What’s Getting in the Way of Fairer National Priority Setting for Universal Health Coverage?
The LHSS-JLN Learning Exchange on Institutionalizing Explicit Processes for Setting National Health Priorities
By Sarah Insanally and Julia Watson
The question of how to best allocate limited health resources to meet population health needs is brought into sharp focus during crises such as the COVID-19 pandemic. But ministries of health have long grappled with how to set equitable national health priorities and ensure that these priorities are reflected in national health plans and budgets.
To help tackle this issue, the USAID Local Health System Sustainability Project (LHSS), in collaboration with the Joint Learning Network for Universal Health Coverage (JLN), last year launched the Institutionalizing Explicit Processes for Setting National Priorities Learning Exchange. This activity aims to understand and address challenges to institutionalizing explicit national priority-setting processes for health from the perspective of Ministry of Health practitioners.
What learning exchange participants are working on is not the priority setting that happens when a country decides what to include in a benefit package or an essential medicines list. Their focus is on how best to set the broad priorities that guide national health policies and that feed through into strategic planning for health and, ultimately, to budget allocations and planning for services. This national priority-setting process uses information about the population’s health needs and the strengths and weaknesses of the health system to determine the main objectives of the health sector for a given period.
Why is this learning exchange’s work important? Because when priority-setting processes are not explicit and institutionalized, it is difficult for ministries of health to align health policies, strategies, and plans with national health and development goals and ensure that scarce human, financial, and other resources are used to help achieve these goals.
Through the LHSS-JLN learning exchange, health practitioners from Bangladesh, Lao PDR, Malaysia, Philippines, Rwanda, South Africa, and Thailand are sharing successful country experiences and promising practices to institutionalize explicit national priority-setting processes for health.
The learning exchange is a forum for interested countries to share promising practices, problem-solve, and generate lessons that can be adapted for different country contexts. Participants are gaining a greater understanding of enabling factors, barriers, and practical steps they can take to advance the institutionalization of explicit priority setting as part of strategic planning for the health sector. A report due for release later in 2022 will sum up what they learned.
A shared vision for an institutionalized, explicit process
At their first meeting in December 2021, learning exchange participants developed a shared understanding of what an institutionalized, explicit process for setting national health priorities looks like. They agreed that such a process is inclusive and fair, transparent and accountable, informed by evidence, and realistic (Figure 1).
And the process can only be said to be truly successful if two further criteria are met: the priorities generated go on to influence health sector plans and budgets; and the process is institutionalized, meaning that it is routinely incorporated in national planning and strategy development cycles, with strong leadership and other needed capacity within the Ministry of Health. While all participating countries have a process to identify priorities, it often falls short of what would be considered institutionalized and explicit.
Moving towards institutionalizing an explicit national priority-setting process
The participants agreed on four categories of factors that need to be in place to create an enabling environment for priority setting:
1. Framework and structure governing the process
2. Mechanisms to engage stakeholders
3. Good quality data and the capacity to use it
4. Links with subsequent plans and budgets
What comes next?
Of the challenges and complexities countries face, learning exchange participants prioritized two areas for joint learning: 1) stakeholder engagement, and 2) impact on plans and budgets. In future meetings, they will continue to validate and add depth to this framework. They’ll discuss how to reduce the inhibiting factors and develop a more enabling environment for setting fairer national health priorities that will help countries make faster progress towards universal health coverage and better health for all.
About the authors:
Sarah Insanally, DrPH, is a health systems specialist on the LHSS Project.
Julia Watson, PhD, is a health economics and financing specialist on the LHSS Project