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Criteria Used for Priority-Setting for Public Health Resource Allocation in Low- and Middle-Income Countries: A Systematic Review

Published online by Cambridge University Press:  16 July 2019

Gunjeet Kaur ,
Shankar Prinja ,
P.V.M. Lakshmi ,
Laura Downey ,
Deepshikha Sharma  and
Yot Teerawattananon
Gunjeet Kaur
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research
Shankar Prinja*
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research
P.V.M. Lakshmi
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research
Laura Downey
Affiliation:
Centre for Global Health and Development, Imperial College
Deepshikha Sharma
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research
Yot Teerawattananon
Affiliation:
Health Intervention and Technology Assessment Program (HITAP); Saw Swee Hock School of Public Health, National University of Singapore
*
Author for correspondence: Shankar Prinja, E-mail: shankarprinja@gmail.com
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Abstract

Objectives

This systematic review aimed to identify criteria being used for priority setting for resource allocation decisions in low- and middle-income countries (LMICs). Furthermore, the included studies were analyzed from a policy perspective to understand priority setting processes in these countries.

Methods

Searches were carried out in PubMed, Embase, Econlit, and Cochrane databases, supplemented with pre-identified Web sites and bibliographic searches of relevant papers. Quality appraisal of included studies was undertaken. The review protocol is registered in International Prospective Register of Systematic Reviews PROSPERO CRD42017068371.

Results

Of 16,412 records screened by title and abstract, 112 papers were identified for full text screening and 44 studies were included in the final analysis. At an overall level, cost-effectiveness 52 percent (n = 22) and health benefits 45 percent (n = 19) were the most cited criteria used for priority setting for public health resource allocation. Inter-region (LMICs) and between various approaches (like health technology assessment, multi-criteria decision analysis (MCDA), accountability for reasonableness (AFR) variations among criteria were also noted. Our review found that MCDA approach was more frequently used in upper middle-income countries and AFR in lower-income countries for priority setting in health. Policy makers were the most frequently consulted stakeholders in all regions.

Conclusions and Recommendations

Priority-setting criteria for health resource allocation decisions in LMICs largely comprised of cost-effectiveness and health benefits criteria at overall level. Other criteria like legal and regulatory framework conducive for implementation, fairness/ethics, and political considerations were infrequently reported and should be considered.

Keywords

Priority settingResource allocationCriteriaSystematic reviewHealth policy
Type
Theme Submission
Information
International Journal of Technology Assessment in Health Care , Volume 35 , Issue 6 , 2019 , pp. 474 - 483
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

We are grateful to the assistance provided by the ICMR Advanced Centre for Evidence based Child Health and Mrs. Uma Gupta (library) of Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh. We thank Mr. Chandrashekhar Tripathi, Business Manager EBSCO Information Services, India, for considering our request and providing us complimentary access to Econlit database. We also thank the editors and anonymous reviewers of the journal whose comments have significantly improved this article. Centre for Global Health and Development of Imperial College (L.D.), HITAP and NUS (Y.T.) are part of the international Decision Support Initiative (iDSI) funded by the Bill and Melinda Gates Foundation and the Department for International Development, United Kingdom, and Rockfeller Foundation. Funding: This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

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