Priority setting

优先级设置
  • 文章类型: Journal Article
    A follow up to an online questionnaire survey (in a kind of a sequential study design), qualitative assessment was made on the views of selected animal health experts on disease prioritization methods, resource allocation and use of decision-support tools. This was done through in-depth interviews with experts working for national or international organizations and sectors. A semi-structured question guide was formulated based on the information generated in the online questionnaire and a systematic content analysis of animal and human health manuals for disease prioritization and resource allocation. In-depth, one-on-one, online interviews on the process of disease prioritization, animal health decision-making, types of prioritization tools and aspects of improvements in the tools were conducted during March and April 2022 with 20 expert informants. Prioritization approaches reported by experts were either single criterion-based or multiple criteria-based. Experts appreciated the single-criterion-based approach (quantitative) for its objectivity in contrast to multicriteria prioritization approaches which were criticized for their subjectivity. Interviews with the experts revealed a perceived lack of quality and reliable data to inform disease prioritization, especially in smallholder livestock production systems. It was found that outputs of disease prioritization exercises do not generally directly influence resource allocation in animal health and highlighted the paucity of funding for animal health compared to other agricultural sectors. The experts considered that the available decision-support tools in animal health need improvement in terms of data visualization for interpretation, management decision making and advocacy. Further recommendations include minimizing subjective biases by increasing the availability and quality of data and improving the translation of disease prioritization outputs into actions and the resources to deliver those actions. DATA AVAILABILITY STATEMENT: The data can be obtained from the corresponding author upon request.
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  • 文章类型: Journal Article
    在受危机和冲突影响的国家,孕产妇和新生儿死亡率过高。这项研究旨在了解影响可持续发展目标(SDG)时代人道主义和脆弱环境中的MNH在全球卫生议程中的优先地位的因素。这包括审查推动议程制定和决策的政策和进程,以及全球行为者的看法。它进一步反映了全球里程碑的作用,reports,召集人,和高级冠军,基于全球优先排序导致更多关注和资源分配的前提,最终有助于改善受危机影响地区的母亲和新生儿的结局。
    一项从2022年4月至2023年6月进行的定性研究,采用案头审查和23次半结构化关键线人采访来自捐助机构的全球行为者,实施组织,研究机构,联合国机构,专业协会,和联盟,主要位于全球北部。使用归纳主题分析对数据进行分析,并以Walt和Gibson健康政策三角框架为指导进行研究。
    与会者认为,MNH的全球议程制定和投资决策主要由联合国机构推动,捐助者,以及在全球范围内实施组织。尽管千年发展目标时代成功地将MNH列为优先事项,在可持续发展目标期间,这一重点已经减弱,尤其是HFS。确定的障碍包括在这些情况下降低死亡率的复杂性,政治意愿有限,MNH投资疲劳,喜欢快速获胜。人道主义和发展部门之间的分裂以及长期危机中任务规定不明确也阻碍了进展。如果没有加强全球宣传,问责制,以及对HFS的定向投资,受访者认为全球MNH目标无法实现。
    虽然捐助者兴趣的减弱和HFS在全球MNH决策中的孤岛化带来了挑战,解决这些障碍的有针对性的行动可能包括在全球MNH会议中为人道主义行为者指定配额,发展传达共同利益的共享信息,并采用公平的镜头。在全球议程上优先考虑HFS中的MNH要求持续承诺,通过专门的宣传和问责制,确保这些环境不是事后的想法,高层政治活动,全球里程碑,并利用机会来吸引主流兴趣。未能改变全球优先事项将导致整个HFS的MNH结果持续停滞和恶化。
    UNASSIGNED: Maternal and newborn mortality rates are disproportionately high in crisis and conflict-affected countries. This study aims to understand factors influencing how MNH in humanitarian and fragile settings (HFS) is prioritized on the global health agenda during the Sustainable Development Goal (SDG) era. This includes examining the policies and processes driving agenda setting and decision-making, as well as the perceptions of global actors. It further reflects on the role of global milestones, reports, convenings, and high-level champions, based on the premise that global prioritization leads to increased attention and resource allocation, ultimately contributing to improved outcomes for mothers and newborns in crisis-affected areas.
