Priority setting in developing countries health care institutions: the case of a Ugandan hospital

This article, published by Health Services Research in BioMed Central, describes how priorities are set in a teaching hospital in Uganda and uses an ethical framework to evaluate whether this process is a fair one. In particular, it asks whether the process is accountable and reasonable. The article finds that priority is given to several factors including need, emergencies and the number of patients. Decisions are made by senior managers. These are publicised through general meetings and circulars, but this information does not always reach the front line practitioners. There are no formal mechanisms for challenging the reason of these decisions or mechanisms to ensure adherence to the conditions of a fair process.

The article concludes that priority setting at this hospital does not satisfy the conditions of fairness. The authors make some recommendations to improve priority setting in the hospital and other similar contexts. The hospital should engage front line practitioners, publicise the reasons for decisions both within the hospital and to the general public, and develop formal mechanisms for challenging the reasoning. In addition, capacity strengthening is required for senior managers who must accept responsibility for ensuring that these conditions are met. [adapted from authors]