Abstract
BackgroundLittle is known about the social and political factors that influence priority setting for different health services in low- and middle-income countries (LMICs), yet these factors are integral to understanding how national health agendas are established. We investigated factors that facilitate or prevent surgical care from being prioritized in LMICs.Methods and FindingsWe undertook country case studies in Papua New Guinea, Uganda, and Sierra Leone, using a qualitative process-tracing method. We conducted 74 semi-structured interviews with stakeholders involved in health agenda setting and surgical care in these countries. Interviews were triangulated with published academic literature, country reports, national health plans, and policies. Data were analyzed using a conceptual framework based on four components (actor power, ideas, political contexts, issue characteristics) to assess national factors influencing priority for surgery.Political priority for surgical care in the three countries varies. Priority was highest in Papua New Guinea, where surgical care is firmly embedded within national health plans and receives significant domestic and international resources, and much lower in Uganda and Sierra Leone. Factors influencing whether surgical care was prioritized were the degree of sustained and effective domestic advocacy by the local surgical community, the national political and economic environment in which health policy setting occurs, and the influence of international actors, particularly donors, on national agenda setting. The results from Papua New Guinea show that a strong surgical community can generate priority from the ground up, even where other factors are unfavorable.ConclusionsNational health agenda setting is a complex social and political process. To embed surgical care within national health policy, sustained advocacy efforts, effective framing of the problem and solutions, and country-specific data are required. Political, technical, and financial support from regional and international partners is also important.
Highlights
Improving the health of populations, especially those in the world’s poorest regions, is a defining global issue of the early 21st century, attracting significant public and political attention, priority, and resources
Three out of the eight Millennium Development Goals (MDGs), adopted in 2000 by United Nations member states, were directly concerned with public health improvement, and health is central to the Sustainable Development Goals (SDGs) that were adopted in September 2015
There has been relatively little research on why and how different health issues receive different political attention and priority at the national level in low- and middle-income countries (LMICs), such that some become embedded within national health policy and some do not [2]
Summary
Improving the health of populations, especially those in the world’s poorest regions, is a defining global issue of the early 21st century, attracting significant public and political attention, priority, and resources. But especially in low- and middle-income countries (LMICs), distributing scarce public resources among competing health and development priorities is a complex social and political process [2,3]. Poorly understood is why governments choose to channel resources towards some health challenges and not to others, even among diseases that exert a similar burden on the population These questions are integral to understanding how the health systems, health services, and health policies of countries are shaped. Little is known about the social and political factors that influence priority setting for different health services in low- and middle-income countries (LMICs), yet these factors are integral to understanding how national health agendas are established. The allocation of scarce public resources to competing health and other priorities is a complex social and political process, especially in low- and middle-income countries (LMICs). Little is known about why governments channel resources towards some health challenges and not others or about why some health issues become embedded within national health policy while others—including those responsible for a large burden of illness—are largely ignored by national health systems
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