Lydia Kapiriri

McMaster University | McMaster · Department of Health, Aging, and Society

Background The COVID-19 pandemic has significantly disrupted health systems and exacerbated pre-existing resource gaps in the Eastern Mediterranean Region (WHO-EMRO). Active humanitarian and refugee crises have led to mass population displacement and increased health system fragility, which has implication for equitable priority setting (PS). We ex...

Background The World Health Organization- South-East Asia Region (WHO-SEARO) accounted for almost 17% of all the confirmed cases and deaths of COVID-19 worldwide. While the literature has documented a weak COVID-19 response in the WHO-SEARO, there has been no discussion of the degree to which this could have been influenced/ mitigated with the inte...

The Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights include recommendations and protections for housing as a human right. The rising costs of housing has created difficulties for many individuals, particularly older adults/seniors. This study aimed to determine whether Ontario housing rel...

Black older adults’ (BOAs) experience of loneliness differs from other ethnic groups because of the disproportionate disadvantages faced across their life course. This scoping review aimed to describe the range of research on loneliness or subjective social isolation among BOAs, identifying the contributing factors to loneliness in this population,...

Background During the COVID-19 pandemic, the public health workforce has experienced re-deployment from core functions such as health promotion, disease prevention, and health protection, to preventing and tracking the spread of COVID-19. With continued pandemic deployment coupled with the exacerbation of existing health disparities due to the pand...

Globally, significant progress has been made in the realm of adolescent sexual and reproductive health. We conceptualised “last mile” adolescents as having two or more of the following factors of identity: refugee, Indigenous, 2SLGBTQIA+, out of school, rurally or remotely located, slum dwelling, incarcerated or previously incarcerated, HIV/AIDS in...

Background Latin America and the Caribbean (LAC) are among those regions most affected by the COVID-19 pandemic worldwide. The COVID-19 pandemic has strained health systems in the region. In this context of severe healthcare resource constraints, there is a need for systematic priority-setting to support decision-making which ensures the best use o...

Studies that assess the association between race and health have focused intently on the cumulative impact of continuous exposure to racism over an extended period. While these studies have contributed significantly to the general understanding of the life experiences and health status of racialized people, few studies have explicitly bridged the e...

Priority setting and health system governance are critical for optimising healthcare interventions and determining how best to allocate limited resources. The COVID-19 pandemic has buttressed the need for these especially now that vaccines are available to curb the spread of the disease. In many low- and middle-income countries (LMICs), vaccine cov...

Background During previous disease outbreaks, the World Health Organization developed a framework to guide national pandemic planning. The degree to which this framework supported the development of the current COVID-19 pandemic planning is not well understood. While there are opportunities for integrating priority setting in the four stages of the...

Priority setting during public health emergencies presents an enormous challenge for federal and state decision makers in the U.S. Objectives We describe the degree to which U.S. priority setting adheres to established quality indicators and explore relationships between such indicators and states’ demographic characteristics. Methods Data includ...

Background The COVID-19 pandemic has imposed a burden on all health systems budgets and pushed policymakers to rapidly set priorities for resource allocation. This study aimed to identify quality parameters of priority setting (PS) incorporated in a sample of the national response plans. Methods We reviewed a sample of COVID-19 national response p...

Background Forcibly displaced people represent a huge humanitarian problem globally. At the end of 2020, the total number was 82,4 million; from those, 34,4 million were refugees, asylum seekers, and Venezuelan displaced abroad. Forcibly displaced people were identified as priority populations during the pandemic due to their risk of being the last...

Background The COVID-19 pandemic has significantly disrupted health systems in the Eastern Mediterranean Region (WHO-EMRO), where over half of the countries are affected by armed conflict. Active humanitarian and refugee crises have led to mass population displacement and increased health system fragility. This has exacerbated pre-existing resource...

Introduction The COVID-19 pandemic has forced governments across Europe to consider how to prioritise the allocation of scarce resources. Many took decisions to increase funding for health services, and to redirect current fiscal, human and technical resource towards meeting the new threat. Methods We conducted document analysis of pandemic prepar...

Background The importance of stakeholder involvement in priority setting has been recognized in theoretical and empirical literature; however, there is a paucity of evidence reporting on stakeholder involvement in planning the response to public health emergencies. The COVID-19 pandemic provides an opportunity to explore how stakeholders are involv...

Background There is increasing acceptance of the importance of social values like equity and fairness in health care priority setting (PS). However, equity is difficult to define; it means different things to different people. How equity is understood in theory, may not align with how it is operationalized. There is limited literature on how develo...