    UNASSIGNED: A qualitative study conducted from April 2022 to June 2023, employing a desk review and 23 semi-structured key informant interviews with global actors from donor agencies, implementing organizations, research institutes, United Nations agencies, professional associations, and coalitions, predominantly based in the Global North. Data were analyzed using inductive thematic analysis and the research was guided by the Walt and Gibson Health Policy Triangle framework.
    UNASSIGNED: Participants believe that global agenda-setting and investment decisions for MNH are primarily driven by UN agencies, donors, and implementing organizations at the global level. Although the Millennium Development Goal era successfully prioritized MNH, this focus has diminished during the SDGs, especially for HFS. Identified barriers include the complexity of reducing mortality rates in these contexts, limited political will, MNH investment fatigue, and a preference for quick wins. Fragmentation between humanitarian and development sectors and unclear mandates in protracted crises also hinder progress. Without enhanced global advocacy, accountability, and targeted investments in HFS, respondents deem global MNH targets unattainable.
    UNASSIGNED: While waning donor interest and the siloing of HFS in global MNH decision-making pose challenges, targeted actions to address these barriers may include designating quotas for humanitarian actors in global MNH convenings, developing shared messages that convey common interests, and adopting an equity lens. Prioritizing MNH in HFS on the global agenda demands sustained commitment to ensure these settings are not an afterthought through dedicated advocacy and accountability, high-level political engagements, global milestones, and by leveraging opportunities to capture mainstream interest. Failing to shift global priorities will result in continued stagnation and worsening MNH outcomes across HFS.
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  • 文章类型: Journal Article
    本研究旨在开发和应用一种结构化的方法来优先考虑公共卫生系统评价的主题,根据随时适用的PICO格式构建框架,这鼓励利益相关者的偏好参与一个透明的问题。
    我们开发了一个多阶段工艺,包括范围界定和两个Delphi阶段,进行基于网络的调查,并邀请瑞士的公共卫生利益相关者参与:首先,受访者为不同的公共卫生领域指定了主题,通过内容分析以PICO格式重新表述。第二,受访者使用五个利益相关者完善的评估标准对主题进行了评级。计算总体排名以评估利益相关者群体和评级标准之间的差异。
    总共,215名受访者总共提出了728个主题。两个Delphi阶段的有效率分别为91.6%和77.6%,分别。最受好评的审查主题集中在为不同目标群体提供教育的干预措施的有效性上,其次是增加获得特定医疗保健服务的干预措施。
    我们的方法鼓励利益相关者参与确定系统审查的优先事项,并强调利益相关者之间以及个人标准之间的差异。
    UNASSIGNED: This study aimed to develop and apply a structured approach for prioritising topics for systematic reviews in public health, framed according to the readily applicable PICO format, which encourages the involvement of stakeholders\' preferences in a transparent matter.
    UNASSIGNED: We developed a multi-stage process, consisting of a scoping and two Delphi stages with web-based surveys and invited public health stakeholders in Switzerland to participate: First, respondents specified topics for different public health domains, which were reformulated in a PICO format by content analysis. Second, respondents rated the topics using five stakeholder-refined assessment criteria. Overall rankings were calculated to assess differences between stakeholder groups and rating criteria.
    UNASSIGNED: In total, 215 respondents suggested 728 topics altogether. The response rate in the two Delphi stages was 91.6% and 77.6%, respectively. Most top-rated review topics focused on the effectiveness of interventions providing education to different target groups, followed by interventions to increase access to specific healthcare services.
    UNASSIGNED: Our approach encourages involvement of stakeholders in identifying priorities for systematic reviews and highlights disparities between stakeholders and between individual criteria.
