Health priority-setting for ofcial development assistance in low-income and middle-income countries: a Best Fit Framework Synthesis study with primary data from Ethiopia, Nigeria and Tanzania

Abstract

Abstract Background: Decision making process for Ofcial Development Assistance (ODA) for healthcare sector in low income and middle-income countries involves multiple agencies, each with their unique power, priorities and fund‑ ing mechanisms. This process at country level has not been well studied. Methods: This paper developed and applied a new framework to analyze decision-making process for priority set‑ ting in Ethiopia, Nigeria, and Tanzania, and collected primary data to validate and refne the model. The framework was developed following a scoping review of published literature. Interviews were then conducted using a pre determined interview guide developed by the research team. Transcripts were reviewed and coded based on the framework to identify what principles, players, processes, and products were considered during priority setting. Those elements were further used to identify where the potential capacity of local decision-makers could be harnessed. Results: A framework was developed based on 40 articles selected from 6860 distinct search records. Twenty-one interviews were conducted in three case countries from 12 institutions. Transcripts or meeting notes were analyzed to identify common practices and specifc challenges faced by each country. We found that multiple stakeholders work‑ ing around one national plan was the preferred approach used for priority setting in the countries studied. Conclusions: Priority setting process can be further strengthened through better use of analytical tools, such as the one described in our study, to enhance local ownership of priority setting for ODA and improve aid efectiveness.