Background There have been divergent approaches used by countries to curb and control the spread, impact and burden of COVID-19. While priority setting – defined as decision-making about the allocation of resources between competing claims of different services, populations and elements of care – is recognized as critical for promoting accountabili...

Background During the COVID-10 pandemic, governments worldwide were faced with priority setting challenges as the resource needs outpaced the available resources. Explicit criteria and ethical principles are recommended since they improve the consistency, transparency and the fairness of the priority setting and resource allocation processes. Obje...

Background There is increasing acceptance of the importance of social values such as equity and fairness in health care priority setting (PS). However, equity is difficult to define: the term means different things to different people, and the ways it is understood in theory often may not align with how it is operationalized. There is limited liter...

Stakeholders play an important role in health priority setting, and their roles have been discussed in the literature, mainly in relationship to their power. An emerging body of literature is focusing on the legitimacy of the stakeholders. Using the case of the Uganda health system, the overall aim of this paper is to assess the utility of the sali...

Background: Loneliness is a public and social issue affecting older adults, but in varying degrees across ethnic groups. Black older adults (BOAs) are more prone to loneliness because they have unique and accumulated factors (e.g., low socioeconomic status, high number of chronic conditions) that predispose them to loneliness. This review aims to d...

Background: Loneliness is a public and social issue affecting older adults, but in varying degrees across ethnic groups. Black older adults (BOAs) are more prone to loneliness because they have unique and accumulated factors (e.g., low socioeconomic status, high number of chronic conditions) that predispose them to loneliness. This review aims to d...

Background: Loneliness is a public and social issue affecting older adults, but in varying degrees across ethnic groups. Black older adults (BOAs) are more prone to loneliness because they have unique and accumulated factors (e.g., low socioeconomic status, high number of chronic conditions) that predispose them to loneliness. This review aims to d...

Priority setting represents an even bigger challenge during public health emergencies than routine times. This is because such emergencies compete with routine programs for the available health resources, strain health systems, and shift health care attention and resources towards containing the spread of the epidemic and treating those that fall s...

Rapid qualitative research (RQR) studies are increasingly employed to inform decision-making in public health emergencies. Despite this trend, there remains a lack of clarity around what these studies actually involve in terms of methodological processes and practical considerations or challenges. Our team conducted a global RQR study during the CO...

The COVID-19 pandemic, where the need-resource gap has necessitated decision makers in some contexts to ration access to life-saving interventions, has demonstrated the critical need for systematic and fair priority setting and resource allocation mechanisms. Disease outbreaks are becoming increasingly common and priority setting lessons from previ...

Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that migh...

Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that migh...

Background: Decentralization of healthcare decision-making in Uganda led to the promotion of public participation. To facilitate this, participatory structures have been developed at sub-national levels. However, the degree to which the participation structures have contributed to improving the participation of vulnerable populations, specifically...

Background: Over the years, several approaches to health research priority setting (HRPS) have been devised and applied in low-incomes countries for national level research prioritization. However, there is often a disconnect between the evidence that health policymakers require for decision-making and the research that receives funding. There is a...

Objectives Evidence-informed deliberative processes (EDPs) were introduced to guide health technology assessment (HTA) agencies to improve their processes toward more legitimate decision making. A survey among members of the International Network of Agencies for HTA (INAHTA) showed that EDPs can also be relevant for countries that have not (yet) es...

Health systems are critical to the realisation of Universal Health Coverage. There has been insufficient attention to the evaluation of priority setting for health system strengthening within low income countries, including evaluation of the local capacity to implement priorities. This study evaluated the extent to which health system strengthening...

Over the past few decades, disease outbreaks have become increasingly frequent and widespread. The epicenters of these outbreaks have differed, and could be linked to different economic contexts. Arguably, the responses to these outbreaks have been “political” and inherently burdensome to marginalized populations. Key lessons can be learned from ex...

Background: There is a growing body of literature on evidence-informed priority setting. However, the literature on the use of evidence when setting healthcare priorities in low-income countries (LICs), tends to treat the healthcare system (HCS) as a single unit, despite the existence of multiple programs within the HCS, some of which are donor su...

The purpose of this paper is to discuss the potential feasibility and utility of evidence-informed deliberative processes (EPDs) in low income country (LIC) contexts. EDPs are implemented in high and middle income countries and thought to improve the quality, consistency, and transparency of decisions informed by health technology assessment (HTA)....