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  • 文章类型: Journal Article
    COVID-19大流行迫使世界各国政府考虑如何优先分配资源。大多数国家制定了大流行防备计划,指导和协调医疗保健,包括如何分配稀缺资源,如呼吸机,人力资源,和治疗学。这项研究的目的是比较和对比世界上几个国家将有效优先级设置(PS)的既定参数纳入COVID-19大流行应对计划的程度。
    我们使用Kapriri和Martin框架进行了有效的优先级设置,并进行了定量描述性分析,以探讨国家/地区类型的卫生系统是否以及如何,政治,和经济环境影响了将这些参数纳入其COVID-19大流行计划。我们分析了世界卫生组织六个地区的86个国家计划。
    抽样的国家占AFRO国家的40%,EMRO的54.5%,欧元的45%,46%的泛美卫生组织,64%的SEARO,和41%的WPRO。它们还占全球所有HIC的39%,39%的中上层,54%的中低端,和48%的LIC。世卫组织区域或国家收入水平没有出现关注PS参数的模式。参数:政治意愿的证据,利益相关者的参与,在超过80%的计划中发现了使用科学证据/采纳世卫组织建议的情况。我们在7%的计划中确定了对特定PS流程的描述;在36.5%中明确了PS标准;在65%中纳入了宣传策略;在20%中提到了上诉决定或实施程序以改善内部问责制并减少腐败的机制;在15%中明确提及了公共价值;在5%中描述了增强对决定的遵守的手段。
    调查结果为决策者反思其优先次序计划并确定需要加强的领域提供了基础。总的来说,很少考虑明确的优先程序和工具,并且对公平考虑的关注有限;这可能是对改善未来准备和应对计划感兴趣的政策制定者的起点。尽管这项研究集中在COVID-19大流行上,优先级设置仍然是政策制定者最突出的挑战之一。政策制定者应考虑将系统的优先级设置纳入其常规决策过程。
    UNASSIGNED: The COVID-19 pandemic forced governments across the world to consider how to prioritize resource allocation. Most countries produced pandemic preparedness plans that guide and coordinate healthcare, including how to allocate scarce resources such as ventilators, human resources, and therapeutics. The objective of this study was to compare and contrast the extent to which established parameters for effective priority setting (PS) were incorporated into COVID-19 pandemic response planning in several countries around the world.
    UNASSIGNED: We used the Kapriri and Martin framework for effective priority setting and performed a quantitative descriptive analysis to explore whether and how countries\' type of health system, political, and economic contexts impacted the inclusion of those parameters in their COVID-19 pandemic plans. We analyzed 86 country plans across six regions of the World Health Organization.
    UNASSIGNED: The countries sampled represent 40% of nations in AFRO, 54.5% of EMRO, 45% of EURO, 46% of PAHO, 64% of SEARO, and 41% of WPRO. They also represent 39% of all HICs in the world, 39% of Upper-Middle, 54% of Lower-Middle, and 48% of LICs. No pattern in attention to parameters of PS emerged by WHO region or country income levels. The parameters: evidence of political will, stakeholder participation, and use of scientific evidence/ adoption of WHO recommendations were each found in over 80% of plans. We identified a description of a specific PS process in 7% of the plans; explicit criteria for PS in 36.5%; inclusion of publicity strategies in 65%; mention of mechanisms for appealing decisions or implementing procedures to improve internal accountability and reduce corruption in 20%; explicit reference to public values in 15%; and a description of means for enhancing compliance with the decisions in 5%.
    UNASSIGNED: The findings provide a basis for policymakers to reflect on their prioritization plans and identify areas that need to be strengthened. Overall, there is little consideration for explicit prioritization processes and tools and restricted attention to equity considerations; this may be a starting point for policymakers interested in improving future preparedness and response planning. Although the study focused on the COVID-19 pandemic, priority setting remains one of the policymakers\' most prominent challenges. Policymakers should consider integrating systematic priority setting in their routine decision-making processes.
