Establishing health system financing research priorities in developing countries using a participatory methodology

Presenter: Michael Ranson, World Health Organization

Abstract

Background: Funding for health financing research is inadequate and is often poorly aligned with national priorities. Previous priority setting exercises have generally been "top-down", involving a limited number of technical experts, or have failed to incorporate health financing issues. And where agendas for national health research have been established, they have not been consolidated into a clear agenda for funders. This paper describes work carried out by the Alliance and its partners to generate consensus about a core set of research questions that urgently require attention in order to facilitate policy development in low and middle income countries.

Methodology: There were three key inputs into the priority setting process: key informant interviews with health policy makers, researchers, community and civil society representatives across twenty-four low and middle income countries in four regions (Latin America, East Africa, South- East Asia and Middle East/North Africa); overview of relevant literature reviews to identify research completed to date; and ranking of emerging research questions by 12 key informants at a workshop. Policy concerns and research priorities were categorized by health financing functions -- including collection of funds, pooling of resources, allocation and purchasing -- drawing on a conceptual framework developed by Joseph Kutzin.

Findings: A list of nineteen priority research questions emerged from key informant interviews. While each broad research topic was common to several countries or regions, the more specific 'sub-topics' of interest varied considerably. The overview of systematic review provided little insight into the relative importance of the research questions. Many of the questions received little or no attention in the review literature. Even where questions had been addressed (or partially addressed) by the review literature, the authors of the review papers generally suggested that additional primary, or research of higher quality, was still required. However, this overview of reviews was instructive in showing which health financing topics have had comparatively little written about them, despite being identified as important by key informants. At the consultative workshop, a group of 12 researchers refined and ranked the priority research questions. The five top-ranked questions were as follows:

1. How do we develop and implement universal financial protection?

2. What are the pros and cons of the different ways of identifying the poor?

3. To what extent do health benefits reach the poor?

4. What are the pros and cons of implementing demand-side subsidies?

5. What is the cost-effectiveness of service delivery models and health systems strategies?

Conclusions: While there has been significant progress in the field of health financing research as applied to low and middle income countries, policy makers still need evidence to inform many basic questions about the design and implementation of national health financing systems. Coordinated efforts across the research community and research funders to address the priority questions identified above would significantly inform policy. The identified list of high priority, tractable HSF research questions are being communicated to research funders and researchers through Alliance HPSR publications and advocacy work.