All the studies used a qualitative case study approach. The priority setting activity that was studied across all the selected papers was the planning and resource allocation (or budgeting) process at the regional level. Of the 16 studies, 12 sought to describe and evaluate the priority setting process, while four sought to only evaluate the priority setting process. Five studies were done in Canada, four in Tanzania, three in United Kingdom, two in Kenya, and two in Zambia. Of the 16 studies, both HICs and LMICs had eight each. Table 1 presents a list of the selected papers and their characteristics. This was followed by screening by abstract which led to the elimination of 78 more and finally screening by reading the full papers led to the selection of 16 articles that met the eligibility criteria ( Screening by title led to the elimination of 798 articles. The objective of the review was to synthesize evidence on findings of studies that evaluated priority setting practices at the meso level in both developed and developing countries.Ī total of 1003 papers were found, of which 67 duplicates were removed. To contribute to the evidence and knowledge on how well healthcare priorities are set, we conducted a thematic review of empirical literature on meso level priority setting. How well priorities are set, and how well resources are allocated at the meso/regional level of the health system is therefore a key research and policy question. Further, these regional levels are charged with the daunting task of managing and allocating resources to all public health facilities. In Kenya, in the financial year 2016–2017, the counties were responsible for about 60% of the total health sector budget ( In England for example, the primary care trusts (PCTs) were responsible for approximately 80% of the National Health Service budget (Įt al., 2012). Under decentralized systems, regional levels are critical in delivery of healthcare services and control significant resources. Meso level priority setting is crucial given that decentralization has been at the center stage of most health system reforms. However, priority setting research has focused on macro and micro level, neglecting meso level priority setting practices (Įt al., 2017). hospital), and micro (frontline clinician) level. Priority setting in the health sector occurs at the macro (national), meso (regional, e.g. Priority setting for health interventions is one of the key challenges facing decision makers worldwide, because resources are scarce, while healthcare needs are unlimited (Įt al., 2009). Priority setting refers to the distribution of resources among competing programmes and patients or patient groups (Įt al., 1997). This can be achieved through incorporating and adapting systematic priority setting processes and frameworks to the context where used, and making considerations of both process and outcome measures during priority setting and resource allocation. Limitations: Our study was limited by the fact that there are very few empirical studies that have evaluated priority setting at the meso-level and there is likelihood that we did not capture all the studies.Ĭonclusions: Improving priority setting practices at the meso level is crucial to strengthening health systems. Efficiency, reallocation of resources and options for service delivery redesign were the most common outcome measures used to evaluate priority setting. Accountability for reasonableness was the most common evaluative framework as it was used in 12 of the 16 studies. The priority setting process at the meso-level is a top-down approach with minimal involvement of the community. Both formal and informal criteria are used in priority-setting, however, informal criteria appear to be more perverse in LMICs compared to HICs. Results: Few studies used systematic priority setting processes, and all but one were from HICs. We analyzed data from the selected papers by thematic review. A total of 16 papers were identified from LMICs and HICs. We only included empirical studies that described and evaluated, or those that only evaluated priority setting practice at the meso-level. Methods: We systematically searched PubMed, ScienceDirect and Google scholar databases and supplemented these with manual searching for relevant studies, based on the reference list of selected papers. We aimed to review empirical literature that evaluated priority setting practice at the meso (sub-national) level of health systems. These regions are tasked with the difficult responsibility of determining healthcare priorities and resource allocation amidst scarce resources. Background: Decentralization of health systems has made sub-national/regional healthcare systems the backbone of healthcare delivery.
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