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Criteria Used for Priority-Setting for Public Health Resource Allocation in Low- and Middle-Income Countries: A Systematic Review

Published online by Cambridge University Press:  16 July 2019

Gunjeet Kaur ,
Shankar Prinja ,
P.V.M. Lakshmi ,
Laura Downey ,
Deepshikha Sharma  and
Yot Teerawattananon
Gunjeet Kaur
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research
Shankar Prinja*
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research
P.V.M. Lakshmi
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research
Laura Downey
Affiliation:
Centre for Global Health and Development, Imperial College
Deepshikha Sharma
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research
Yot Teerawattananon
Affiliation:
Health Intervention and Technology Assessment Program (HITAP); Saw Swee Hock School of Public Health, National University of Singapore
*
Author for correspondence: Shankar Prinja, E-mail: [email protected]
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Abstract

Objectives

This systematic review aimed to identify criteria being used for priority setting for resource allocation decisions in low- and middle-income countries (LMICs). Furthermore, the included studies were analyzed from a policy perspective to understand priority setting processes in these countries.

Methods

Searches were carried out in PubMed, Embase, Econlit, and Cochrane databases, supplemented with pre-identified Web sites and bibliographic searches of relevant papers. Quality appraisal of included studies was undertaken. The review protocol is registered in International Prospective Register of Systematic Reviews PROSPERO CRD42017068371.

Results

Of 16,412 records screened by title and abstract, 112 papers were identified for full text screening and 44 studies were included in the final analysis. At an overall level, cost-effectiveness 52 percent (n = 22) and health benefits 45 percent (n = 19) were the most cited criteria used for priority setting for public health resource allocation. Inter-region (LMICs) and between various approaches (like health technology assessment, multi-criteria decision analysis (MCDA), accountability for reasonableness (AFR) variations among criteria were also noted. Our review found that MCDA approach was more frequently used in upper middle-income countries and AFR in lower-income countries for priority setting in health. Policy makers were the most frequently consulted stakeholders in all regions.

Conclusions and Recommendations

Priority-setting criteria for health resource allocation decisions in LMICs largely comprised of cost-effectiveness and health benefits criteria at overall level. Other criteria like legal and regulatory framework conducive for implementation, fairness/ethics, and political considerations were infrequently reported and should be considered.

Keywords

Priority settingResource allocationCriteriaSystematic reviewHealth policy
Type
Theme Submission
Information
International Journal of Technology Assessment in Health Care , Volume 35 , Issue 6 , 2019 , pp. 474 - 483
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

We are grateful to the assistance provided by the ICMR Advanced Centre for Evidence based Child Health and Mrs. Uma Gupta (library) of Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh. We thank Mr. Chandrashekhar Tripathi, Business Manager EBSCO Information Services, India, for considering our request and providing us complimentary access to Econlit database. We also thank the editors and anonymous reviewers of the journal whose comments have significantly improved this article. Centre for Global Health and Development of Imperial College (L.D.), HITAP and NUS (Y.T.) are part of the international Decision Support Initiative (iDSI) funded by the Bill and Melinda Gates Foundation and the Department for International Development, United Kingdom, and Rockfeller Foundation. Funding: This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

