EHS-COVID (445) Priority Setting and Equity in COVID-19 Pandemic Plans in 18 African countries

24 September, 2021

A new paper in Health Policy and Planning. Citation, abstract, extract and comment from me below.

CITATION: Priority Setting and Equity in COVID-19 Pandemic Plans: A Comparative Analysis of eighteen African Countries

Lydia Kapiriri, Suzanne Kiwanuka, Godfrey Biemba, Claudia Velez, S Donya Razavi, Julia Abelson, Beverly Essue, Marion Danis, Susan Goold, Mariam Noorulhuda ... Show more

Health Policy and Planning, https://doi.org/10.1093/heapol/czab113

Published: 21 September 2021

ABSTRACT: Priority setting represents an even bigger challenge during public health emergencies than routine times. This is because such emergencies compete with routine programs for the available health resources, strain health systems, and shift health care attention and resources towards containing the spread of the epidemic and treating those that fall seriously ill. This paper is part of a larger global study the aim of which is to evaluate the degree to which National COVID-19 preparedness and response plans incorporated priority setting concepts. IT and provides important insights into what and how priority decisions were made in a context of a pandemic. Specifically, with a focus on a sample of 18 African countries’ pandemic plans, the paper aims to: (i) Explore the degree to which the documented priority setting processes adhere to established quality indicators of effective priority setting and (ii) To examine if there is a relationship between the number of quality indicators present in the pandemic plans and the country’s economic context, health system and prior experiences with disease outbreaks. All the reviewed plans contained some aspects of expected priority setting processes but none of the national plans addressed all quality parameters. Most of the parameters were mentioned by less than 10 of the 18 country plans reviewed, and several plans identified one or two aspects of fair priority setting processes. Very few plans identified equity as a criterion for priority setting. Since the parameters are relevant to the quality of priority setting that is implemented during public health emergencies, and that most of the countries have pre-existing pandemic plans; it would be advisable that for the future (if not already happening) countries consider priority setting as a critical part of their routine health emergency and disease outbreak plans. Such an approach would ensure that priority setting is integral to pandemic planning, response, and recovery.

SELECTED EXTRACT: 'Critical to pandemic planning is the need to maintain routine essential services. We assessed the degree to which the plans included strategies to sustain the country’s routine health programs. Of the eighteen plans, eight included plans for sustaining essential services. Identified essential services included maternal and child health, HIV treatment, and chronic diseases.'

COMMENT (Neil): Prioritisation is part of our brief for the current discussion supported by WHO. We welcome comments from HIFA members on this topic. Of course, what matters is not just the plan, it is the extent to which it is implemented. A perfect plan has no impact if it is not implemented. We welcome comments on this too.

Best wishes, Neil

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org