Conceptual Framework

2016-PMAC-ConceptFramework-large-size

The PMAC 2016 sessions were developed on the conceptual framework illustrating essential elements of health priority setting that addresses the need for evidence-informed decision making in support of universal health coverage (UHC) (figure). In this sense, priority setting of health problems and solutions involves two major steps of evidence generation (Subtheme 1) and use of evidence in resource allocation, program management and quality assurance in health delivery (Subtheme 2). Priority setting in particular health systems is implicated by a wide range of political, economic and sociocultural factors, through the following building blocks:

  • Governing structure, functions and regulation of respective institutes and their interrelationship;
  • Resource availability and mobilization to support priority setting activities;
  • Capacity building programs for well understanding and knowledge concerning health priority setting among policymakers, researchers and other stakeholders including general public; and
  • Collaboration and networks of local, international and global organizations those aim to strengthen UHC policy decisions.

 

Evidence generation, either from research studies or from relatively simpler analysis of information, requires not only capable human resources, but also reliable and up-to-date data/information, rigorous methods and practical approaches. Health technology assessment has been recognized as a useful tool for priority setting of biomedical interventions and public health measures. Other approaches for determining priority health interventions also exist. Meanwhile, connection between evidence, priority setting processes and policy decisions is politically-oriented, as it is shaped by social values (such as efficiency, equity, morality, and solidarity) and variety of interests, all of which are usually competing with each other.

In practice, health priority setting (Subtheme 3) in most low- and middle-income countries is imperfect, owing to constraints in the four building blocks. Importantly, the absence of good governance can result in inadequate resources, system capacity and support from different organizations. These allow powerful interests, with certain values, to dominate both the technical and political aspects of priority setting, and subsequently undermine quality of evidence as well as political commitment to using evidence to inform coverage decisions, disinvestment, program designs and guidelines formulation in the UHC context.