Document Type : Original Article
Authors
1
Department of Global Public Health and Primary Care, Bergen Centre of Ethics and Priority Setting (BCEPS), Faculty of Medicine, University of Bergen (UiB), Bergen, Norway
2
Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen (UiB), Bergen, Norway
3
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
4
National Program of Non-Communicable Diseases, Directorate of Curative Services, Ministry of Health, Dodoma, Tanzania
5
Section for Global Health and Rehabilitation, Western Norway University of Applied Sciences, Bergen, Norway
Abstract
Background
Priority-setting in health systems involves difficult trade-offs among competing interventions within limited resources. Explicit criteria can provide a fair, transparent, and efficient process. Although numerous criteria exist in the literature, it remains unclear which are most relevant to Tanzania and how they should be prioritised. This study identified and ranked national priority-setting criteria through a participatory stakeholder process.
Methods
A five-step participatory process was employed: selecting stakeholders, establishing criteria, organising and grouping the criteria, ranking, and validating results. A total of 36 participants listed criteria in order of perceived importance. During analysis, scores were assigned on a scale of 1 (least important) to 9 (most important) and analysed using descriptive statistics and weighted mean scores (WMSs). Participants were categorised as non-health workers, clinical workers, and non-clinical health workers to explore differences in criteria patterns. Validation involved in-depth interviews with 21 stakeholders who had participated in revising Tanzania’s National Essential Health Benefit Package (EHBP); none had participated in the initial ranking exercise.
Results
Ten priority-setting criteria were identified. Disease burden ranked highest (WMS 7.0), reflecting both frequent mention and high perceived importance. Five criteria received moderate rankings (scores 4–6): cost of treatment to patients, affordability, health benefits, equity, and political acceptability. Cost-effectiveness, cost to the provider, public acceptability, and feasibility ranked lowest (scores 1–2). Criteria varied across stakeholder groups, with non-health workers prioritising affordability and patient costs, while non-clinical health workers prioritised political acceptability. Twelve equity dimensions were identified, with disease severity most frequently mentioned. Six criteria corresponded directly with those used during the national EHBP revision, while the remainder reflected related but non-comparable considerations.
Conclusion
Locally relevant priority-setting criteria can help align resource allocation with population health needs. The participatory approach used in this study may support transparent and context-sensitive priority-setting in Tanzania and other resource-constrained settings pursuing Universal Health Coverage.
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