Date of Award

12-2023

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Ahsana Nazish

Second Advisor

Muhammad Asim

Third Advisor

Waqas Hameed

Department

Community Health Sciences

Abstract

BACKGROUND: Priority-setting is a key component of health-related policymaking. Priority-setting is one of the most challenging tasks for stakeholders and policymakers worldwide, but even more so for those in low-and middle-income countries (LMICs). The level of priority accorded to public health initiatives by international and national stakeholders can differ significantly and little is known about the sources of variance in priority levels afforded to health initiatives, primarily due to inadequate research on this subject. Using the Polio Eradication Initiative (PEI) as a case study, this research seeks to delve into the process of priority-setting and discern the key factors influencing its direction in Pakistan.
METHODS: This qualitative study adopted key-informant interviews and document review as methods of data collection. The study recruited participants using purposive sampling technique to garner a wide array of perspectives from a diverse group of stakeholders spread across the globe. The semi-structured guide was guided by Shiffman and Smith’s framework for priority[1]setting, consisting of four domains: (i) the strength of the actors involved in the initiative, (ii) the power of ideas they use to portray the issue, (iii) the nature of the political contexts in which they operate, and (iv) characteristics of the issue itself. The comprehensive review of documents from multiple sources was done to first grasp the commitments articulated within the policies related to Polio Eradication Initiative and secondly, seeking to pinpoint evidence 8 and contextual factors used to underpin the decisions regarding priority-setting of the program.
RESULT: The findings revealed that there is a notable deficiency in the technical expertise required for effective priority-setting at the national level. Global actors significantly influenced the prioritization of public health programs by providing financial and technical support, and research funding, leading to a focus on programs of international rather than national interest. The absence of proper accountability measures, such as checks, clear standards, and technical capabilities to monitor adherence to set priorities make it difficult to hold individuals or entities accountable for the follow-through of these priorities. Moreover, most participants agreed that the distinct characteristics of the Polio virus make it a suitable target for eradication, justifying its high priority. Participants suggested that in Pakistan, the prioritization of health initiatives should ideally be steered by key organizations including the Ministry of Health and various advisory committees in a legitimate and inclusive manner. Yet, the process often fell short due to limited technical capacity, funding issues, and reliance on donor support, leading to disorganized and sometimes contradictory program prioritization.
CONCLUSION: The prioritization of health programs in Pakistan faces challenges due to institutional constraints and dependency on external funding, which undermines the effectiveness of established decision-making processes and leads to inconsistent program prioritization. Global governance structures, particularly the role of international bodies like the WHO, have significantly influenced Pakistan's health priority agenda.

First Page

1

Last Page

75

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