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Essue BM, Kapiriri L, Mohamud H, Vélez CM, Nouvet E, Aguilera B, Williams I, Kiwanuka S. Priority setting in times of crises: an analysis of priority setting for the COVID-19 response in the Western Pacific Region. Health Policy 2024; 142:105010. [PMID: 38364637 DOI: 10.1016/j.healthpol.2024.105010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/13/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND While priority setting is recognized as critical for promoting accountability and transparency in health system planning, its role in supporting rational, equitable and fair pandemic planning and responses is less well understood. This study aims to describe how priority setting was used to support planning in the initial stage of the pandemic response in a subset of countries in the Western Pacific Region (WPR). METHODS We purposively sampled a subset of countries from WPR and undertook a critical document review of the initial national COVID-19 pandemic response plans. A pre-specified tool guided data extraction and the analysis examined the use of quality parameters of priority setting, and equity considerations. RESULTS Nine plans were included in this analysis, from the following countries: Papua New Guinea, Tonga, The Philippines, Fiji, China, Australia, New Zealand, Japan, and Taiwan. Most commonly the plans described strong political will to respond swiftly, resource needs, stakeholder engagement, and defined the roles of institutions that guided COVID-19 response decision-making. The initial plans did not reflect strong evidence of public engagement or considerations of equity informing the early responses to the pandemic. CONCLUSION This study advances an understanding of how priority setting and equity considerations were integrated to support the development of the initial COVID-19 responses in nine countries in WPR and contributes to the literature on health system planning during emergencies. This baseline assessment reveals evidence of the common priority setting parameters that were deployed in the initial responses, the prioritized resources and equity considerations and reinforces the importance of strengthening health system capacity for priority setting to support future pandemic preparedness.
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Affiliation(s)
- Beverley M Essue
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, 155 College Street West Toronto ON M5T 3M6, Canada.
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, L8S 4M4, Hamilton, Ontario, Canada
| | - Hodan Mohamud
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, 155 College Street West Toronto ON M5T 3M6, Canada
| | - Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, L8S 4M4, Hamilton, Ontario, Canada; Faculty of Medicine, University of Antioquia, Cra 51d #62-29, Medellín, Antioquia, Colombia
| | - Elysee Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, N6A 3K7, London, Ontario, Canada
| | - Bernardo Aguilera
- Faculty of Medicine and Science at the Universidad San Sebastian, Santiago de Chile, Providencia, Región Metropolitana, Chile
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, 40 Edgbaston Park Rd, B15 2RT, Birmingham, UK
| | - Suzanne Kiwanuka
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Uganda
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Kapiriri L, Ieystn W, Vélez CM, Essue BM, Susan G, Danis M, Aguilera B. A global comparative analysis of the criteria and equity considerations included in eighty-six national COVID-19 plans. Health Policy 2024; 140:104961. [PMID: 38228031 DOI: 10.1016/j.healthpol.2023.104961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024]
Abstract
Systematic priority setting (PS), based on explicit criteria, is thought to improve the quality and consistency of the PS decisions. Among the PS criteria, there is increased focus on the importance of equity considerations and vulnerable populations. This paper discusses the PS criteria that were included in the national COVID-19 pandemic plans, with specific focus on equity and on the vulnerable populations considered. Secondary synthesis of data, from a global comparative study that examined the degree to which the COVID-19 plans included PS, was conducted. Only 32 % of the plans identified explicit criteria. Severity of the disease and/or disease burden were the commonly mentioned criteria. With regards to equity considerations and prioritizing vulnerable populations, 22 countries identified people with co-morbidities others mentioned children, women etc. Low social-economic status and internally displaced population were not identified in any of the reviewed national plans. The limited inclusion of explicit criteria and equity considerations highlight a need for policy makers, in all contexts, to consider instituting and equipping PS institutions who can engage diverse stakeholders in identifying the relevant PS criteria during the post pandemic period. While vulnerability will vary with the type of health emergency- awareness of this and having mechanisms for identifying and prioritizing the most vulnerable will support equitable pandemic responses.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada.
