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Background: The COVID-19 pandemic forced governments across the world to consider how to prioritize resource allocation. Most countries produced pandemic preparedness plans that guide and coordinate healthcare, including how to allocate scarce resources such as ventilators, human resources, and therapeutics. The objective of this study was to compare and contrast the extent to which established parameters for effective priority setting (PS) were incorporated into COVID-19 pandemic response planning in several countries around the world. Methods: We used the Kapriri and Martin framework for effective priority setting and performed a quantitative descriptive analysis to explore whether and how countries' type of health system, political, and economic contexts impacted the inclusion of those parameters in their COVID-19 pandemic plans. We analyzed 86 country plans across six regions of the World Health Organization. Results: The countries sampled represent 40% of nations in AFRO, 54.5% of EMRO, 45% of EURO, 46% of PAHO, 64% of SEARO, and 41% of WPRO. They also represent 39% of all HICs in the world, 39% of Upper-Middle, 54% of Lower-Middle, and 48% of LICs. No pattern in attention to parameters of PS emerged by WHO region or country income levels. The parameters: evidence of political will, stakeholder participation, and use of scientific evidence/ adoption of WHO recommendations were each found in over 80% of plans. We identified a description of a specific PS process in 7% of the plans; explicit criteria for PS in 36.5%; inclusion of publicity strategies in 65%; mention of mechanisms for appealing decisions or implementing procedures to improve internal accountability and reduce corruption in 20%; explicit reference to public values in 15%; and a description of means for enhancing compliance with the decisions in 5%. Conclusion: The findings provide a basis for policymakers to reflect on their prioritization plans and identify areas that need to be strengthened. Overall, there is little consideration for explicit prioritization processes and tools and restricted attention to equity considerations; this may be a starting point for policymakers interested in improving future preparedness and response planning. Although the study focused on the COVID-19 pandemic, priority setting remains one of the policymakers' most prominent challenges. Policymakers should consider integrating systematic priority setting in their routine decision-making processes.

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BACKGROUND: A recent Lancet commission called for more research on palliative care in low- and middle-income (LMIC) countries such as Colombia. A research priority setting approach has been recommended by The Global Forum for Health Research to address the huge gap in research output between LMIC and high-income countries, with influential health service bodies recommending the active involvement of non-research expert stakeholders in establishing research priorities to address service user needs. METHOD: Priority setting partnership (PSP) following the four stages of the James Lind Alliance methodology; establishing the partnership, identifying evidence uncertainties, refining questions and uncertainties, and prioritization. Data from MS forms were analysed using descriptive statistics. RESULTS: A total of 33 stakeholders attended an online PSP workshop and completed the Mentimeter exercise in Microsoft Teams. A total of 48 attended the subsequent in person prioritisation exercise in urban Bogota (n = 22) and rural Popayan (n = 25). The stakeholders were a diverse group of health professionals (physicians, medical students, nurses, dentists, physiotherapists, nutritionist, occupational and speech therapists), financial and administrative staff and patients with life-limiting illness and caregivers. Top research priorities included patient and caregiver needs, service provider education and training, and better integration of palliative care with cancer and non-cancer services. The key challenges included a lack of interest in palliative care research, along with funding, time and resource constraints. Key solutions included collaboration across disciplines and settings, highlighting benefits of palliative research to help secure adequate resources, and multicentre, mixed method research, with patient involvement from the research development stage. CONCLUSION: The findings of this PSP should be disseminated among palliative care associations worldwide to inform international multicentre studies, and among governmental and nongovernmental organisations that promote research in Colombia. A focus on patient and family caregiver palliative care needs in Colombia should be prioritised.

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Stakeholder participation is a key component of a fair and equitable priority-setting in health. The COVID-19 pandemic highlighted the need for fair and equitable priority setting, and hence, stakeholder participation. To date, there is limited literature on stakeholder participation in the development of the pandemic plans (including the priority setting plans) that were rapidly developed during the pandemic. Drawing on a global study of national COVID-19 preparedness and response plans, we present a secondary analysis of COVID-19 national plans from 70 countries from the six WHO regions, focusing on stakeholder participation. We found that most plans were prepared by the Ministry of Health and acknowledged WHO guidance, however less than half mentioned that additional stakeholders were involved. Few plans described a strategy for stakeholder participation and/or accounted for public participation in the plan preparation. However, diverse stakeholders (including multiple governmental, non-governmental, and international organizations) were proposed to participate in the implementation of the plans. Overall, there was a lack of transparency about who participated in decision-making and limited evidence of meaningful participation of the community, including marginalized groups. The critical relevance of stakeholder participation in priority setting requires that governments develop strategies for meaningful participation of diverse stakeholders during pandemics such as COVID-19, and in routine healthcare priority setting.

