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Using burden of disease/cost-effectiveness as an instrument for district health planning: experiences from Uganda.

Jeppsson, Anders LU ; Östergren, Per-Olof LU ; Agatre Okuonzi, Sam and Hagström, Bo (2004) In Health Policy 70(3). p.261-270
Abstract
The burden of disease/cost-effectiveness analysis (BoD/CE) was introduced as a method for detailed planning and budgeting in 13 districts of Uganda. This endeavor can be seen as a “natural experiment”, attempting to pursue policy implementation by means of a heavy focus on rationalistic/technical arguments as a main supportive factor. However, modern theory of policy implementation, e.g. the new institutionalism postulate that the implementation process is far from a passive diffusion process which only would need support by technical rationality, and that the result of the implementation process often is very different from prior expectations and depend on a number of factors in the so called translation process. The aim of this paper was... (More)
The burden of disease/cost-effectiveness analysis (BoD/CE) was introduced as a method for detailed planning and budgeting in 13 districts of Uganda. This endeavor can be seen as a “natural experiment”, attempting to pursue policy implementation by means of a heavy focus on rationalistic/technical arguments as a main supportive factor. However, modern theory of policy implementation, e.g. the new institutionalism postulate that the implementation process is far from a passive diffusion process which only would need support by technical rationality, and that the result of the implementation process often is very different from prior expectations and depend on a number of factors in the so called translation process. The aim of this paper was to study the outcome of the mentioned “natural experiment” and, if the outcome diverted from the intended ones (which we hypothesized), to analyze some of the reasons for this by using the theoretical framework of new institutionalism. District budgets as well as actual expenditures before and after the introduction of the BoD and CE methods were analyzed. District health officials were interviewed to obtain their views and experiences of the method. Our study of budget allocations and actual expenditures revealed an increasing discrepancy from the pattern shown in the BoD/CE analysis. The district officials were positive about the methods but stated that it had to be used together with other methods. However, we found that the seemingly pure focus of BoD/CE, i.e. technical efficiency of budget allocations at the district level, collided with issues of accountability. The final budgets, and even more, the actual expenditures can be seen as the outcome of negotiation processes where other rationalities have considered, that is the translation process.



This implies that the “technical” issue of efficiency has to become better understood and integrated in the notion of an accountable health care system at the district level. It is proposed that an increased involvement of the peripheral parts of the health care system, and most likely the target population itself, is needed to accomplish this. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Burden of disease, Cost-effectiveness, Health policy diffusion, Health planning, District health services, Uganda
in
Health Policy
volume
70
issue
3
pages
261 - 270
publisher
Elsevier
external identifiers
  • pmid:15488993
  • wos:000225004900001
  • scopus:5444246298
ISSN
1872-6054
DOI
10.1016/j.healthpol.2004.02.009
language
English
LU publication?
yes
id
82f67207-1360-43f0-83fe-fecdd176e4b5 (old id 129796)
date added to LUP
2007-07-24 12:16:00
date last changed
2017-09-24 03:47:30
@article{82f67207-1360-43f0-83fe-fecdd176e4b5,
  abstract     = {The burden of disease/cost-effectiveness analysis (BoD/CE) was introduced as a method for detailed planning and budgeting in 13 districts of Uganda. This endeavor can be seen as a “natural experiment”, attempting to pursue policy implementation by means of a heavy focus on rationalistic/technical arguments as a main supportive factor. However, modern theory of policy implementation, e.g. the new institutionalism postulate that the implementation process is far from a passive diffusion process which only would need support by technical rationality, and that the result of the implementation process often is very different from prior expectations and depend on a number of factors in the so called translation process. The aim of this paper was to study the outcome of the mentioned “natural experiment” and, if the outcome diverted from the intended ones (which we hypothesized), to analyze some of the reasons for this by using the theoretical framework of new institutionalism. District budgets as well as actual expenditures before and after the introduction of the BoD and CE methods were analyzed. District health officials were interviewed to obtain their views and experiences of the method. Our study of budget allocations and actual expenditures revealed an increasing discrepancy from the pattern shown in the BoD/CE analysis. The district officials were positive about the methods but stated that it had to be used together with other methods. However, we found that the seemingly pure focus of BoD/CE, i.e. technical efficiency of budget allocations at the district level, collided with issues of accountability. The final budgets, and even more, the actual expenditures can be seen as the outcome of negotiation processes where other rationalities have considered, that is the translation process.<br/><br>
<br/><br>
This implies that the “technical” issue of efficiency has to become better understood and integrated in the notion of an accountable health care system at the district level. It is proposed that an increased involvement of the peripheral parts of the health care system, and most likely the target population itself, is needed to accomplish this.},
  author       = {Jeppsson, Anders and Östergren, Per-Olof and Agatre Okuonzi, Sam and Hagström, Bo},
  issn         = {1872-6054},
  keyword      = {Burden of disease,Cost-effectiveness,Health policy diffusion,Health planning,District health services,Uganda},
  language     = {eng},
  number       = {3},
  pages        = {261--270},
  publisher    = {Elsevier},
  series       = {Health Policy},
  title        = {Using burden of disease/cost-effectiveness as an instrument for district health planning: experiences from Uganda.},
  url          = {http://dx.doi.org/10.1016/j.healthpol.2004.02.009},
  volume       = {70},
  year         = {2004},
}