Consensus and contention in the priority setting process: examining the health sector in Uganda.
Health priority setting is a critical and contentious issue in low-income countries because of the high burden of disease relative to the limited resource envelope. Many sophisticated quantitative tools and policy frameworks have been developed to promote transparent priority setting processes and allocative efficiency. However, low-income countries frequently lack effective governance systems or implementation capacity, so high-level priorities are not determined through evidence-based decision-making processes. This study uses qualitative research methods to explore how key actors' priorities differ in low-income countries, using Uganda as a case study. Human resources for health, disease prevention and family planning emerge as the common priorities among actors in the health sector (although the last of these is particularly emphasized by international agencies) because of their contribution to the long-term sustainability of health-care provision. Financing health-care services is the most disputed issue. Participants from the Ugandan Ministry of Health preferentially sought to increase net health expenditure and government ownership of the health sector, while non-state actors prioritized improving the efficiency of resource use. Ultimately it is apparent that the power to influence national health outcomes lies with only a handful of decision-makers within key institutions in the health sector, such as the Ministries of Health, the largest bilateral donors and the multilateral development agencies. These power relations reinforce the need for ongoing research into the paradigms and strategic interests of these actors.
Department of Geography, Trinity College, Dublin, Dublin 2, Ireland & School of Earth and Environment, University of Leeds, Leeds LS2 9JT, UK, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban 4041, South Africa and School of Public Health, Makerere University, Kampala, Uganda & Commissioner Health Services, Ministry of Health, Kampala, Uganda sarah.colenbrander@gmail.com.
Sarah
S
Colenbrander
Department of Geography, Trinity College, Dublin, Dublin 2, Ireland & School of Earth and Environment, University of Leeds, Leeds LS2 9JT, UK, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban 4041, South Africa and School of Public Health, Makerere University, Kampala, Uganda & Commissioner Health Services, Ministry of Health, Kampala, Uganda.
Charles
C
Birungi
Department of Geography, Trinity College, Dublin, Dublin 2, Ireland & School of Earth and Environment, University of Leeds, Leeds LS2 9JT, UK, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban 4041, South Africa and School of Public Health, Makerere University, Kampala, Uganda & Commissioner Health Services, Ministry of Health, Kampala, Uganda.
Anthony K
AK
Mbonye
D032921:Consensus; D003657:Decision Making; D003695:Delivery of Health Care; D003906:Developing Countries; D019981:Health Care Sector / Q000458:organization & administration*; D006292:Health Priorities / Q000592:standards*; D061889:Healthcare Financing; D006801:Humans; D011203:Poverty; D014454:Uganda
Priority setting; Uganda; aid modalities; development assistance; disease prevention; health system strengthening; human resources for health