Beyond cost-effectiveness, morbidity and mortality: a comprehensive evaluation of priority setting for HIV programming in Uganda
Abstract Background While there has been progress in controlling the HIV epidemic, HIV still remains a disease of global concern. Some of the progress has been attributed to increased public awareness and uptake of public health interventions, as well as increased access to anti- retroviral treatmen...
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-019-6690-8 |
| _version_ | 1819151141926076416 |
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| author | Lydia Kapiriri Na-Mee Lee Lauren Jean Wallace Brendan Kwesiga |
| author_facet | Lydia Kapiriri Na-Mee Lee Lauren Jean Wallace Brendan Kwesiga |
| author_sort | Lydia Kapiriri |
| collection | DOAJ |
| description | Abstract Background While there has been progress in controlling the HIV epidemic, HIV still remains a disease of global concern. Some of the progress has been attributed to increased public awareness and uptake of public health interventions, as well as increased access to anti- retroviral treatment and the prevention of vertical HIV transmission. These interventions would not have been possible without substantial investments in HIV programs. However, donor fatigue introduces the need for low income countries to maximize the benefits of the available resources. This necessitates identification of priorities that should be funded. Evaluating prioritization processes would enable decision makers to assess the effectiveness of their processes, thereby designing intervention strategies. To date most evaluations have focused on cost-benefit analyses, which overlooks additional critical impacts of priority setting decisions. Kapiriri & Martin (2010) developed and validated a comprehensive framework for evaluating PS in low income countries. The objective of this paper report findings from a comprehensive evaluation of priority setting for HIV in Uganda, using the framework; and to identify lessons of good practice and areas for improvement. Methods This was a qualitative study based on forty interviews with decision makers and policy document review. Data were analysed using INVIVO 10, and based on the parameters in Kapiriri et al’s evaluation framework. Results We found that HIV enjoys political support, which contributes to the availability of resources, strong planning institutions, and participatory prioritization process based on some criteria. Some of the identified limitations included; undue donor and political influence, priorities not being publicized, and lack of mechanisms for appealing the decisions. HIV prioritization had both positive and negative impacts on the health system. Conclusions The framework facilitated a more comprehensive evaluation of HIV priority setting. While there were successful areas, the process could be strengthened by minimizing undue influence of external actors, and support the legitimate institutions to set priorities and implement them. These should also institute mechanisms for publicizing the decisions, appeals and increased accountability. While this paper looked at HIV, the framework is flexible enough to be used in evaluating priority setting for other health programs within similar context. |
| first_indexed | 2024-12-22T14:28:41Z |
| format | Article |
| id | doaj.art-453ff9792e9147529a2f8dab753c082d |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-22T14:28:41Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-453ff9792e9147529a2f8dab753c082d2022-12-21T18:22:49ZengBMCBMC Public Health1471-24582019-04-0119111510.1186/s12889-019-6690-8Beyond cost-effectiveness, morbidity and mortality: a comprehensive evaluation of priority setting for HIV programming in UgandaLydia Kapiriri0Na-Mee Lee1Lauren Jean Wallace2Brendan Kwesiga3Department of Health, Aging and Society KTH-236, McMaster UniversityGlobal Health program, McMaster UniversityDepartment of Health, Aging and Society, McMaster UniversityWorld Health Organisation, Uganda Country OfficeAbstract Background While there has been progress in controlling the HIV epidemic, HIV still remains a disease of global concern. Some of the progress has been attributed to increased public awareness and uptake of public health interventions, as well as increased access to anti- retroviral treatment and the prevention of vertical HIV transmission. These interventions would not have been possible without substantial investments in HIV programs. However, donor fatigue introduces the need for low income countries to maximize the benefits of the available resources. This necessitates identification of priorities that should be funded. Evaluating prioritization processes would enable decision makers to assess the effectiveness of their processes, thereby designing intervention strategies. To date most evaluations have focused on cost-benefit analyses, which overlooks additional critical impacts of priority setting decisions. Kapiriri & Martin (2010) developed and validated a comprehensive framework for evaluating PS in low income countries. The objective of this paper report findings from a comprehensive evaluation of priority setting for HIV in Uganda, using the framework; and to identify lessons of good practice and areas for improvement. Methods This was a qualitative study based on forty interviews with decision makers and policy document review. Data were analysed using INVIVO 10, and based on the parameters in Kapiriri et al’s evaluation framework. Results We found that HIV enjoys political support, which contributes to the availability of resources, strong planning institutions, and participatory prioritization process based on some criteria. Some of the identified limitations included; undue donor and political influence, priorities not being publicized, and lack of mechanisms for appealing the decisions. HIV prioritization had both positive and negative impacts on the health system. Conclusions The framework facilitated a more comprehensive evaluation of HIV priority setting. While there were successful areas, the process could be strengthened by minimizing undue influence of external actors, and support the legitimate institutions to set priorities and implement them. These should also institute mechanisms for publicizing the decisions, appeals and increased accountability. While this paper looked at HIV, the framework is flexible enough to be used in evaluating priority setting for other health programs within similar context.http://link.springer.com/article/10.1186/s12889-019-6690-8Priority settingEvaluationEvaluation frameworkHIVLow income countriesUganda |
| spellingShingle | Lydia Kapiriri Na-Mee Lee Lauren Jean Wallace Brendan Kwesiga Beyond cost-effectiveness, morbidity and mortality: a comprehensive evaluation of priority setting for HIV programming in Uganda BMC Public Health Priority setting Evaluation Evaluation framework HIV Low income countries Uganda |
| title | Beyond cost-effectiveness, morbidity and mortality: a comprehensive evaluation of priority setting for HIV programming in Uganda |
| title_full | Beyond cost-effectiveness, morbidity and mortality: a comprehensive evaluation of priority setting for HIV programming in Uganda |
| title_fullStr | Beyond cost-effectiveness, morbidity and mortality: a comprehensive evaluation of priority setting for HIV programming in Uganda |
| title_full_unstemmed | Beyond cost-effectiveness, morbidity and mortality: a comprehensive evaluation of priority setting for HIV programming in Uganda |
| title_short | Beyond cost-effectiveness, morbidity and mortality: a comprehensive evaluation of priority setting for HIV programming in Uganda |
| title_sort | beyond cost effectiveness morbidity and mortality a comprehensive evaluation of priority setting for hiv programming in uganda |
| topic | Priority setting Evaluation Evaluation framework HIV Low income countries Uganda |
| url | http://link.springer.com/article/10.1186/s12889-019-6690-8 |
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