Table 1 Parameters for evaluating priority setting with corresponding means of verification and indicators
Parameters of Successful Priority Setting | Objectively Verifiable Indicators (OVI) | Means of Verification (MOV) |
|---|---|---|
Contextual Factors | ||
Conducive political, economic, social and cultural context | Relevant contextual factors that may impact priority setting | Follow up intermittent interviews with local stakeholders, systematic longitudinal observations, relevant reports, media |
Pre-requisites | ||
Political will | Degree to which politicians support the set priorities | Follow up intermittent interviews with local stakeholders, systematic longitudinal observations, relevant reports, media |
Resources | Budgetary and human resource allocation to the health sector | National budget documents |
Legitimate and credible priority-setting institutions | Degree to which the priority setting institution can set priorities; public confidence in the institution | Stakeholder and public interviews |
Incentives | Material and financial incentives | National budget documents |
The Priority Setting Process | ||
Stakeholder participation | Number of stakeholders participating, number of opportunities each stakeholder expresses opinion | Observations/minutes at meetings, media reports, special reports |
Use of clear priority setting process/tool/methods | Documented priority setting process and/or use of priority setting framework | Observation/minutes at meetings, media reports, special reports |
Use of explicit relevant priority setting criteria | Documented/articulated criteria | Observations/minutes at meetings, media reports, special reports |
Use of evidence | Number of times available data is resourced/number of studies commissioned/strategies to collect relevant data | Observations/minutes at meetings, media reports, special reports |
Reflection of public values Publicity of priorities and criteria Functional mechanisms for appealing the decisions | Number and type of members from the general public represented, how they are selected, number of times they get to express their opinion, proportion of decisions reflecting public values, documented strategy to enlist public values, number of studies commissioned to elicit public values Number of times decisions and rationales appear in public documents Number of decisions appealed, number of decisions revised | Observations/minutes at meetings, study reports, meeting minutes and strategic plans Media reports Observations/minutes at meetings, media reports, special reports |
Functional mechanisms for enforcement | Number of cases of failure to adhere to priority-setting process reported | Observations/minutes at meetings, media reports, special reports |
Efficiency of the priority-setting process | Proportion of meeting time spent on priority setting, number of decisions made on time | Observations/minutes at meetings, annual budget documents, health system reports |
Implementation | ||
Decreased dissentions | Number of complaints from stakeholders | Meeting minutes, media reports |
Allocation of resources according to priorities | Degree of alignment of resource allocation and agreed upon priorities, times budget is re-allocated from less prioritized to high prioritized areas, stakeholder satisfaction with decisions | Annual budget reports, evaluation documents |
Decreased resource wastage | Proportion of budget unused, drug stock-outs | Budget documents, evaluation reports |
Increased stakeholder understanding, satisfaction and compliance with the priority setting process | Number of stakeholders attending meetings, number of complaints from stakeholders, % stakeholders that can articulate the concepts used in priority setting and appreciate the need for priority setting | Observations/minutes at meetings, special reports, SH satisfaction survey, media reports, stakeholder interviews, evaluation reports |
Improved internal accountability/reduced corruption | Number of publicized resource allocation decisions | Evaluation reports, stakeholder interviews, media reports |
Strengthening of the priority setting institution | Indicators of increased efficiency, use of data, quality of decisions, appropriate resource allocation, % stakeholders with the capacity to set priorities | Training reports, evaluation reports, budget documents |
Impact on institutional goals and objectives | % of institutional objectives met that are attributed to the priority setting process | Evaluation reports, special studies |
Outcome/Impact | ||
Impact on health policy and practice | Changes in health policy to reflect identified priorities | Policy documents |
Achievement of health system goals | % reduction in DALYs, % reduction of the gap between the lower and upper quintiles, % of poor populations spending more than 50% of their income on health care, % users who report satisfaction with the healthcare system | Ministry of Health documents, Demographic and Health Surveys, commissioned studies |
Improved financial and political accountability | Number of publicized financial resource allocation decisions, number of corruption instances reported, % of the public reporting satisfaction with the process | Reports, media reports, interviews with stakeholders |
Increased investment in the health sector and strengthening of the health care system | Proportion increase in the health budget, proportion increase in the retention of health workers, % of the public reporting satisfaction with the health care system | National budget allocation documents, human resources survey reports, interviews with stakeholders, media reports |