References

1.Sibbald, SL, Singer, PA, Upshur, R, Martin, DK (2009) Priority setting: What constitutes success? A conceptual framework for successful priority setting. BMC Health Serv Res 9, 43.CrossRefGoogle ScholarPubMed
2.Martin, D, Singer, P (2003) A strategy to improve priority setting in health care institutions. Health Care Anal 11, 59–68.CrossRefGoogle ScholarPubMed
3.Williams, A (1988) Priority setting in public and private health care. A guide through the ideological jungle. J Health Econ 7, 173–83.CrossRefGoogle ScholarPubMed
4.Baltussen, R, Jansen, MP, Mikkelsen, E, et al. (2016) Priority setting for universal health coverage: We need evidence-informed deliberative processes, not just more evidence on cost-effectiveness. Int J Health Policy Manage 5, 615–618.CrossRefGoogle Scholar
5.WHO (2015) Tracking Universal Health Coverage: First Global Monitoring Report. Geneva: World Health Organization; 2015. Report No.: 9241564970.Google Scholar
6.Ham, C, Coulter, A (2001) Explicit and implicit rationing: Taking responsibility and avoiding blame for health care choices. J Health Serv Res Policy 6, 163–169.CrossRefGoogle ScholarPubMed
7.Mooney, G (2009) Challenging Health Economics. Oxford: Oxford University Press.CrossRefGoogle Scholar
8.Jan, S (2014) Proceduralism and its role in economic evaluation and priority setting in health. Soc Sci Med 108, 257–261.CrossRefGoogle ScholarPubMed
9.Barasa, EW, Molyneux, S, English, M, Cleary, S (2015) Setting healthcare priorities at the macro and meso levels: A framework for evaluation. Int J Health Policy Manage 4, 719–732.CrossRefGoogle ScholarPubMed
10.Daniels, N, Sabin, J (1998) The ethics of accountability in managed care reform. Health Aff (Millwood) 17, 50–64.CrossRefGoogle ScholarPubMed
11.Kapiriri, L, Martin, DK (2007) A strategy to improve priority setting in developing countries. Health Care Anal 15, 159–167.CrossRefGoogle ScholarPubMed
12.Glassman, A, Chalkidou, K (2012) Priority-Setting in Health: Building Institutions for Smarter Public Spending. Washington, DC: Center for Global Development.Google Scholar
13.WHO (2014) Making fair choices on the path to universal health coverage: Final report of the WHO Consultative Group on Equity and Universal Health Coverage.Google Scholar
14.Soto, E, Alderman, K, Hipgrave, D, Firth, S, Anderson, I (2012) Prioritization of Investments in Reproductive, Women's and Children's Health Evidence-Based Recommendations For Low And Middle Income Countries in Asia and the Pacific –A Subnational Focus. Australia: School of Population Health, University of Queensland.Google Scholar
15.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.Google ScholarPubMed
16.Musgrove, P (1999) Public spending on health care: How are different criteria related? Health Policy 47, 207–223.CrossRefGoogle ScholarPubMed
17.Golan, O, Hansen, P (2012) Which health technologies should be funded? A prioritization framework based explicitly on value for money. Isr J Health Policy Res 1, 44.CrossRefGoogle ScholarPubMed
18.Guindo, LA, Wagner, M, Baltussen, R, et al. (2012) From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking. Cost Eff Resour Alloc 10, 9.CrossRefGoogle ScholarPubMed
19.Barasa, EW, Molyneux, S, English, M, Cleary, S (2015) Setting healthcare priorities in hospitals: A review of empirical studies. Health Policy Plan 30, 386–396.CrossRefGoogle ScholarPubMed
20.Kapiriri, L, Razavi, D (2017) How have systematic priority setting approaches influenced policy making? A synthesis of the current literature. Health Policy 121, 937–946.CrossRefGoogle ScholarPubMed
21.Youngkong, S, Kapiriri, L, Baltussen, R (2009) Setting priorities for health interventions in developing countries: A review of empirical studies. Trop Med Int Health 14, 930–939.CrossRefGoogle ScholarPubMed
22.Hipgrave, DB, Alderman, KB, Anderson, I, Soto, EJ (1982) Health sector priority setting at meso-level in lower and middle income countries: Lessons learned, available options and suggested steps. Soc Sci Med 102, 190–200.CrossRefGoogle Scholar
