title: Setting Healthcare Priorities at the Macro and Meso Levels: A Framework for Evaluation.
abstract: BACKGROUND
  Priority setting in healthcare is a key determinant of health system performance. However, there is no widely accepted priority setting evaluation framework. We reviewed literature with the aim of developing and proposing a framework for the evaluation of macro and meso level healthcare priority setting practices.
  
  
  METHODS
  We systematically searched Econlit, PubMed, CINAHL, and EBSCOhost databases and supplemented this with searches in Google Scholar, relevant websites and reference lists of relevant papers. A total of 31 papers on evaluation of priority setting were identified. These were supplemented by broader theoretical literature related to evaluation of priority setting. A conceptual review of selected papers was undertaken.
  
  
  RESULTS
  Based on a synthesis of the selected literature, we propose an evaluative framework that requires that priority setting practices at the macro and meso levels of the health system meet the following conditions: (1) Priority setting decisions should incorporate both efficiency and equity considerations as well as the following outcomes; (a) Stakeholder satisfaction, (b) Stakeholder understanding, (c) Shifted priorities (reallocation of resources), and (d) Implementation of decisions. (2) Priority setting processes should also meet the procedural conditions of (a) Stakeholder engagement, (b) Stakeholder empowerment, (c) Transparency, (d) Use of evidence, (e) Revisions, (f) Enforcement, and (g) Being grounded on community values.
  
  
  CONCLUSIONS
  Available frameworks for the evaluation of priority setting are mostly grounded on procedural requirements, while few have included outcome requirements. There is, however, increasing recognition of the need to incorporate both consequential and procedural considerations in priority setting practices. In this review, we adapt an integrative approach to develop and propose a framework for the evaluation of priority setting practices at the macro and meso levels that draws from these complementary schools of thought.
authors.affiliation: KEMRI Centre for Geographic Medicine Research - Coast, and Welcome Trust Research Programme, Nairobi, Kenya.|Health Economics Unit, University of Cape Town, Cape Town, South Africa.
authors.forename: Edwine W
authors.initials: EW
authors.lastname: Barasa
authors.affiliation: KEMRI Centre for Geographic Medicine Research - Coast, and Welcome Trust Research Programme, Nairobi, Kenya.|Centre for Tropical Medicine, University of Oxford, Oxford, UK.
authors.forename: Sassy
authors.initials: S
authors.lastname: Molyneux
authors.affiliation: KEMRI Centre for Geographic Medicine Research - Coast, and Welcome Trust Research Programme, Nairobi, Kenya.|Department of Paediatrics, University of Oxford, Oxford, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: English
authors.affiliation: Health Economics Unit, University of Cape Town, Cape Town, South Africa.
authors.forename: Susan
authors.initials: S
authors.lastname: Cleary
mesh_terms: D015276:Health Care Rationing; D000069576:Health Equity; D006292:Health Priorities / Q000941:ethics / Q000592:standards; D006801:Humans
keywords: Communitarianism; Healthcare Rationing; Priority Setting; Priority Setting Evaluation; Resource Allocation