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Selecting priorities for MCH

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Introduction. Prioritising between different health interventions is an important first step to achieving optimal allocation of resources in the health sector. – PowerPoint PPT presentation

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Title: Selecting priorities for MCH


1
Selecting priorities for MCH
  • Use of a prioritization matrix

2
  • The process of selecting the appropriate/ key
    interventions
  • whose voices are heard,
  • whose views prevail and, thus,
  • whose health interests are advanced?
  • (RESEARCH INTO ACTION 1997)

Those likely to have the greatest impact in the
relevant setting
3
Learning objectives
  • Based on the situation analysis DCSTs to be able
    to
  • Decide the priority maternal and child health
    problems that will be addressed
  • Guide which interventions will be implemented at
    community, first level and referral level to
    address the priority maternal and child health
    problems
  • Guide which of the identified gaps in health care
    provision and health care utilisation will be
    addressed by them

4
Introduction
  • Prioritising between different health
    interventions is an important first step to
    achieving optimal allocation of resources in the
    health sector.
  • This presentation discusses criteria used to
    select and prioritise interventions.
  • The best policies and actions to promote and
    deliver these priority interventions is the
    subject of a subsequent session

5
  • Any process designed to set priorities ... should
    not lose sight of the fundamental questions
  • whose voices are heard,
  • whose views prevail and, thus,
  • whose health interests are advanced?
  • (RESEARCH INTO ACTION 1997)

6
What is priority setting?
  • Prioritisation is a process whereby all potential
    options (interventions), that address the
    problems identified in the situation analysis,
    are reviewed according to an agreed set of
    criteria.
  • The aim of this process is to select the key
    interventions that are likely to have the
    greatest impact in the relevant setting.
  • Once the appropriate interventions have been
    selected, suitable strategies can be developed to
    maximize the effectiveness of the interventions.

7
What is priority setting?
  • Prioritisation cannot be resolved by purely
    technical and scientific methods
  • Adequate attention has to be given to other
    dimensions of priority setting such as -
    the political context - the decision-making
    process - the institutional and management
    implications, and - the role of community
    values in the allocation of health resources
  • Priority setting requires more than just drawing
    up a list of statistics of poor MCH with a
    statement of determination to address these.
  • It entails making hard decisions about
    priorities, examining the underlying health
    system, and ensuring that implementation,
    monitoring, and accountability processes are in
    place.

8
Essential characteristics of a good priority
setting process
  1. Be adequately informed (by the situational
    analysis)
  2. Achieve balanced participation between different
    stakeholders - particularly between communities
    and professionals
  3. Encourage a multi-sectoral perspective
  4. Encourage integration of activities where
    feasible
  5. Clearly identify the individuals responsible for
    taking the decisions
  6. Be transparent

9
Essential characteristics of a good priority
setting process
  1. Use clear and consistent criteria
  2. Be timely
  3. Be as simple as is consistent with the above
    points
  4. Result in decisions that are consistent with
    services budgetary and implementation abilities
  5. Result in aims and objectives that are clear and
    feasible

10
KEY CONSIDERATIONS IN PRIORITY SETTING
  • Major causes of maternal and child mortality and
    morbidity
  • Coverage targets
  • Existing efforts and delivery channels
  • The quality of services and care provided

11
Summary of steps in a priority setting process
  • Step 1 Determine the aim and scope of the
    priority setting exercise
  • Step 2 Review the situation analysis and compile
    a programme budget
  • Step 3 Convene an advisory panel
  • Step 4 Determine locally relevant
    decision-making criteria
  • Step 5 Identify possible strategy areas
    (interventions)
  • Step 6 Prioritise strategies and make
    recommendations
  • Step 7 Consult stakeholders
  • Step 8 Final decision

12
Summary of steps in a priority setting process
  • Step 1 Determine the aim and scope of the
    priority setting exercise
  • Step 2 Review the situation analysis and compile
    a programme budget
  • Step 3 Convene an advisory panel
  • Step 4 Determine locally relevant
    decision-making criteria
  • Step 5 Identify possible strategy areas
    (interventions)
  • Step 6 Prioritise strategies and make
    recommendations
  • Step 7 Consult stakeholders
  • Step 8 Final decision

13
CRITERIA USED TO PRIORITISE INTERVENTIONS
  • Equity considerations
  • Feasibility
  • Acceptability to community
  • Appropriateness (effectiveness)
  • Cost effectiveness

14
Equity
  • Equity in health can be defined as the absence
    of systematic disparities in health (or in major
    social determinants of health, including access
    to health care) between groups with different
    levels of underlying social advantage or
    disadvantage.
  • Because a particular health intervention is used
    to prevent or treat a disease that is more
    prevalent among the poor, does not necessarily
    mean that the poor will be the ones who benefit
    from increased spending on that intervention

15
Equity
  • Frequently, health interventions, such as
    immunisation, do not adequately reach the poor
    despite being cost-effective and widely promoted.
    On average, immunization coverage in a developing
    country's poorest 20 of the population is around
    35-40 (half the level achieved in the richest
    fifth).
  • Wealth is only one form of inequality. Ethnic,
    language and other divisions are equally or more
    significant markers of gaps in maternal and child
    mortality in many countries. Gender inequity may
    be critical to child health outcomes.