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  • 文章类型: Journal Article
    背景:卫生政策和系统研究(HPSR)是一种生成卫生系统和政策级证据的多学科方法。设置HPSR议程被认为是绘制和确定政策和具有成本效益的研究课题的有效策略,但是它在发展中国家的实践是有限的。本文旨在在埃塞俄比亚进行一项合作的卫生政策和系统研究优先事项设定工作。
    方法:世界卫生组织的计划,工具,发布,并使用评估(PIPE)框架和Delphi技术进行优先级设置练习。PIPE模型用于引导从计划到评估的优先级设置过程,而Delphi技术用于进行评级和排名练习,目的是达成共识。在HPSR议程设置中使用了两轮专家小组研讨会,并辅以在线调查,评级和排名目的。使用世卫组织卫生系统构建模块作为基础框架,以确定和优先考虑HPSR主题。
    结果:在8个主题下,确定了32个子主题和182个HPSR主题。确定的研究主题包括领导力管理和治理,卫生政策,健康信息系统,医疗保健融资,卫生人力资源,医疗产品和供应,服务交付和交叉问题。
    结论:确定了重点关注国家健康优先问题的优先HPSR主题。已确定的主题已与决策者以及学术和研究机构共享。确定的优先主题的证据生成将指导未来的研究工作,并改善循证决策实践,卫生系统绩效和国家卫生目标和指标。
    BACKGROUND: Health policy and systems research (HPSR) is a multi-disciplinary approach of generating health system and policy-level evidence. Setting HPSR agendas is considered as an efficient strategy to map and identify policy and cost-effective research topics, but its practice in developing countries is limited. This paper aimed to conduct a collaborative health policy and system research priority-setting exercise in Ethiopia.
    METHODS: The WHO\'s plan, implement, publish, and evaluate (PIPE) framework and the Delphi technique were used to conduct the priority-setting exercise. The PIPE model was used to lead the priority-setting process from planning to evaluation, while the Delphi technique was used to run the rating and ranking exercise with the aim of reaching a consensus. Two rounds of expert panel workshops supplemented with an online survey were used for the HPSR agenda setting, rating and ranking purposes. Groups were formed using the WHO health system building blocks as a base framework to identify and prioritize the HPSR topics.
    RESULTS: Under 8 themes, 32 sub-themes and 182 HPSR topics were identified. The identified research themes include leadership management and governance, health policy, health information system, healthcare financing, human resource for health, medical products and supply, service delivery and cross-cutting issues.
    CONCLUSIONS: Priority HPSR topics focussing on national health priority issues were identified. The identified topics were shared with policymakers and academic and research institutions. Evidence generation on the identified priority topics will guide future research endeavours and improve evidence-informed decision-making practice, health system performance and national health goals and targets.
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  • 文章类型: Journal Article
    以前关于自闭症研究的社区优先事项的研究受到自闭症患者代表性低的限制,因此偏向于家庭和专业人士的观点。我们旨在确定新西兰奥特罗阿(NZ)自闭症研究的第一个社区主导的优先事项。
    自闭症患者是该项目的重要合作伙伴,从开始和设计到方法和产出。我们收集了自闭症和自闭症社区(包括家庭,从业者,和研究人员)通过焦点小组(n=55)和在线调查(n=450)。几乎40%的受访者表示他们患有自闭症。
