Page 49 - Prioridades en salud y salud intercultural

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The Problem of Priority
Setting in Low and Middle
Income Countries
For the past decade, policy makers,
aided by scholars, from wealthy
health systems in North America
and Europe have been struggling
to set spending priorities because
health system costs have been grow-
ing at an alarming and unsustain-
able rate(1). More recently, policy
makers in Low and Middle Income
Countries (LMIC) have been look-
ing for help to set priorities in their
context where lack of resources
often means that even basic health
care is unaffordable.
Priority setting is arguably most im-
portant when resources are scarce
and spending decisions mean life
or death for many, which is the
IMPROVING PRIORITY SETTING IN LOW
AND MIDDLE INCOME COUNTRIES:
INTERDISCIPLINARY BIOETHICS IN
ACTION
Douglas K. Martin and Lydia Kapiriri
case in most LMIC. In addition,
LMIC are characterized by enor-
mous social and health inequali-
ties, a paucity of credible informa-
tion to support decision making, a
lack of systematic decision making
processes throughout the health
system, political instability that
plagues implementation, and weak
institutions (2). Hence, priority set-
ting within these contexts tends to
be ad hoc –more by chance than by
choice(3).
How should priorities be set in
LMIC?
This paper serves as an update to
a paper written 5 years ago that
provided a strategy for improving
priority setting using an innovative
interdisciplinary approach(4). This
strategy is a generalizable approach