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Health benefits packages in Colombia-what is covered, by whom, and at what cost-have evolved over the past thirty years. Coverage changed from two explicit health benefits packages (with benefits linked to ability to contribute) to an implicit approach that covers, in theory, everything for everyone, excluding a narrow negative list of services and health technologies. This article explores the evolution of priority setting in Colombia during two periods of major reform. Each period had its own advantages and disadvantages associated with different institutional arrangements, processes, and methodologies. Colombia's evolution provides several lessons for other low- and middle-income countries interested in institutionalizing evidence-based priority-setting.

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OBJECTIVE: The objective of Health Technology Assessment International's 6th Latin America Policy Form, held in 2021, was to explore the implementation of deliberative processes in the framework of health technology assessment (HTA) and how agencies in the region could involve stakeholders in this process. METHODS: This paper is based on a preparatory survey, a background document, and the deliberative work of participants at the virtual Forum conducted in 2021. There were ninety-one participants in the open session and fifty-two in the closed sessions, representing twelve countries and diverse areas of the health sector. RESULTS: While there are mechanisms in most countries in Latin America to consider stakeholder involvement to some degree, it remains reduced or limited to a consultative role, making true participative involvement rare. There are significant barriers and structural and contextual limitations that have impeded or slowed progress toward deliberative processes. Relatively low levels of institutionalization and knowledge about HTA, as well as the lack of trust among stakeholders are important challenges. This situation has impacted health systems by diminishing the legitimacy of decisions and the very structures and processes of HTA. CONCLUSION: The Forum's broad group of participants identified barriers, facilitators, and recommendations to improve the use of deliberative processes in Latin America to foster improved fairness and reasonableness in HTA and decision making.

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BACKGROUND: This study aims to assess preferences and values for priority setting in healthcare in Chile through an original and innovative survey method. Based on the answers from a previous survey that look into the barriers the Chilean population face, this study considers the preferences of the communities overcoming those barriers. As a result six programs were identified: (1) new infrastructure, (2) better healthcare coverage, (3) increasing physicians/specialists, (4) new informatics systems, (5) new awareness healthcare programs, and (6) improving availability of drugs. METHODS: We applied an innovative survey method developed for this study to sample subjects to prioritize these programs by their opinion and by allocating resources. The survey also asked people's preferences for a distributive justice principle for healthcare to guide priority setting of services in Chile. The survey was conducted with a sample of 1142 individuals. RESULTS: More than half of the interviewees (56.4%) indicated a single program as their first priority, while 20.1% selected two of them as their first priority. To increase the number of doctors/specialists and improve patient-doctor communication was the program that obtained the highest priority. The second and third priorities correspond to improving and investing in infrastructure and expanding the coverage of healthcare insurances. Additionally, the results showed that equal access for equal healthcare is the principle selected by the majority to guide distributive justice for the Chilean health system. CONCLUSIONS: This study shows how a large population sample can participate in major decision making of national health policies, including making a choice of a distributive justice principle. Despite the complexity of the questions asked, this study demonstrated that with an innovative method and adequate guidance, average population is capable of engaging in expressing their preferences and values. Results of this study provide policy-makers useful community generated information for prioritizing policies to improve healthcare access.

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OBJECTIVES: The recent development of value frameworks to inform healthcare resource allocation responds to a demand to make the decision-making process more inclusive and explicit. The objectives of the 2018 Latin American (LAtam) Health Technology Assessment International (HTAi) Policy Forum were to explore the current international experiences and to discuss the potential application of value frameworks in Latin America. METHODS: A background paper, presentations, and group discussions of Policy Forum members (43 participants, 12 LAtam countries represented) at the 2018 HTAi Policy Forum meeting informed this paper. RESULTS: Participants agreed that HTA and decision making based on more comprehensive and inclusive value frameworks could improve health system effectiveness, efficiency, sustainability, and equity; promote transparency in the decision process; sustain a more comprehensive assessment of technologies; and facilitate stakeholder participation as well as accountability of decisions. Criteria that were identified as essential to be included in a value framework for LAtam were burden of illness and severity of the disease, effectiveness and safety of the technology, quality of the evidence, cost-effectiveness, and budget impact. Potential challenges identified for the application of value frameworks in LAtam, included scarcity of human resources and delays in the assessment process. CONCLUSIONS: Forum participants agreed that the next steps should be to identify appropriate processes and methodologies, adapted to the context of each country, regarding the application of value frameworks to improve the link between HTA and decision making.

