Department of Health, Aging and Society, McMaster University, KTH-236, Main Street West 1280, Hamilton, ON, Canada.
BMC Health Serv Res. 2019 Jul 8;19(1):465. doi: 10.1186/s12913-019-4170-6.
Despite continued investment, Maternal, Newborn and Child Health (MNCH) indicators in low and middle income countries have remained relatively poor. This could, in part, be explained by inadequate resources to adequately address these problems, inappropriate allocation of the available resources, or lack of implementation of the most effective interventions. Systematic priority setting and resource allocation could contribute to alleviating these limitations. There is a paucity of literature that follows through MNCH prioritization processes to implementation, making it difficult for policy makers to understand the impact of their decision-making on population health. The overall objective of this paper was to describe and evaluate priority setting for maternal, newborn and child health interventions in Uganda.
Fifty-four key informant interviews and a review of policies and media reports were used to describe priority setting for MNCH in Uganda. Kapiriri and Martin's conceptual framework was used to evaluate priority setting for MNCH.
There were three main prioritization exercises for maternal, newborn and child health in Uganda. The processes were participatory and were guided by explicit tools, evidence, and criteria, however, the public and the districts were insufficiently involved in the priority setting process. While there were conducive contextual factors including strong political support, implementation was constrained by the presence of competing actors, with varying priorities, an unequal allocation of resources between child health and maternal health interventions, limited financial and human resources, a weak health system and limited institutional capacity.
Stronger institutional capacity at the Ministry of Health and equitable engagement of key stakeholders in decision-making processes, especially the public, and implementers, would improve understanding, satisfaction and compliance with the priority setting process. Availability of financial and human resources that are appropriately allocated would facilitate the implementation of well-developed policies.
尽管持续投入，中低收入国家的孕产妇、新生儿和儿童健康（MNCH）指标仍相对较差。这在一定程度上可以解释为，解决这些问题的资源不足，可用资源分配不当，或者最有效的干预措施没有得到实施。系统的优先排序和资源分配可以有助于缓解这些限制。在孕产妇、新生儿和儿童健康优先排序过程到实施方面，文献相对较少，这使得决策者难以了解他们的决策对人口健康的影响。本文的总体目标是描述和评估乌干达孕产妇、新生儿和儿童健康干预措施的优先排序。
采用 54 次关键知情人访谈和对政策及媒体报道的审查，描述乌干达孕产妇、新生儿和儿童健康的优先排序。采用 Kapiriri 和 Martin 的概念框架评估孕产妇、新生儿和儿童健康的优先排序。
乌干达有三项主要的孕产妇、新生儿和儿童健康优先排序工作。这些过程是参与性的，并以明确的工具、证据和标准为指导，但公众和地区在优先排序过程中参与不足。尽管存在有利的背景因素，包括强有力的政治支持，但实施受到竞争行为者的制约，这些行为者具有不同的优先事项，儿童健康和孕产妇健康干预措施之间资源分配不均，财政和人力资源有限，卫生系统薄弱，机构能力有限。
卫生部的机构能力更强，以及关键利益攸关方在决策过程中的公平参与，特别是公众和执行者的参与，将提高对优先排序过程的理解、满意度和遵守程度。提供适当分配的财政和人力资源将有助于制定完善的政策的实施。