Background: There is a growing body of literature that describes, applies, and evaluates applications of health-system priority-setting frameworks in different contexts. However, little explicit focus has been given to examining operationalization of the stakeholder participation component of these frameworks. The literature identifies the public...

Background Despite continued investment, Maternal, Newborn and Child Health (MNCH) indicators in low and middle income countries have remained relatively poor. This could, in part, be explained by inadequate resources to adequately address these problems, inappropriate allocation of the available resources, or lack of implementation of the most eff...

Stakeholder participation is relevant in strengthening priority setting processes for health worldwide, since it allows for inclusion of alternative perspectives and values that can enhance the fairness, legitimacy and acceptability of decisions. Low-income countries operating within decentralized systems recognize the role played by sub-national a...

Background While there has been progress in controlling the HIV epidemic, HIV still remains a disease of global concern. Some of the progress has been attributed to increased public awareness and uptake of public health interventions, as well as increased access to anti- retroviral treatment and the prevention of vertical HIV transmission. These in...

Priority-setting (PS) for health research presents an opportunity for the relevant stakeholders to identify and create a list of priorities that reflects the country’s knowledge needs. Zambia has conducted several health research prioritisation exercises that have never been evaluated. Evaluation would facilitate gleaning of lessons of good practic...

While there is increasing recognition of the importance of stakeholder involvement in health research priority setting there is a paucity of literature reporting on stakeholder involvement in health research priority setting in low income countries. This paper fills this gap by identifying and discussing the roles and legitimacy of different stakeh...

Priority setting (PS) and resource allocation during health emergencies are key factors influencing an effective response. However, there is limited understanding of how priorities and resource allocation during disease outbreaks occur and the extent to which these processes are successful. This paper, based on 23 in-depth interviews with policy ma...

Purpose Current conditions have intensified the need for health systems to engage in the difficult task of priority setting. As the search for a “magic bullet” is replaced by an appreciation for the interplay between evidence, interests, culture, and outcomes, progress in relation to these dimensions requires assessment of achievements to date and...

Background: The double burden of infectious diseases coupled with noncommunicable diseases poses unique challenges for priority setting and for achieving equitable action to address the major causes of disease burden in health systems already impacted by limited resources. Noncommunicable disease control is an important global health and developme...

Background Priority-setting for health research in low-income countries remains a major challenge. While there have been efforts to systematise and improve the processes, most of the initiatives have ended up being a one-off exercise and are yet to be institutionalised. This could, in part, be attributed to the limited capacity for the priority-set...

Background: There is a growing body of literature on systematic approaches to healthcare priority setting from various countries and different levels of decision making. This paper synthesizes the current literature in order to assess the extent to which program budgeting and marginal analysis (PBMA), burden of disease & cost-effectiveness analysi...

Background While there have been efforts to develop frameworks to guide healthcare priority setting; there has been limited focus on evaluation frameworks. Moreover, while the few frameworks identify quality indicators for successful priority setting, they do not provide the users with strategies to verify these indicators. Kapiriri and Martin (Hea...

Progress towards Universal Health Coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the WHO Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and...

There is limited literature on how donors conceptualise and prioritise evidence in healthcare priority setting (PS) affecting low income countries (LICs). We interviewed 35 donors and reviewed their websites to describe how they conceptualise, prioritise and perceive the role evidence plays in their organisation's healthcare prioritisation affectin...

Background: To date, research on priority-setting for new vaccines has not adequately explored the influence of the global, national and sub-national levels of decision-making or contextual issues such as political pressure and stakeholder influence and power. Using Kapiriri and Martin’s conceptual framework, this paper evaluates priority setting f...

Study/Objective To explore how policies and ethics inform each other, in order to better understand where problems arise in humanitarian healthcare organizations, and how policy can be improved in this regard. Background Researchers have just begun to understand the range of ways in which humanitarian healthcare organizations’ policies can shape e...

Background: The African, Caribbean and Black communities have been found to be reluctant to participate in health research in North America. This is partly attributed to historical experiences as well as their cultural beliefs. Cultural beliefs about the uses of breast milk/fluids could further hinder the participation of African, Caribbean, and B...

There’s evidence that implementing the four medical ethics principles may be challenging especially in low income country contexts with extreme resource scarcity and limited capacity to facilitate deliberations on the different ethical dilemmas. These challenges can partly be explained by the social, economic, and political contexts in which the de...