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BACKGROUND: All healthcare systems face problems of justice and efficiency related to setting priorities for allocating limited financial resources. Therefore, explicit decision-making in healthcare depicted as a continuum from evidence generation to deliberation and communication of the decision made, needs to be transparent and fair. Nevertheless, priority-setting in many parts of the world remains being implicit and ad-hoc process. Health Technology Assessment (HTA) and Multi-Criteria Decision Analysis (MCDA) have emerged as policy tools to assist informed decision-making. Both, MCDA and HTA have pros and cons. MAIN BODY: Colombia experienced an important institutional transformation after the establishment of the Health Technology Assessment Institute in 2012. This paper briefly presents the current challenges of the Colombian health system, the general features of the new health sector reform, the main characteristics of HTA in Colombia and the potential benefits and caveats of incorporating MCDA approaches into the decision-making process. CONCLUSION: Structured and objective consideration of the factors that are both measurable and value-based in an open and transparent manner may be feasible through combining HTA and MCDA in contexts like Colombia. Further testing and validation of HTA and MCDA solely or combined in LMICs are needed to advance these approaches into healthcare decision-making worldwide.

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The interest on Multicriteria decision analysis (MCDA) for healthcare priority setting has grown in popularity in the last few years. Literature shows several exercises where MCDA can be used to inform different types of priorities; however, there is little evidence on the feasibility of implementing this method in current institutionalized decision-making processes. We examined the willingness to implement MCDA as a tool to facilitate decision-making in Central America and the Caribbean (CAC). We convene 41 representatives of the healthcare public sector from 10 countries to explore whether they consider MCDA a robust tool to be incorporated in local priority setting processes and which ongoing decision-making process could be benefited from this methodology. We developed a 2-days hands-on training course to explain the technique, advantages and limitations. The group achieved a broad consensus that MCDA can be used in CAC to help priority setting processes because it introduces transparency, facilitates the implementation of a systematic process and is relatively easy to explain to many stakeholders. It was acknowledged that MCDA can be used to inform decisions about coverage, though a major opportunity was identified to help informing other decisions, such as priorities for joint purchasing and the elaboration of national plans.

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BACKGROUND: Scientific knowledge is a fundamental tool for making informed health policy decisions, but the link between health research and public policy decision-making is often missing. This study aims to identify and prioritize a national set of research gaps in mental health. METHODS: A multi-approach method to identify gaps in knowledge was developed, including (1) document analysis and identification of possible research questions, (2) interviews to Ministry of Health key informants, (3) focus groups with different stakeholders, and (4) a web consultation addressed to academics. The identified gaps were translated to a standardized format of research questions. Criteria for prioritization were extracted from interviews and focus groups. Then, a team of various professionals applied them for scoring each question research. FINDINGS: Fifty-four people participated in the knowledge gaps identification process through an online consultation (n = 23) and focus groups (n = 18). Prioritization criteria identified were: extent of the knowledge gap, size of the objective population, potential benefit, vulnerability, urgency and applicability. 155 research questions were prioritized, of which 44% were related to evaluation of systems and/or health programs, and 26% to evaluation of interventions, including questions related to cost-effectiveness. 30% of the research questions came from the online consultation, and 36% from key informants. Users groups contributed with 10% of total research questions. CONCLUSION: A final priority setting for mental health research was reached, making available for authorities and research agencies a list of 155 research questions ordered by relevance. The experience documented here could serve to other countries interested in developing a similar process.

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BACKGROUND: The Chilean health system has undergone profound reforms since 1990, while going through political upheaval and facing demographic, health, and economic transformations. The full information requirements to develop an evidence-informed process implied the best possible use of the available data, as well as efforts to improve information systems. OBJECTIVE: To examine, from a historical perspective, the use of evidence during the health sector reforms undertaken in Chile from 1990 to date, and to identify the factors that have both determined improvements in the data and facilitated their use. METHODS: A qualitative methodological approach was followed to review the Chilean experience with data on decision-making. We use as the primary source our first-hand experience as officials of the Ministry of Health (MOH) and the Ministry of Finance before and during the reform period considered. A literature review was also conducted, using documents from official sources, historical accounts, books, policy reports, and articles published in indexed journals reviewing and discussing the reform process, looking for the use of data. RESULTS: The Chilean health-care reform process was intensive in its use and production of information. The MOH conducted several studies on the burden of disease, efficacy of interventions, cost-effectiveness, out-of-pocket payments, fiscal impact, social preferences, and other factors. Policy and prioritization frameworks developed by international agencies strongly influenced the use of data and the study's agenda. CONCLUSIONS: The Chilean example provides evidence that tradition, receptiveness to foreign ideas, and benchmarking with international data determined the use of data, facilitated by the political influence of physicians and, later, other technocrats. Internationally comparable statistics are also shown to play a significant role in the policy debate.

