Priority setting for prevention and control of coronary heart disease in the occupied Palestinian territory: a pilot study

Abstract

Background The burden of coronary heart diseases is increasing at an alarming rate in most low-income and middle-income countries. The findings of evidence-based studies suggest that this burden can be prevented through health policies. Various methods to define and select policies have been developed including evidence-based prioritisation, which is important in view of the scarce resources in and data for low-income and middle-income countries. The aim of this study was to assess and prioritise context-specific policies for the prevention and control of coronary heart diseases in the occupied Palestinian territory (oPt). Methods In this mixed-methods pilot study, a set of policy options was developed and shortlisted on the basis of integrated findings from country-specific qualitative situational analysis inputs and quantitative modelling of related risk factors and treatments with the IMPACT Excel-based model. A simple Excel sheet was used to calculate a priority score for each policy and then the policies were ranked in terms of their importance. Criteria from WHO's prioritised research agenda and stepwise framework were used to rate the policies. The specific policies were scored and prioritised by five key informants (mid-level health managers, health practitioners, and academics) from the oPt and then ranked in terms of importance. Ethics approval to undertake the study was obtained from the Institute of Community and Public Health, Birzeit University, Ramallah, West Bank, oPt. All participants provided verbal informed consent. Findings Key informants shortlisted and rated 19 polices. The top five policies were population-level primary prevention with focus on blood pressure (n=2), health-system level with focus on collaboration and capacity building of health-care providers (n=2), and treatment for high-risk patient groups (n=1). Interpretation Policies with focus on primary prevention and health systems indicate a good understanding of the epidemiology of diseases and the needs of the community. However, the small number and scope of the policy makers (directly related to health) who rated the policies in this study were limitations for improved identification of evidence-based policies. This approach of ranking pre-identified policies might be important for engaging policy makers and, when there are few resources, prioritising policies. Funding European Community's Seventh Framework Programme.