Nossal Institute for Global Health, University of Melbourne, Victoria 3010, Australia; UNICEF, 3 UN Plaza, New York 10017, USA.
School of Population Health, University of Queensland, Herston, Australia.
Soc Sci Med. 2014 Feb;102:190-200. doi: 10.1016/j.socscimed.2013.11.056. Epub 2013 Dec 10.
Setting priority for health programming and budget allocation is an important issue, but there is little consensus on related processes. It is particularly relevant in low resource settings and at province- and district- or "meso-level", where contextual influences may be greater, information scarce and capacity lower. Although recent changes in disease epidemiology and health financing suggest even greater need to allocate resources effectively, the literature is relatively silent on evidence-based priority-setting in low and middle income countries (LMICs). We conducted a comprehensive review of the peer-reviewed and grey literature on health resource priority-setting in LMICs, focussing on meso-level and the evidence-based priority-setting processes (PSPs) piloted or suggested there. Our objective was to assess PSPs according to whether they have influenced resource allocation and impacted the outcome indicators prioritised. An exhaustive search of the peer-reviewed and grey literature published in the last decade yielded 57 background articles and 75 reports related to priority-setting at meso-level in LMICs. Although proponents of certain PSPs still advocate their use, other experts instead suggest broader elements to guide priority-setting. We conclude that currently no process can be confidently recommended for such settings. We also assessed the common reasons for failure at all levels of priority-setting and concluded further that local authorities should additionally consider contextual and systems limitations likely to prevent a satisfactory process and outcomes, particularly at meso-level. Recent literature proposes a list of related attributes and warning signs, and facilitated our preparation of a simple decision-tree or roadmap to help determine whether or not health systems issues should be improved in parallel to support for needed priority-setting; what elements of the PSP need improving; monitoring, and evaluation. Health priority-setting at meso-level in LMICs can involve common processes, but will often require additional attention to local health systems.
确定卫生规划和预算分配的优先事项是一个重要问题，但相关流程尚未达成共识。在资源匮乏的环境中，尤其是在省、地区或“中观”层面，由于受到更多的背景因素影响，信息匮乏且能力较低，这一问题显得更为重要。尽管疾病流行病学和卫生筹资最近发生了变化，这表明需要更有效地分配资源，但文献对于中低收入国家（LMICs）基于证据的优先事项设定相对较少。我们对中观层面和基于证据的优先事项设定流程（PSPs）在 LMICs 中的同行评议和灰色文献进行了全面审查，重点关注中观层面和试点或建议的基于证据的优先事项设定流程。我们的目标是根据这些流程是否影响资源分配以及对优先考虑的结果指标产生影响来评估 PSP。在过去十年中，我们对同行评议和灰色文献进行了全面搜索，共检索到 57 篇背景文章和 75 篇与 LMIC 中观层面优先事项设定相关的报告。尽管某些 PSP 的支持者仍主张使用它们，但其他专家则建议采用更广泛的要素来指导优先事项设定。我们的结论是，目前针对这些情况，无法有把握地推荐任何流程。我们还评估了所有层面优先事项设定失败的常见原因，并得出结论，地方当局还应考虑可能阻止过程和结果令人满意的背景和系统限制，尤其是在中观层面。最近的文献提出了一系列相关属性和警告信号，并为我们制定了一个简单的决策树或路线图，以帮助确定是否需要同时改进卫生系统问题以支持所需的优先事项设定；需要改进 PSP 的哪些要素；监测和评估。LMICs 中观层面的卫生优先事项设定可能涉及共同的流程，但通常需要更多地关注当地卫生系统。
