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 |