The goal of achieving Universal Health Coverage (UHC) can generally be realized only in stages. Moreover, resource, capacity and political constraints mean governments often face difficult trade-offs on the path to UHC. In a 2014 report, Making fair choices on the path to UHC, the WHO Consultative Group on Equity and Universal Health Coverage artic...

Background Priority setting in health research is an emerging field. In Zambia, like many other African countries, various priority setting activities have been undertaken with a view to identify research activities to which the available resources can be targeted while at the same time maximising the health impact for resource allocation to suppor...

Over 60 countries criminalise ‘the “willful” transmission of HIV’. Such a law has the potential to hinder public health interventions. There is limited literature discussing the perceptions of this law and the impact, it has had on HIV-positive women. This paper describes the knowledge of and attitudes of this law by HIV-positive women living in On...

New technologies have remarkably changed the healthcare field over the last three decades by improving the functionality and efficiency of health care systems and patient outcomes. However, if not well managed, new technologies present ethical challenges to clinicians globally but more so in low income countries (LICs) where there is lack of resour...

As part of the growing international consensus and commitments reflected in the World Health Assembly Resolution 64.9 on sustainable health financing structures and universal coverage, and the 12 December 2012 Resolution of the UN General Assembly on universal health coverage, many countries, especially low and middle income countries, have embarke...

This Guidance for Priority Setting in Health Care (GPS-Health), initiated by the World Health Organization, offers a comprehensive map of equity criteria that are relevant to health care priority setting and should be considered in addition to cost-effectiveness analysis. The guidance, in the form of a checklist, is especially targeted at decision...

Unlabelled: Mothers in HIV-endemic countries are advised to exclusively breastfeed their babies until six months because of lack of resources and better chances for child survival, while in developed countries, replacement feeding is advised. What are the experiences of HIV-positive women who migrate from HIV-endemic countries to developed countri...

Since 2010, more than seventy countries have requested policy support and technical advice from the World Health Organization (WHO) for how to move toward universal health coverage (UHC). As part of the response, WHO set up a Consultative Group on Equity and Universal Health Coverage. This final report by the Consultative Group addresses the ke...

The Essential Health Care Package (EHP) approach has been promoted as a tool for guiding priority setting (PS) in Low Income Countries (LICs). This approach was expected to improve PS by; (i) providing credible evidence, (ii) improving efficiency, (iii) making PS more transparent, explicit and objective, (iv) increasing public empowerment and accou...

Priority setting presents one of the biggest challenges policy makers in low-income countries have to deal with on a daily basis. Extreme lack of resources in these contexts introduces non-state stakeholders whose priorities may not necessarily reflect the national priorities. This raises concerns about the legitimacy of the non-state stakeholders'...

Despite the increase in the number of clinical trials in low and middle income countries (LMICs), there has been little serious discussion of whether First in Human (FIH; phase 0 and phase 1) clinical trials should be conducted in LMICs, and if so, under what conditions. Based on our own experience, studies and consultations, this paper aims to sti...

As part of a series on maternal, neonatal, and child health in sub-Saharan Africa, Igor Rudan and colleagues discuss various priority-setting tools for health care and research that can help develop evidence-based policy.

The purpose of this study was to describe, using qualitative case study methods, and evaluate, using the ethical framework 'accountability for reasonableness', priority setting in a hospital in Chile. In policy making contexts that have historically been dominated by central authority, especially where there are limited resources, fair priority set...

Purpose: To describe and evaluate priority setting in an Acute Care hospital in Argentina, using Accountability for Reasonableness, an ethical framework for fair priority setting. Methods: Case Study involving key informant interviews and document review. Thirty respondents were identified using a snowball sampling strategy. A modified thematic app...

The purpose of this paper is to explore how rationing decisions are made by government and hospital policy makers and practitioners, at the micro, meso and macro levels of analysis, through examining the rationing of cardiac care in a Canadian hospital, and discussing how the interaction between policy makers and practitioners at each of these leve...

To assess and summarize empirical studies on priority-setting in developing countries. Literature review of empirical studies on priority-setting of health interventions in developing countries in Medline and EMBASE (Ovid) databases. Eighteen studies were identified and classified according to their characteristics and methodological approaches. Al...

To evaluate decisions selecting patients for anti-retroviral treatment (ART) in Uganda. We held 39 semi-structured interviews with 41 health professionals holding various selection roles and 5 focus groups with 47 HIV/AIDS patients in diverse ART programs. Decisions were evaluated using accountability for reasonableness (A4R). A4R considers a decis...