The relationship between prevention of mother to child transmission of HIV and stakeholder decision making in Uganda: implications for health policy

Kapiriri, Lydia; Robbestad, Bjarne; Norheim, Ole Frithjof

doi:10.1016/s0168-8510(03)00062-9

Cited by 9 publications

(4 citation statements)

References 22 publications

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“…We also recognise the limitations to empirical ethics and the fact that there are additional criteria and values of relevance to priority setting which are not presented in this paper [35]. However we maintain that the findings, provide an initial step to the understanding some of the values held by people from a low-income context, more so since similar results were found in the pre-survey group discussions and in another study in similar settings [36]. …”

Section: Discussionsupporting

confidence: 64%

Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda

Kapiriri

Arnesen

Norheim

2004

Cost Eff Resour Alloc

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IntroductionSeveral studies carried out to establish the relative preference of cost-effectiveness of interventions and severity of disease as criteria for priority setting in health have shown a strong preference for severity of disease. These preferences may differ in contexts of resource scarcity, as in developing countries, yet information is limited on such preferences in this context.ObjectiveThis study was carried out to identify the key players in priority setting in health and explore their relative preference regarding cost-effectiveness of interventions and severity of disease as criteria for setting priorities in Uganda.Design610 self-administered questionnaires were sent to respondents at national, district, health sub-district and facility levels. Respondents included mainly health workers. We used three different simulations, assuming same patient characteristics and same treatment outcome but with varying either severity of disease or cost-effectiveness of treatment, to explore respondents' preferences regarding cost-effectiveness and severity.ResultsActual main actors were identified to be health workers, development partners or donors and politicians. This was different from what respondents perceived as ideal. Above 90% of the respondents recognised the importance of both severity of disease and cost-effectiveness of intervention. In the three scenarios where they were made to choose between the two, a majority of the survey respondents assigned highest weight to treating the most severely ill patient with a less cost-effective intervention compared to the one with a more cost-effective intervention for a less severely ill patient. However, international development partners in in-depth interviews preferred the consideration of cost-effectiveness of intervention.ConclusionsIn a survey among health workers and other actors in priority setting in Uganda, we found that donors are considered to have more say than the survey respondents found ideal. Survey respondents considered both severity of disease and cost-effectiveness important criteria for setting priorities, with severity of disease as the leading principle. This pattern of preferences is similar to findings in context with relatively more resources. In-depth interviews with international development partners, showed that this group put relatively more emphasis on cost-effectiveness of interventions compared to severity of disease. These discrepancies in attitudes between national health workers and representatives from the donors require more investigation. The different attitudes should be openly debated to ensure legitimate decisions.

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Section: Discussionsupporting

confidence: 64%

Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda

Kapiriri

Arnesen

Norheim

2004

Cost Eff Resour Alloc

Self Cite

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“…Experiences from real life e.g. from New Zealand, and Tanzania [ 35 , 36 ], and from research settings in Uganda and Tanzania could be explored [ 37 , 38 ]. Although the radio would also be effective in publicizing this information, lack of resources may hinder its use.…”

Section: Discussionmentioning

confidence: 99%

Priority setting in developing countries health care institutions: the case of a Ugandan hospital

Kapiriri

Martin

2006

BMC Health Serv Res

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Background: Because the demand for health services outstrips the available resources, priority setting is one of the most difficult issues faced by health policy makers, particularly those in developing countries. However, there is lack of literature that describes and evaluates priority setting in these contexts. The objective of this paper is to describe priority setting in a teaching hospital in Uganda and evaluate the description against an ethical framework for fair priority setting processes -Accountability for Reasonableness.

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“…Health programs and interventions in resource-limited settings are frequently sponsored by donor agencies with their own disease- or population-specific objectives (Kapiriri et al, 2004; Kapiriri & Norheim, 2004; Kapiriri, Robberstad, & Frithjof Norheim, 2003; Lasry, Carter, & Zaric, 2011; Reichenbach, 2002). For example, from 2003 through 2012, the Global Fund disbursed nearly $550 million to Malawi for HIV-related activities ( Global Fund Disbursements by Region, Country and Grant Agreement (in USD equivalents) , 2012).…”

Section: The Ethically Indifferent Cea Thresholdsmentioning

confidence: 99%

Hidden costs: The ethics of cost-effectiveness analyses for health interventions in resource-limited settings

Rutstein

Price

Rosenberg³

et al. 2016

Global Public Health

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Cost-effectiveness analysis (CEA) is an increasingly appealing tool for evaluating and comparing health-related interventions in resource-limited settings. The goal is to inform decision-makers regarding the health benefits and associated costs of alternative interventions, helping guide allocation of limited resources by prioritizing interventions that offer the most health for the least money. Although only one component of a more complex decision-making process, CEAs influence the distribution of healthcare resources, directly influencing morbidity and mortality for the world’s most vulnerable populations. However, CEA-associated measures are frequently setting-specific valuations, and CEA outcomes may violate ethical principles of equity and distributive justice. We examine the assumptions and analytical tools used in CEAs that may conflict with societal values. We then evaluate contextual features unique to resource-limited settings, including the source of health-state utilities and disability weights; implications of CEA thresholds in light of economic uncertainty; and the role of external donors. Finally, we explore opportunities to help align interpretation of CEA outcomes with values and budgetary constraints in resource-limited settings. The ethical implications of CEAs in resource-limited settings are vast. It is imperative that CEA outcome summary measures and implementation thresholds adequately reflect societal values and ethical priorities in resource-limited settings.

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The relationship between prevention of mother to child transmission of HIV and stakeholder decision making in Uganda: implications for health policy

Cited by 9 publications

References 22 publications

Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda

Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda

Priority setting in developing countries health care institutions: the case of a Ugandan hospital

Hidden costs: The ethics of cost-effectiveness analyses for health interventions in resource-limited settings

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