23.Wiseman, V, Mitton, C, Doyle-Waters, MM, et al. (2016) Using economic evidence to set healthcare priorities in low-income and lower-middle-income countries: A systematic review of methodological frameworks. Health Econ 25(Suppl 1), 140–161.CrossRefGoogle ScholarPubMed
24.Walt, G, Gilson, L (1994) Reforming the health sector in developing countries: The central role of policy analysis. Health Policy Plann 9, 353–370.CrossRefGoogle ScholarPubMed
25.CRD (2009) CRD's Guidance for Undertaking Reviews in Health Care. York: University of York; 2009.Google Scholar
26.Kaur, G, Prinja, S, Sharma, D, Teerawattananon, Y (2017) Systematic review to identify criteria for priority setting in health care in low- and middle-income countries (LMICs). PROSPERO: International prospective register of systematic reviews CRD42017068371 Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017068371.Google Scholar
27.Sirriyeh, R, Lawton, R, Gardner, P, Armitage, G (2012) Reviewing studies with diverse designs: The development and evaluation of a new tool. J Eval Clin Pract 18, 746–52.CrossRefGoogle ScholarPubMed
28.Hardy, M, Johnson, L, Sharples, R, Boynes, S, Irving, D (2016) Does radiography advanced practice improve patient outcomes and health service quality? A systematic review. Br J Radiol 89, 20151066.CrossRefGoogle ScholarPubMed
29.Moher, D, Liberati, A, Tetzlaff, J, Altman, DG (2010) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg 8, 336–341.CrossRefGoogle ScholarPubMed
30.Makundi, E, Kapiriri, L, Norheim, OF (2007) Combining evidence and values in priority setting: Testing the balance sheet method in a low-income country. BMC Health Serv Res 7, 152.CrossRefGoogle Scholar
31.Mshana, S, Shemilu, H, Ndawi, B, et al. (2007) What do district health planners in Tanzania think about improving priority setting using ‘Accountability for reasonableness’? Health Serv Res 7, 180.CrossRefGoogle ScholarPubMed
32.Kapiriri, L, Norheim, OF, Martin, DK (2007) Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda. Health Policy 82, 78–94.CrossRefGoogle ScholarPubMed
33.Colenbrander, S, Birungi, C, Mbonye, AK (2015) Consensus and contention in the priority setting process: Examining the health sector in Uganda. Health Policy Plann 30, 555–565.CrossRefGoogle ScholarPubMed
34.Maluka, S, Kamuzora, P, San Sebastian, M, et al. (2010) Improving district level health planning and priority setting in Tanzania through implementing accountability for reasonableness framework: Perceptions of stakeholders. BMC Health Serv Res 10, 322.CrossRefGoogle ScholarPubMed
35.Rubinstein, A, Belizan, M, Discacciati, V (2007) Are economic evaluations and health technology assessments increasingly demanded in times of rationing health services? The case of the Argentine financial crisis. Int J Technol Assess Health Care 23, 169–176.CrossRefGoogle ScholarPubMed
36.Avan, BI, Berhanu, D, Umar, N, Wickremasinghe, D, Schellenberg, J (2016) District decision-making for health in low-income settings: A feasibility study of a data-informed platform for health in India, Nigeria and Ethiopia. Health Policy Plann 31(Suppl 2), ii3–ii11.CrossRefGoogle ScholarPubMed
37.WHO (2016) WHO CHOICE. https://www.who.int/choice/cost-effectiveness/en/.Google Scholar
38.Jamison, DT, Breman, JG, Measham, AR, et al. (2006) Disease Control Priorities in Developing Countries. Washington, DC: The World Bank; 2006.Google ScholarPubMed
39.Norheim, OF, Baltussen, R, Johri, M, et al. (2014) Guidance on priority setting in health care (GPS-Health): The inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Eff Resour Alloc 12, 18.CrossRefGoogle Scholar
40.Hoedemaekers, R, Dekkers, W (2003) Key concepts in health care priority setting. Health Care Anal 11, 309–323.CrossRefGoogle ScholarPubMed
41.Mitton, C, Donaldson, C (2004) Health care priority setting: Principles, practice and challenges. Cost Eff Resour Alloc 2, 3.CrossRefGoogle ScholarPubMed
42.Devlin, N, Sussex, J (2011) Incorporating Multiple Criteria in HTA. Methods and Processes. London: Office of Health Economics.Google Scholar
43.Baltussen, R, Niessen, L (2006) Priority setting of health interventions: The need for multi-criteria decision analysis. Cost Eff Resour Alloc 4, 14.CrossRefGoogle ScholarPubMed
