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Table 2 Evaluating priority setting for MNCH in Uganda using the parameters of successful priority setting

From: Priority setting for maternal, newborn and child health in Uganda: a qualitative study evaluating actual practice

Parameters of Successful Priority Setting

MNCH Case Study

Contextual factors

 Conducive political, economic, social and cultural context

Low priority of the health sector and low education levels of the public posed challenges for implementation of priorities. Alignment with global priorities, especially the MDGs facilitated the prioritization and implementation of MNCH priorities.

Prerequisites

 Political will

Strong political commitment, especially with reference to MDG 4 and 5

 Resources

Adequate resources for priority setting; funding for MNCH priorities increased during the period under review

 Legitimate and credible priority-setting institutions

MNCH technical working groups have capacity and legitimacy

Incentives

Poor working conditions de-incentivized health workers for implementation

Priority setting process

 Stakeholder participation

Extent to which districts and the public are involved in priority setting unclear. Legitimacy of the role of politicians questioned.

 Use of clear priority setting process/tool/methods

Tanahashi model, Lives Saved Tool and UN OneHealth Costing tool, BOD/CEA

 Use of explicit relevant priority setting criteria

Equity, global priorities and calls, burden of disease, cost effectiveness

 Use of evidence

Analysis of indicators and trends from UDHS, and HSSIPs, BOD, CEA, commodity profiles and coverage, and equity

 Reflection of public values

No clear articulation of if/how public values considered. Some prioritization processes involved representatives of the public.

 Publicity of priorities and criteria

Some MNCH plans and priorities publicized; No clear dissemination of the government’s rationale for prioritization.

 Functional mechanisms for appealing the decisions

No mechanisms reported

 Functional mechanisms for enforcement

No mechanisms reported

 Efficiency of the priority-setting process

Inefficiencies in time spent developing multiple policies with similar priorities/messages with a lack of follow-up; delays in disbursements of funding to districts and in delivering reproductive health commodities to facilities

Implementation

 Allocation of resources according to priorities

Due to DAP influence, interventions aimed at child health reportedly received more resources than interventions related to maternal health, Implementation of child health related interventions and targeted reduction in child mortality were on track. Targeted drop in maternal mortality was well below the MDG target.

 Decreased resource wastage

Not assessed

 Increased stakeholder understanding, satisfaction and compliance with the priority setting process

Public and district representatives reported less understanding and satisfaction with the process. General dissatisfaction on part of all stakeholders with the outcomes of the process

 Decreased dissentions

None reported

Outcome/Impact

 Improved internal accountability/reduced corruption

None reported.

 Strengthening of the priority setting institution

See below

 Increased investment in the health sector and strengthening of the health care system

Investment specific to MNCH increased over the period. MOH staff turnover a challenge

 Impact on institutional goals and objectives

See below

 Impact on health policy and practice

Three new policies formed to address MNCH, practice resulted in shifting service delivery to the hardest to reach and most burdened areas of the country

 Achievement of health system goals

MDG 4 nearly achieved, MDG 5 not achieved; Fairness in financial contribution not reported; Response to public’s expectations could not be assessed

 Improved financial and political accountability

None reported.