    焦点小组和调查的发现强调了集中自闭症患者经验和需求的研究的重要性,特别是自闭症新西兰人,包括针对毛利人和太平洋人民的文化特定研究。自闭症成年人的所有五个优先主题也是至少一个其他组的优先主题:(1)健康,心理健康,和自闭症患者(所有群体)的福祉;(2)终生服务(自闭症成年人,卫生保健/残疾,和教育从业者);(3)新西兰奥特罗阿自闭症患者的需求(自闭症成年人,whhānau);(4)具有各种支持需求的自闭症患者(自闭症成年人;教育从业者)的观点;(5)新西兰奥特罗阿自闭症患者的生活质量(自闭症成年人;医疗保健/残疾从业者)。
    我们讨论了自闭症患者参与研究的优势,以及这些社区优先事项如何为新西兰未来的研究和政策提供信息。
    为什么这是一个重要的问题?以前没有自闭症和自闭症社区确定的Aotearoa新西兰自闭症研究重点。新西兰(NZ)的人口特征和社会文化背景是独一无二的。这项研究的目的是什么?我们想找出自闭症和自闭症社区认为未来自闭症研究应该关注的重点。研究人员做了什么?自闭症患者是这个项目的重要合作伙伴,并为设计做出了贡献,方法,和输出。我们对自闭症患者和更广泛的自闭症社区成员(家庭,从业者,和研究人员)在新西兰。在焦点小组中,我们询问了55人,他们认为新西兰未来的自闭症研究应该关注什么。三名研究人员(一名自闭症患者和两名非自闭症患者)分析了焦点组数据。他们阅读焦点小组的书面成绩单。然后,他们多次会面,谈论他们认为的想法是什么,并就最终的想法(主题)达成一致。在在线调查中,我们要求450人评价不同的自闭症研究主题对他们的重要性。为了分析调查数据,两位研究人员研究了每个自闭症研究课题对不同社区群体的重要性,包括自闭症成年人,家庭,从业者,和研究人员。研究结果如何?结果显示,社区认为未来的自闭症研究应该关注自闭症患者的经历,特别是自闭症新西兰人。社区成员还认为,有针对新西兰的自闭症研究很重要,包括针对毛利人和太平洋人民的文化特定研究。自闭症成年人被评为最重要的五个主题也是自闭症社区中至少一个其他人群的优先事项(例如,从业者)。健康,心理健康,自闭症患者的幸福是所有群体的优先主题。这些发现对我们已经知道的事情有什么补充?这些发现告诉我们自闭症成年人认为什么对新西兰未来的自闭症研究很重要。研究结果还向我们展示了自闭症成年人认为对未来自闭症研究重要的东西之间的异同,以及更广泛的自闭症社区中的其他人认为什么很重要。这项研究的潜在弱点是什么?焦点小组和在线调查可能并不适合所有愿意参加的人。所以我们可能错过了一些人的意见。这些发现将如何帮助现在或将来的自闭症成年人?我们已经确定了对自闭症患者和更广泛的自闭症社区对未来自闭症研究的重要意义。我们可以利用这些信息为新西兰未来的自闭症研究提供信息。资助机构可以使用这些信息来告知他们有关自闭症研究资助的决定。我们希望我们将自闭症成年人纳入这个项目的方式也能启发新西兰的其他自闭症研究,这将使自闭症研究更合适,相关,和道德。
    UNASSIGNED: Previous studies of community priorities for autism research have been limited by low representation of autistic people and thus a bias toward the views of families and professionals. We aimed to determine the first community-led priorities for autism research in Aotearoa New Zealand (NZ).
    UNASSIGNED: Autistic people were essential partners in the project, from inception and design through to methods and outputs. We gathered the views of the autistic and autism communities (including family, practitioners, and researchers) through focus groups (n = 55) and an online survey (n = 450). Almost 40% of the survey respondents indicated that they were autistic.
    UNASSIGNED: The findings across the focus groups and survey highlighted the importance of research that centralizes the experiences and needs of autistic people, particularly of autistic New Zealanders, including culturally specific research for Māori and Pacific peoples. All five priority topics for autistic adults were also priorities for at least one other group: (1) Health, mental health, and well-being of autistic people (all groups); (2) Services across the life span (autistic adults, health care/disability, and education practitioners); (3) Needs of autistic people in Aotearoa NZ (autistic adults, whānau); (4) Perspectives from autistic people with a diverse range of support needs (autistic adults; education practitioners); (5) Quality of life of autistic people in Aotearoa NZ (autistic adults; health care/disability practitioners).
