Abstract
Background: There is a growing body of literature on evidence-informed priority setting. However, the literature on the use of evidence when setting healthcare priorities in low-income countries (LICs), tends to treat the healthcare system (HCS) as a single unit, despite the existence of multiple programs within the HCS, some of which are donor supported. Objectives: (i) To examine how Ugandan health policy-makers define and attribute value to the different types of evidence; (ii) Based on 6 health programs (HIV, maternal, newborn and child health [MNCH], vaccines, emergencies, health systems, and non- communicable diseases [NCDs]) to discuss the policy-makers’ reported access to and use of evidence in priority setting across the 6 health programs in Uganda; and (iii) To identify the challenges related to the access to and use of evidence. Methods: This was a qualitative study based on in-depth key informant interviews with 60 national level (working in 6 different health programs) and 27 sub-national (district) level policy-makers. Data were analysed used a modified thematic approach. Results: While all respondents recognized and endeavored to use evidence when setting healthcare priorities across the 6 programs and in the districts; more national level respondents tended to value quantitative evidence, while more district level respondents tended to value qualitative evidence from the community. Challenges to the use of evidence included access, quality, and competing values. Respondents from highly politicized and donor supported programs such as vaccines, HIV and maternal neonatal and child health were more likely to report that they had access to, and consistently used evidence in priority setting. Conclusion: This study highlighted differences in the perceptions, access to, and use of evidence in priority setting in the different programs within a single HCS. The strong infrastructure in place to support for the access to and use of evidence in the politicized and donor supported programs should be leveraged to support the availability and use of evidence in the relatively under-resourced programs. Further research could explore the impact of unequal availability of evidence on priority setting between health programs within the HCS.
Highlights
Evidence[1], in its myriad forms, is perceived as a critical part of policy-making in health.[1,2] Priority setting is a critical process within the health policy-making and implementation cycle
The infrastructure and resources that are available to the programs that are well-supported should be leveraged to strengthen the use of evidence in priority setting within all programs in the whole healthcare system (HCS)
We found that since healthcare systems (HCSs) in low-income countries (LICs) still have donor supported programs, these programs tend to have more accessible, quality evidence compared to the other programs
Summary
Evidence[1], in its myriad forms, is perceived as a critical part of policy-making in health.[1,2] Priority setting is a critical process within the health policy-making and implementation cycle. Systematic healthcare priority setting[2] involves an explicit process of selecting which health interventions to pursue, for the purposes of resource allocation. According to the literature, using evidence (eg, burden of disease, cost-effectiveness, and cost-benefit assessments) when setting healthcare priorities promotes objectivity, improves consistency, and strengthens the validity of the prioritization process and the decisions. The result is an improved quality of decisions.[3,4] The use of evidence in priority setting is critical, especially in low-income countries (LICs) where resources are scarce.[5,6,7,8]
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