44.WHO (2015) Developing An Approach For Using Health Technology Assessments in Reimbursement Systems For Medical Products. Geneva: World Health Organization; 2015.Google Scholar
45.Cookson, R, Dolan, P (1999) Public views on health care rationing: A group discussion study. Health Policy 49, 63–74.CrossRefGoogle ScholarPubMed
46.Hrabac, B, Ljubic, B, Bagaric, I (2000) Basic package of health entitlements and solidarity in the Federation of Bosnia and Herzegovina. Croat Med Journal 41, 287–293.Google ScholarPubMed
47.Green, A, Ali, B, Naeem, A, Ross, D (2000) Resource allocation and budgetary mechanisms for decentralized health systems: Experiences from Balochistan, Pakistan. Bull World Health Organ 78, 1024–1035.Google ScholarPubMed
48.Fortes, PA, Zoboli, EL (2002) A study on the ethics of microallocation of scarce resources in health care. J Med Ethics 28, 266–269.CrossRefGoogle Scholar
49.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 Eff Resour Alloc 2, 1.CrossRefGoogle ScholarPubMed
50.Tromp, N, Prawiranegara, R, Subhan Riparev, H, et al. (2015) Priority setting in HIV/AIDS control in West Java Indonesia: An evaluation based on the accountability for reasonableness framework. Health Policy Plann 30, 345–355.CrossRefGoogle ScholarPubMed
51.Iglesias, CP, Drummond, MF, Rovira, J (2005) Health-care decision-making processes in Latin America: Problems and prospects for the use of economic evaluation. Int J Technol Assess Health Care 21, 1–14.CrossRefGoogle ScholarPubMed
52.Baltussen, R, Stolk, E, Chisholm, D, Aikins, M (2006) Towards a multi-criteria approach for priority setting: An application to Ghana. Health Econ 15, 689–696.CrossRefGoogle ScholarPubMed
53.Gonzalez-Pier, E, Gutierrez-Delgado, C, Stevens, G, et al. (2006) Priority setting for health interventions in Mexico's System of Social Protection in Health. Lancet 368, 1608–18.CrossRefGoogle ScholarPubMed
54.Kapiriri, L, Martin, DK (2006) Priority setting in developing countries health care institutions: The case of a Ugandan hospital. BMC Health Serv Res 6, 127.CrossRefGoogle ScholarPubMed
55.Baltussen, R, ten Asbroek, AH, Koolman, X, et al. (2007) Priority setting using multiple criteria: Should a lung health programme be implemented in Nepal? Health Policy Plann 22, 178–185.CrossRefGoogle ScholarPubMed
56.Dror, DM, Koren, R, Ost, A, et al. (2007) Health insurance benefit packages prioritized by low-income clients in India: Three criteria to estimate effectiveness of choice. Soc Sci Med 64, 884–896.CrossRefGoogle Scholar
57.Madi, BC, Hussein, J, Hounton, S, et al. (2007) Setting priorities for safe motherhood programme evaluation: A participatory process in three developing countries. Health Policy 83, 94–104.CrossRefGoogle ScholarPubMed
58.Husain, S, Kadir, M, Fatmi, Z (2007) Resource allocation within the National AIDS Control Program of Pakistan: A qualitative assessment of decision maker's opinions. BMC Health Serv Res 7, 11.CrossRefGoogle ScholarPubMed
59.Jehu-Appiah, C, Baltussen, R, Acquah, C, et al. (2008) Balancing equity and efficiency in health priorities in Ghana: The use of multicriteria decision analysis. Value Health 11, 1081–1087.CrossRefGoogle ScholarPubMed
60.Teerawattananon, Y, Russell, S (2008) The greatest happiness of the greatest number? Policy actors' perspectives on the limits of economic evaluation as a tool for informing health care coverage decisions in Thailand. BMC Health Serv Res 8, 197.CrossRefGoogle ScholarPubMed
61.Ottersen, T, Mbilinyi, D, Maestad, O, Norheim, OF (2008) Distribution matters: Equity considerations among health planners in Tanzania. Health Policy 85, 218–227.CrossRefGoogle ScholarPubMed
62.Kasemsup, V, Schommer, JC, Cline, RR, Hadsall, RS (2008) Citizen's preferences regarding principles to guide health-care allocation decisions in Thailand. Value Health 11, 1194–1202.CrossRefGoogle ScholarPubMed
63.Hansen, KS, Chapman, G (2008) Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease. Cost Eff Resour Alloc 6, 14.CrossRefGoogle ScholarPubMed