    UNASSIGNED: We discuss the advantages of autistic involvement in research, and how these community priorities can inform future research and policy in NZ.
    Why is this an important issue? There are no previous autism research priorities for Aotearoa New Zealand that have been determined by the autistic and autism communities. The population characteristics and social and cultural context of Aotearoa New Zealand (NZ) are unique. What was the purpose of this study? We wanted to find out what the autistic and autism communities think future autism research should focus on. What did the researchers do? Autistic people were essential partners in this project and contributed to the design, methods, and outputs. We carried out focus groups and an online survey of autistic people and members of the broader autism community (family, practitioners, and researchers) in NZ. In the focus groups, we asked 55 people what they thought future autism research in NZ should focus on. Three researchers (one autistic and two non-autistic) analyzed the focus group data. They read the written transcripts of the focus groups. Then, they met multiple times to talk about what they thought the ideas were and agree on the final ideas (themes). In the online survey, we asked 450 people to rate how important different autism research topics were to them. To analyze the survey data, two researchers looked at how important each autism research topic was for different community groups, including autistic adults, family, practitioners, and researchers. What were the results of the study? The results showed that the community thought future autism research should focus on the experiences of autistic people, particularly of autistic New Zealanders. Community members also thought that it was important that there is autism research that is specific to NZ, including culturally specific research for Māori and Pacific peoples. The five topics rated as most important by autistic adults were also priorities for at least one other group of people from the autism community (e.g., practitioners). Health, mental health, and well-being of autistic people was a priority topic for all groups. What do these findings add to what was already known? These findings tell us what autistic adults think is important for future autism research in NZ to focus on. The findings also show us the similarities and differences between what autistic adults think is important for future autism research, and what other people in the broader autism community think is important. What are the potential weaknesses in the study? The focus groups and online survey may not have been accessible to everyone who would like to take part. So we may have missed the opinion of some people. How will these findings help autistic adults now or in the future? We have determined what is important to autistic people and the broader autism community for future autism research. We can use this information to inform future autism research in NZ. Funding bodies can use this information to inform their decisions about funding for autism research. We hope that the way we included autistic adults in this project will also inspire other autism research in NZ, which will make autism research more appropriate, relevant, and ethical.
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  • 文章类型: Journal Article
    2030年可持续发展目标(SDG)议程致力于“确保没有人掉队”。在当今关于移民治理和融合的高度两极化的政治话语中,应用非公民和国际移民的健康权具有挑战性。我们探讨了优先级设置方法的作用,以帮助更好地支持,在移民健康方面制定更公平、更透明的政策。确定优先事项的方法还必须纳入移徙保健,以更有效和公平地分配稀缺资源。明确承认权衡取舍是战略规划的一部分,会在危机期间规避临时决策,不适合公平。围绕扩大向移民或移民分组提供服务的决定进行的讨论,哪些服务和对谁应该是透明和公平的。我们得出的结论是,通过与决策者在逐步实现移民健康方面面临的实际挑战更加紧密地保持一致,确定优先事项的方法可以帮助更好地为政策制定提供信息。
    The 2030 Sustainable Development Goals (SDG) agenda has committed to \'ensuring that no one is left behind\'. Applying the right to health of non-citizens and international migrants is challenging in today\'s highly polarized political discourse on migration governance and integration. We explore the role of a priority setting approach to help support better, fairer and more transparent policy making in migration health. A priority setting approach must also incorporate migration health for more efficient and fair allocation of scarce resources. Explicitly recognizing the trade-offs as part of strategic planning, would circumvent ad hoc decision-making during crises, not well-suited for fairness. Discussions surrounding decisions about expanding services to migrants or subgroups of migrants, which services and to whom should be transparent and fair. We conclude that a priority setting approach can help better inform policy making by being more closely aligned with the practical challenges policy makers face towards the progressive realization of migration health.
