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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.
 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
 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
 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.