources allocated to support policy and program development

Decreased resource wastage/misallocation

Increased stakeholder understanding, satisfaction and compliance with the Priority setting process

Stakeholders had a good understanding of the process and were somewhat satisfied though recognised that the process was not fully transparent. There was no evidence that stakeholders failed to comply with decisions.

Implementation of the set priorities

Impact on internal, financial and political accountability and corruption

Greater internal, financial and political accountability were still needed to minimize opportunities for corruption and mismanagement to interfere with the process.

Strengthening of the priority setting institution

Malalignment between priorities and resource allocation and lack of transparency for the allocation of resources and implementation of priority areas indicates that there is scope for further strengthening of the PS institutions

Impact on institutional goals and objectives

Priority setting outcomes

Impact on health policy and practice

Increase in health policies to support NCD control and some impact on practice.

Achievement of health system goals

-improved population health

-reduction in health inequalities

-fair financial contribution

-responsive health care system

Increased investment in the health sector and strengthening of the health care system

Evidence of increased investment and a commitment to strengthen the health care system to address NCDs

  1. Non-italics = immediate parameters; Italics = delayed parameters
  2. - = unable to assess. For Achievement of health system goals, − = too early to assess
  3. NCD noncommunicable diseases, PS Priority setting