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  • 文章类型: Introductory Journal Article
    为了实现全民健康覆盖,各国总是面临着用公共资金支付哪些服务的问题,给谁,以什么代价。这种确定优先级的过程对所提供护理的成本和收益产生重大影响。这些过程不仅仅是技术性的,而且具有高度的政治性和组织性以及社会价值观的表达。本特刊侧重于建立机构以确定卫生优先事项。这些机构服务于公共目的,主要关注进行或使用卫生技术评估(HTA)来指导资源分配决策。我们首先定义卫生优先设置机构的概念以及评估和评估这些机构的方法考虑因素。接下来,我们提出关键的共同主题,并总结文章中的关键信息,包括在建立这些机构方面吸取的经验教训和未来的挑战。
    In the pursuit of universal health coverage, countries are invariably confronted with questions about which services to pay with public funds, to whom, and at what cost. Such priority-setting processes have major ramifications for the costs and benefits of care delivered. These processes are not just technical, but also highly political and organizational in nature and expressions of social values. This special issue focuses on building institutions for priority setting in health. These institutions serve a public purpose and are primarily concerned with conducting or using health technology assessment (HTA) to inform resource allocation decisions. We first define the concept of institutions for priority setting in health and the methodological considerations of assessing and evaluating these institutions. Next, we present key common themes and summarize key messages across the articles, including lessons learned and future challenges in building these institutions.
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  • 文章类型: Journal Article
    背景:疾病控制优先事项3(DCP3)项目为巴基斯坦制定和实施其全民健康覆盖基本卫生服务包(UHC-EPHS)提供了长期支持。本文报告了2019-2020年期间EPHS设计中使用的优先级设置过程,采用了循证审议过程(EDP)的框架,一个确定优先事项的工具,其明确目的是优化制定健康福利一揽子计划的决策合法性。
    方法:我们在荷兰的两次研讨会上计划了框架的六个步骤,参与者来自所有DCP3巴基斯坦合作伙伴(2019年10月和2020年2月),他们在2019年和2020年在巴基斯坦国家一级实施了这些措施。实施后,我们进行了一项半结构化的在线调查,以收集UHC福利包设计参与者对优先程序的意见。
    结果:EDP框架中的关键步骤是建立咨询委员会(涉及多个技术工作组[TWG]和国家咨询委员会[NAC]的150多名成员),决策标准的定义(有效性,成本效益,可避免的疾病负担,股本,金融风险保护,预算影响,社会经济影响和可行性),选择评估干预措施(共170种),以及这些干预措施的评估和评价(跨越UHC立方体的三个维度)。调查答复者在优先事项确定过程的几个方面总体上是积极的。
    结论:尽管面临一些挑战,包括由于COVID-19大流行造成的部分中断,通过让利益攸关方参与审议,实施优先事项确定过程可能提高了决策的合法性,证据知情和透明。吸取了重要的经验教训,这些经验教训可能有益于其他国家设计自己的健康福利一揽子计划,例如关于广泛利益攸关方参与的选择和局限性。
    BACKGROUND: The Disease Control Priorities 3 (DCP3) project provides long-term support to Pakistan in the development and implementation of its universal health coverage essential package of health services (UHC-EPHS). This paper reports on the priority setting process used in the design of the EPHS during the period 2019-2020, employing the framework of evidence-informed deliberative processes (EDPs), a tool for priority setting with the explicit aim of optimising the legitimacy of decision-making in the development of health benefit packages.
    METHODS: We planned the six steps of the framework during two workshops in the Netherlands with participants from all DCP3 Pakistan partners (October 2019 and February 2020), who implemented these at the country level in Pakistan in 2019 and 2020. Following implementation, we conducted a semi-structured online survey to collect the views of participants in the UHC benefit package design about the prioritisation process.
    RESULTS: The key steps in the EDP framework were the installation of advisory committees (involving more than 150 members in several Technical Working Groups [TWGs] and a National Advisory Committee [NAC]), definition of decision criteria (effectiveness, cost-effectiveness, avoidable burden of disease, equity, financial risk protection, budget impact, socio-economic impact and feasibility), selection of interventions for evaluation (a total of 170), and assessment and appraisal (across the three dimensions of the UHC cube) of these interventions. Survey respondents were generally positive across several aspects of the priority setting process.