| | - Williams Ieystn
- School of Social Policy, HSMC, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK
| | - Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | - Beverley M Essue
- Centre for Global Health Research, St. Michael's Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada
| | - Goold Susan
- Internal Medicine and Health Management and Policy. Center for Bioethics and Social Sciences in Medicine, University of Michigan. 2800 Plymouth Road, Bldg. 14, G016, Ann Arbor, MI 48109-2800, USA
| | - Marion Danis
- Section on Ethics and Health Policy, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Bernardo Aguilera
- Facultad de Medicina y Ciencia, Universidad San Sebastian, Providencia, Santiago, Chile
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Príncipe AS, Filho ASN, Machado BAS, Barbosa JDV, Winkler I, Ferreira CV. Decision Support Frameworks in Public Health Emergencies: A Systematic Review of Dynamic Models in Complex Contexts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6685. [PMID: 37681825 PMCID: PMC10487630 DOI: 10.3390/ijerph20176685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
Public health emergencies are extraordinary events of disease spread, with health, economic, and social consequences, which require coordinated actions by governments and society. This work aims to analyze scopes, application possibilities, challenges, and gaps of decision support frameworks in PHE management, using the components of the Health Emergency and Disaster Risk Management Framework (H-EDRM) and the Preparedness, Prevention, Response and Recovery Model (PPRR Model), providing guidelines for the development of new models. A systematic literature review was carried out using the Web of Science, Scopus, and Pubmed knowledge databases on studies published between 2016 and 2023, and thirty-six articles were selected. The outcomes show a concentration of frameworks on short-term emergency response operations, with a limited emphasis on the political and strategic components that drive actors and responsibilities. Management prioritizes monitoring, evaluation, and information management frameworks. However, the models need to overcome the challenges of multisectoral and interdisciplinary action, different levels of decisions and actors, data sharing, and development of common platforms of evidence for decisions fitted to the various emergencies.
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Affiliation(s)
| | - Aloísio S. N. Filho
- Department of Management and Industrial Technology, SENAI CIMATEC University Center, Salvador 41650-010, Brazil; (A.S.N.F.); (B.A.S.M.); (J.D.V.B.)
| | - Bruna A. S. Machado
- Department of Management and Industrial Technology, SENAI CIMATEC University Center, Salvador 41650-010, Brazil; (A.S.N.F.); (B.A.S.M.); (J.D.V.B.)
| | - Josiane D. V. Barbosa
- Department of Management and Industrial Technology, SENAI CIMATEC University Center, Salvador 41650-010, Brazil; (A.S.N.F.); (B.A.S.M.); (J.D.V.B.)
| | - Ingrid Winkler
- Department of Management and Industrial Technology, SENAI CIMATEC University Center, Salvador 41650-010, Brazil; (A.S.N.F.); (B.A.S.M.); (J.D.V.B.)
- Institute for Science, Innovation and Technology in Industry 4.0/INCITE INDUSTRIA 4.0, Salvador 41650-010, Brazil
| | - Cristiano V. Ferreira
- Technological Center of Joinville, Federal University of Santa Catarina, Joinville 89219-600, Brazil;
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Kapiriri L, Essue BM, Velez CM, Julia A, Elysee N, Bernardo A, Marion D, Susan G, Ieystn W. Was priority setting included in the Canadian COVID-19 pandemic planning and preparedness? A comparative analysis of COVID-19 pandemic plans from Eight provinces and Three territories. Health Policy 2023; 133:104817. [PMID: 37150048 PMCID: PMC10074731 DOI: 10.1016/j.healthpol.2023.104817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023]
Abstract
Background Variation in priorities during pandemic planning among the federal, provincial and territorial jurisdictions are thought to have impacted Canada's ability to effectively control the spread of the COVID-19 virus, and protect the most vulnerable. The potential influence of diverse and divergent political, cultural, and behavioural factors, regarding inclusion of priority setting (PS) in pandemic preparedness planning across the country is not well understood. This study aimed to examine how the Canadian federal, provincial and territorial COVID-19 pandemic preparedness planning documents integrated PS. Methods A documentary analysis of the federal, eight provincial, three territorial COVID-19 preparedness and response plans. We assessed the degree to which the documented PS processes fulfilled established quality requirements of effective PS using the Kapiriri & Martin framework. Results While the federal plan included most of the parameters of effective PS, the provinces and territories reflected few. The lack of obligation for the provinces and territories to emulate the federal plan is one of the possible reasons for the varying inclusion of these parameters. The parameters included did not vary systematically with the jurisdiction's context. Conclusion Provinces could consider using the framework of the federal plan and the WHO guidelines to guide future pandemic planning. Regular evaluation of the instituted PS would provide a mechanism through which lessons can be harnessed and improvement strategies developed. Future studies should describe and evaluate what PS mechanisms were implemented.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, 1280 Main street West, Hamilton, Ontario, Canada.