64.Tanios, N, Wagner, M, Tony, M, et al. (2013) Which criteria are considered in healthcare decisions? Insights from an international survey of policy and clinical decision makers. Int J Technol Assess Health Care 29, 456–465.CrossRefGoogle ScholarPubMed
65.Kapiriri, L, Norheim, OF, Martin, DK (2009) Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making? Soc Sci Med 68, 766–773.CrossRefGoogle ScholarPubMed
66.Gordon, H, Kapiriri, L, Martin, DK (2009) Priority setting in an acute care hospital in Argentina: A qualitative case study. Acta Bioeth 15. doi:10.4067/S1726-569X2009000200009.CrossRefGoogle Scholar
67.Kapiriri, L, Martin, DK (2010) Successful priority setting in low and middle income countries: A framework for evaluation. Health Care Anal 18, 129–147.CrossRefGoogle ScholarPubMed
68.Youngkong, S, Baltussen, R, Tantivess, S, Koolman, X, Teerawattananon, Y (2010) Criteria for priority setting of HIV/AIDS interventions in Thailand: A discrete choice experiment. BMC Health Serv Res 10, 197.CrossRefGoogle ScholarPubMed
69.Cleary, S, Mooney, G, McIntyre, D (2010) Equity and efficiency in HIV-treatment in South Africa: The contribution of mathematical programming to priority setting. Health Econ 19, 1166–1180.CrossRefGoogle ScholarPubMed
70.Chitama, D, Baltussen, R, Ketting, E, et al. (2011) From papers to practices: District level priority setting processes and criteria for family planning, maternal, newborn and child health interventions in Tanzania. BMC Womens Health 11, 46.CrossRefGoogle ScholarPubMed
71.Mirelman, A, Mentzakis, E, Kinter, E, et al. (2012) Decision-making criteria among national policymakers in five countries: A discrete choice experiment eliciting relative preferences for equity and efficiency. Value Health 15, 534–539.CrossRefGoogle Scholar
72.Youngkong, S, Baltussen, R, Tantivess, S, Mohara, A, Teerawattananon, Y (2012) Multicriteria decision analysis for including health interventions in the universal health coverage benefit package in Thailand. Value Health 15, 961–970.CrossRefGoogle ScholarPubMed
73.Shayo, EH, Norheim, OF, Mboera, LE, et al. (2012) Challenges to fair decision-making processes in the context of health care services: A qualitative assessment from Tanzania. Int J Equity Health 11, 30.CrossRefGoogle ScholarPubMed
74.Mori, AT, Kaale, EA (2012) Priority setting for the implementation of artemisinin-based combination therapy policy in Tanzania: Evaluation against the accountability for reasonableness framework. Implement Sci 7, 18.CrossRefGoogle ScholarPubMed
75.Ghandour, R, Shoaibi, A, Khatib, R, et al. (2015) Priority setting for the prevention and control of cardiovascular diseases: Multi-criteria decision analysis in four eastern Mediterranean countries. Int J Public Health 60(Suppl 1), S73-S81.CrossRefGoogle ScholarPubMed
76.Paolucci, F, Mentzakis, E, Defechereux, T, Niessen, LW (2015) Equity and efficiency preferences of health policy makers in China--A stated preference analysis. Health Policy Plann 30, 1059–1066.CrossRefGoogle ScholarPubMed
77.Venhorst, K, Zelle, SG, Tromp, N, Lauer, JA (2014) Multi-criteria decision analysis of breast cancer control in low- and middle-income countries: Development of a rating tool for policy makers. Cost Eff Resour Alloc 12, 13.CrossRefGoogle ScholarPubMed
78.Iskrov, G, Stefanov, R (2016) Criteria for drug reimbursement decision-making: An emerging public health challenge in Bulgaria. Balkan Med J 33, 27–35.CrossRefGoogle ScholarPubMed
79.Mostafavi, H, Rashidian, A, Arab, M, Mahdavi, MR, Ashtarian, K (2016) Health priority setting in Iran: Evaluating against the social values framework. Glob J Health Sci 8, 53834.CrossRefGoogle ScholarPubMed
80.Castro Jaramillo, HE, Goetghebeur, M, Moreno-Mattar, O (2016) Testing multi-criteria decision analysis for more transparent resource-allocation decision making in Colombia. Int J Technol Assess Health Care 32, 307–314.CrossRefGoogle ScholarPubMed
81.Pooripussarakul, S, Riewpaiboon, A, Bishai, D, Muangchana, C, Tantivess, S (2016) What criteria do decision makers in Thailand use to set priorities for vaccine introduction? BMC Public Health 16, 684.CrossRefGoogle ScholarPubMed
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