Page 14 - Htain Manual

I
n most countries, health service delivery is undertaken by health organizations

that take it upon themselves to meet the requirements of the population as best

they can, with a finite resource pool. If there are more claims on the resources

than the resources available, health organizations undertake some form of prioritization.
From the view-point of central or state governments, regardless of the total resources,

choices need to be made on what to and what not to fund. To do this, some central health

programmes are designed and operationalized along with a pool of resources made available
to states/districts as part of a decentralized approach towards the management of the

healthcare delivery.

What is Priority Setting?

Priority setting or prioritisation refers to the task of determining the priority to be

assigned to a service, a service development or an individual patient at a given point in time.

Prioritisation is needed because claims (be it for needs or demands) for healthcare are greater
than the resources available for providing them. To prioritize a process may also refer to

allocate resources to it with the goal of maximizing its health impact within a defined

budgetary constraint (the major hurdle in our system). Another way for prioritization is to
rank order interventions with an aim to inform decision-makers on all the pros and cons of

implementation of the ranked health interventions. Since budgets are negotiated between

departments of health and the departments of finance, showing the potential value and

affordability of different programmes can also help increase budgetary allocations for

different priorities.

When we talk of setting priorities, it may differ according to requirements of the

population in question for which the health intervention is being implemented or the overall

disease burden that needs to be targeted.

So the levels of prioritizing can be broadly categorized as:

• Macro-level : e.g. national

• Meso-level : e.g. state/ provincial

• Micro-level : e.g. local community level

Other than this categorization based on the scale of the impact of the healthcare
interventions/services, prioritization is of two types: explicit and implicit. As a broad

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