Prioritization of investments in reproductive, women's and children's health: evidence-based recommendations for low and middle income countries in Asia and the Pacific - a subnational focus

Abstract

In the pursuit to take forward the Global Strategy for Women’s and Children’s Health and accelerate progress toward Millennium Development Goals 4 and 5 in Asia and the Pacific, there is ample evidence on what should be done and why investments in Reproductive, Maternal, Neonatal and Child Health (RMNCH) are, or should be, national priorities. However, there is scant evidence on best practice approaches to prioritizing the investment in RMNCH, and implementation of health system strategies to improve the health of women and children, which remains a challenge for many countries in the region.In decentralized systems, which make up the vast majority in the region, prioritization usually takes place at different levels. Decision-making on the content of the benefits package, that is, which health interventions may be financed with public monies are usually taken by national authorities (macro-level or national priority setting). The difficult task of deciding how to deliver the benefits package, that is, the actual mix of providers (public and private), programs, resources, and strategies, usually rests on the shoulders of state, provincial and even district authorities (meso-level or subnational priority setting). Evidence-based recommendations were recently made for low and middle income countries (LMICs) to improve the process of prioritizing health interventions at national level (Glassman et al., 2012). However, scarce evidence exists to guide subnational authorities in their prioritization exercises.The primary aim of this exercise is therefore to provide evidence-based recommendations to inform decisions by subnational authorities on how to prioritize service delivery investments in RMNCH in Asia and the Pacific. For this purpose we undertook a review of the available evidence on priority setting for health in both the published and the grey literature during the last 10 years. Although our primary focus was on priority setting at the subnational level, we also examined the more extensive literature on macro-level priority setting to identify lessons learned.