    CONCLUSIONS: Despite several challenges, including a partial disruption because of the COVID-19 pandemic, implementation of the priority setting process may have improved the legitimacy of decision-making by involving stakeholders through participation with deliberation, and being evidence-informed and transparent. Important lessons were learned that can be beneficial for other countries designing their own health benefit package such as on the options and limitations of broad stakeholder involvement.
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  • 文章类型: Journal Article
    背景:设计健康福利一揽子计划(HBP)以支持实现全民健康覆盖(UHC)的国家需要强有力的成本效益证据。本文报告了巴基斯坦评估全球成本效益证据对国家环境的适用性的方法,作为HBP设计过程的一部分。
    方法:与疾病控制优先事项3(DCP3)项目合作伙伴一起制定并实施了七步程序,以评估全球增量成本效益比(ICER)对巴基斯坦的适用性。首先,要评估的干预措施的范围是确定的,并且是独立的,跨学科团队成立。第二,团队熟悉干预描述。第三,研究小组确定了塔夫茨医学院全球健康成本效益分析(GH-CEA)注册研究.第四,研究小组应用特定的剔除标准,将已确定的研究与当地干预描述相匹配.然后在审阅者之间交叉检查匹配项,并在有多个ICER匹配项的情况下进行进一步选择。第六,对ICER值采用质量评分系统.最后,创建了一个数据库,其中包含ICER的所有结果,并为每个决定提供理由,在HBP审议期间提供给决策者。
    结果:我们发现,只有不到50%的DCP3干预措施可以得到适用于国家背景的成本效益证据的支持。在塔夫茨GH-CEA登记册中确定适用于巴基斯坦的78个ICER中,只有20个ICER与DCP3巴基斯坦干预描述完全匹配,58个为部分匹配.
    结论:本文首次尝试在全球范围内使用主要的公共GH-CEA数据库来估算国家HBPs背景下的成本效益。这种方法对于所有试图根据全球ICER数据库制定基本一揽子计划的国家来说都是有益的学习,它将支持未来证据的设计和方法的进一步发展。
    BACKGROUND: Countries designing a health benefit package (HBP) to support progress towards universal health coverage (UHC) require robust cost-effectiveness evidence. This paper reports on Pakistan\'s approach to assessing the applicability of global cost-effectiveness evidence to country context as part of a HBP design process.
    METHODS: A seven-step process was developed and implemented with Disease Control Priority 3 (DCP3) project partners to assess the applicability of global incremental cost-effectiveness ratios (ICERs) to Pakistan. First, the scope of the interventions to be assessed was defined and an independent, interdisciplinary team was formed. Second, the team familiarized itself with intervention descriptions. Third, the team identified studies from the Tufts Medical School Global Health Cost-Effectiveness Analysis (GH-CEA) registry. Fourth, the team applied specific knock-out criteria to match identified studies to local intervention descriptions. Matches were then cross-checked across reviewers and further selection was made where there were multiple ICER matches. Sixth, a quality scoring system was applied to ICER values. Finally, a database was created containing all the ICER results with a justification for each decision, which was made available to decision-makers during HBP deliberation.
    RESULTS: We found that less than 50% of the interventions in DCP3 could be supported with evidence of cost-effectiveness applicable to the country context. Out of 78 ICERs identified as applicable to Pakistan from the Tufts GH-CEA registry, only 20 ICERs were exact matches of the DCP3 Pakistan intervention descriptions and 58 were partial matches.
    CONCLUSIONS: This paper presents the first attempt globally to use the main public GH-CEA database to estimate cost-effectiveness in the context of HBPs at a country level. This approach is a useful learning for all countries trying to develop essential packages informed by the global database on ICERs, and it will support the design of future evidence and further development of methods.
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