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Claudia M Velez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, KTH-226, Hamilton, Ontario L8S 4M4, Canada; Faculty of Medicine, University of Antioquia, Cra 51d #62-29, Medellín, Antioquia, Colombia
| | - Abelson Julia
- Health Policy Program, McMaster University, 1280 Main Street West, L8S 4M4, Hamilton, Ontario, Canada
| | - Nouvet Elysee
- School of Health Studies, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Aguilera Bernardo
- Facultad de Medicina y Ciencia, Universidad San Sebastian, Providencia, Santiago
| | - Danis Marion
- Section on Ethics and Health Policy, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Goold Susan
- Internal Medicine and Health Management and Policy, Center for Bioethics and social sciences in medicine, University of Michigan, 2800 Plymouth Road, Bldg. 14, G016, Ann Arbor, MI 48109-2800, USA
| | - Williams Ieystn
- School of Social Policy, HSMC, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK
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Razavi S, Noorulhuda M, Marcela Velez C, Kapiriri L, Dreyse BA, Danis M, Essue B, Goold SD, Nouvet E, Williams I. Priority setting for pandemic preparedness and response: A comparative analysis of COVID-19 pandemic plans in 12 countries in the Eastern Mediterranean Region. HEALTH POLICY OPEN 2022; 3:100084. [PMID: 36415539 PMCID: PMC9673227 DOI: 10.1016/j.hpopen.2022.100084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background The COVID-19 pandemic has significantly disrupted health systems and exacerbated pre-existing resource gaps in the Eastern Mediterranean Region (WHO-EMRO). Active humanitarian and refugee crises have led to mass population displacement and increased health system fragility, which has implication for equitable priority setting (PS). We examine whether and how PS was included in national COVID-19 pandemic plans within EMRO. Methods An analysis of COVID-19 pandemic response and preparedness planning documents from a sample of 12/22 countries in WHO-EMRO. We assessed the degree to which documented PS processes adhere to twenty established quality parameters of effective PS. Results While all reviewed plans addressed some aspect of PS, none included all quality parameters. Yemen's plan included the highest number (9) of quality parameters, while Egypt's addressed the lowest (3). Most plans used evidence in their planning processes. While no plans explicitly identify equity as a criterion to guide PS; many identified vulnerable populations - a key component of equitable PS. Despite high concentrations of refugees, migrants, and IDPs in EMRO, only a quarter of the plans identified them as vulnerable. Conclusion PS setting challenges are exacerbated by conflict and the resulting health system fragmentation. Systematic and quality PS is essential to tackle long-term health implications of COVID-19 for vulnerable populations in this region, and to support effective PS and equitable resource allocation.
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Affiliation(s)
- S.Donya Razavi
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | - Mariam Noorulhuda
- Department of Bioethics, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20812, USA
| | - C. Marcela Velez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | | | - Marion Danis
- Department of Bioethics, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20812, USA
| | - Beverly Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada
| | - Susan D. Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Road Building 14, G016, Ann Arbor, MI 48109, USA
| | - Elysée Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, 40 Edgbaston Park Road, Birmingham B15 2RT, UK
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Kapiriri L, Kiwanuka S, Biemba G, Velez C, Razavi SD, Abelson J, Essue B, Danis M, Goold S, Noorulhuda M, Nouvet E, Sandman L, Williams I. Priority Setting and Equity in COVID-19 Pandemic Plans: A Comparative Analysis of eighteen African Countries. Health Policy Plan 2021; 37:297-309. [PMID: 34545395 PMCID: PMC8500007 DOI: 10.1093/heapol/czab113] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/27/2021] [Accepted: 09/20/2021] [Indexed: 12/16/2022] Open
Abstract
Priority setting represents an even bigger challenge during public health emergencies than routine times. This is because such emergencies compete with routine programmes 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 provides important insights into what and how priority decisions were made in the context of a pandemic. Specifically, with a focus on a sample of 18 African countries’ pandemic plans, the paper aims to: (1) explore the degree to which the documented priority setting processes adhere to established quality indicators of effective priority setting and (2) 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 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.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | - Lars Sandman
- Sweden and the Swedish Department of Priority Setting, Linköping University
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