16
Feasibility
  • What is feasible varies widely even among
    low-income countries.
  • An intervention is feasible if there is a
    consensus that it can be implemented successfully
    in the local setting despite resource
    constraints.
  • Feasibility can be viewed as a match between
    technical complexity and capacity.
  • For example, there is a variety of effective
    interventions to prevent hypothermia in newborns
    (i.e. incubators, radiant warmers, wrapping
    warmly in blankets, kangaroo mother care).
    However, if a setting lacks regular electricity,
    kangaroo care is the most feasible (and still
    effective) intervention to achieve the desired
    result.

17
Feasibility
  • The obstacles to intervention delivery include
    insufficient capacity and resources not enough
    money, not enough human resources, not enough
    managerial skills, not enough information, not
    enough political will.
  • Availability of skilled human resources is the
    key constraint
  • While most important prioritisation is among
    health programmes, also necessary to establish
    priorities for services. Consider - Health
    services clinics, community health centres,
    hospitals - Resource management drugs,
    laboratory, human resources, transport,
    etc. - General management health
    information, finance, etc.

18
Acceptability to the community
  • To be sustainable, an intervention must be
    acceptable to the community.
  • Decision makers must consider the community's
    culture, traditions and values.
  • Although an intervention may present a new idea
    to the community, it may be compatible with
    community norms, and therefore easily accepted.
  • Community members must be seen as full partners
    who can make recommendations about what is
    effective and feasible in the local setting

19
Appropriateness (Effectiveness)
  • Effectiveness refers to whether the intervention
    has an effect under the real-life circumstances
    faced by health services.
  • Interventions may be effective in one setting but
    highly dependent on infrastructure and,
    therefore, not feasible in another setting.  
  • The Bellagio Study Group on Child Survival
    estimated that with 99 coverage of proven
    effective interventions, 63 of child mortality
    would be averted

20
Cost-effectiveness
  • In simple terms, the methodology for improving
    health sector spending on health consists of
    estimating the extent to which populations suffer
    from disease (the burden of disease) and the
    costs and effectiveness of curative and
    preventive health interventions known to reduce
    this burden.
  •   The burden of disease is estimated in terms of
    disability adjusted life years (DALYs).

21
DALYS
  • The DALY expresses years of life lost to
    premature death and years lived with a disability
    of specified severity and duration.
  • One DALY is thus one lost year of healthy life.
  • Here, a premature death is defined as one that
    occurs before the age to which the dying person
    could have expected to survive if they were a
    member of a standardized model population with a
    life expectancy at birth equal to that of the
    worlds longest-surviving population (Japan).

22
Example - malaria control (cost/daly saved)
  • Improvement in case management (accurate
    diagnosis, effective treatment) 1-8
  • Insecticide treatment of existing nets 4-10
  • Antimalarial prophylaxis for children (assuming
    an existing delivery system) 3-12
  • Intermittent antimalarial treatment of pregnant
    women 4-29
  • Provision of nets and insecticide treatment
    19-85
  • Residual spraying internal house walls (two
    rounds per year) 32-58

23
PRIORITISING TABLE
Interven-tion Equity Feasibility Acceptability Effectiveness (Appropriateness) Cost-effectiveness Score
1.              
2.              
3.              
4.              
5.              
24
Determining priorities
URGENT NOT URGENT
1 Crises Pressing problems Deadline driven activities 2 Prevention Relationship building Data management Planning Recognising opportunities Recreation
3 Interruptions Some calls, meetings, mail, reports Pressing matters Popular activities 4 Trivia/busy work Some mail/ paper work/ phone calls Time wasters Pleasant activities
Not important IMPORTANT
25
WEIGHTING CRITERIA
  • The assignment of equal or differential weights
    to the criteria should be carefully deliberated
    upon by the participants until a consensus is
    reached on the selected criteria and the weights.
  • For this exercise weigh each criteria as
    follows
  • High (5 points) or
  • Medium (3 points) or
  • Low (1 point) or

26
Once a nation is free it must also be free to
work .
  • A pay cheque maketh a living,
  • BUT work maketh a life.
  • JTibane

27
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