From papers to practices: district level priority setting processes and criteria for family planning, maternal, newborn and child health interventions in Tanzania.
BACKGROUND
Successful priority setting is increasingly known to be an important aspect in achieving better family planning, maternal, newborn and child health (FMNCH) outcomes in developing countries. However, far too little attention has been paid to capturing and analysing the priority setting processes and criteria for FMNCH at district level. This paper seeks to capture and analyse the priority setting processes and criteria for FMNCH at district level in Tanzania. Specifically, we assess the FMNCH actor's engagement and understanding, the criteria used in decision making and the way criteria are identified, the information or evidence and tools used to prioritize FMNCH interventions at district level in Tanzania.


METHODS
We conducted an exploratory study mixing both qualitative and quantitative methods to capture and analyse the priority setting for FMNCH at district level, and identify the criteria for priority setting. We purposively sampled the participants to be included in the study. We collected the data using the nominal group technique (NGT), in-depth interviews (IDIs) with key informants and documentary review. We analysed the collected data using both content analysis for qualitative data and correlation analysis for quantitative data.


RESULTS
We found a number of shortfalls in the district's priority setting processes and criteria which may lead to inefficient and unfair priority setting decisions in FMNCH. In addition, participants identified the priority setting criteria and established the perceived relative importance of the identified criteria. However, we noted differences exist in judging the relative importance attached to the criteria by different stakeholders in the districts.


CONCLUSIONS
In Tanzania, FMNCH contents in both general development policies and sector policies are well articulated. However, the current priority setting process for FMNCH at district levels are wanting in several aspects rendering the priority setting process for FMNCH inefficient and unfair (or unsuccessful). To improve district level priority setting process for the FMNCH interventions, we recommend a fundamental revision of the current FMNCH interventions priority setting process. The improvement strategy should utilize rigorous research methods combining both normative and empirical methods to further analyze and correct past problems at the same time use the good practices to improve the current priority setting process for FMNCH interventions. The suggested improvements might give room for efficient and fair (or successful) priority setting process for FMNCH interventions.
Nijmegen International Center for Health Systems Research and Education, Radboud University, Nijmegen, The Netherlands. dereck.chitama@gmail.com
Dereck
D
Chitama
Rob
R
Baltussen
Evert
E
Ketting
Switbert
S
Kamazima
Anna
A
Nswilla
Phares G M
PG
Mujinja
D000328:Adult; D002648:Child; D002669:Child Welfare / Q000639:trends*; D005260:Female; D006292:Health Priorities / Q000639:trends*; D006293:Health Promotion / Q000639:trends*; D006801:Humans; D007229:Infant Welfare / Q000639:trends*; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000639:trends; D008429:Maternal Welfare / Q000639:trends*; D008430:Maternal-Child Health Centers / Q000639:trends*; D011320:Primary Health Care / Q000639:trends; D013636:Tanzania; D055815:Young Adult