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Dryland cereals and legumes  are important crops in farming systems across the world.  Yet they are frequently neglected among the priorities for international agricultural research and development, often due to lack of information on their magnitude and extent. Given what we know about the global distribution of dryland cereals and legumes, what regions should be high priority for research and development to improve livelihoods and food security? This research evaluated the geographic dimensions of these crops and the farming systems where they are found worldwide. The study employed geographic information science and data to assess the key farming systems and regions for these crops. Dryland cereal and legume crops should be given high priority in 18 farming systems worldwide, where their cultivated area comprises more than 160 million ha. These regions include the dryer areas of South Asia, West and East Africa, the Middle East and North Africa, Central America and other parts of Asia. These regions are prone to drought and heat stress, have limiting soil constraints, make up half of the global population and account for 60 percent of the global poor and malnourished. The dryland cereal and legume crops and farming systems merit more research and development attention to improve productivity and address development problems. This project developed an open access dataset and information resource that provides the basis for future analysis of the geographic dimensions of dryland cereals and legumes.

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Purpose - New hepatitis C medicines such as sofosbuvir underline the need to balance considerations of innovation, clinical evidence, budget impact and equity in health priority-setting. The purpose of this paper is to examine the role of public participation in addressing these considerations. Design/methodology/approach - The paper employs a comparative case study approach. It explores the experience of four countries - Brazil, England, South Korea and the USA - in making coverage decisions about the antiviral sofosbuvir and involving the public and patients in these decision-making processes. Findings - Issues emerging from public participation ac tivities include the role of the universal right to health in Brazil, the balance between innovation and budget impact in England, the effect of unethical medical practices on public perception in South Korea and the legitimacy of priority-setting processes in the USA. Providing policymakers are receptive to these issues, public participation activities may be re-conceptualized as processes that illuminate policy problems relevant to a particular context, thereby promoting an agenda-setting role for the public. Originality/value - The paper offers an empirical analysis of public involvement in the case of sofosbuvir, where the relevant considerations that bear on priority-setting decisions have been particularly stark. The perspectives that emerge suggest that public participation contributes to raising attention to issues that need to be addressed by policymakers. Public participation activities can thus contribute to setting policy agendas, even if that is not their explicit purpose. However, the actualization of this contribution is contingent on the receptiveness of policymakers.

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Although some methods for eliciting preferences to assist participatory priority setting in health care in developed countries are available, the same is not true for poor communities in developing countries whose preferences are neglected in health policy making. Existing methods grounded on self-interested, monetary valuations that may be inappropriate for developing country settings where community care is provided through 'social allocation' mechanisms. This paper proposes and examines an alternative methodology for eliciting preferences for health care programmes specifically catered for rural and less literate populations but which is still applicable in urban communities. Specifically, the method simulates a realistic collective budget allocation experiment, to be implemented in both rural and urban communities in Guatemala. We report evidence revealing that participatory budget-like experiments are incentive compatible mechanisms suitable for revealing collective preferences, while simultaneously having the advantage of involving communities in health care reform processes.

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In this paper, we provide a short summary of recent trends and key issues regarding the current status of health technology assessment (HTA) in Latin America. Initially, we describe worldwide and region-wide initiatives that foster the institutionalization of HTA for decision making and health policy in our region. Then, we describe some countries in the region that are worth mentioning for their application of HTA at a national level. The target audiences are those researchers and decision makers interested in following HTA in our region.

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The World Health Organization (WHO) has contributed to the conceptualization of a Health System stating that it has three main objectives and four functions. The main objective is Health Status, measured in Disability Adjusted Life Expectancy (DALE).The others two are Responsiveness to the people’s Non-Medical Expectations and Equity in Financing. This last is a specific indicator of economic nature. Economics has an increasing role in the health systems and the recognition of this component by actors in health services is more and more important every day. Medical professionals need to understand its meaning and relevance in many senses of medical care. Economic evaluations, mainly cost-effectiveness of health programs and socio-sanitary interventions are more complex to carry out than common social evaluations, whose context is more restricted.When formulating modern health policies, the declared objective is always the improvement and quality of healthcare. Nevertheless, in recent years policy makers have insisted in the need to secure economic rationality of interventions, both inside the program, thus achieving internal technical efficiency, as towards the whole society achieving allocative efficiency. When the purpose is to evaluate health programs, economic evaluation integrates costs with effectiveness and considers the epidemiologic profle and social preferences. The priority setting included in the Health Guarantees Plan (AUGE or GES) established by the Chilean Ministry of Health in 2005 is a clear example of a process of Health Technology Assessment , where cost-effectiveness studies were used to set the program and establish priorities. This is the frst in a series of papers related to economic evaluation of healthcare in-terventions. This paper aims to contribute to the development of this feld, providing basic concepts and its main applications to health care in Chile.

La Organización Mundial de la Salud (OMS) ha contribuido a la conceptualiza-ción de lo que es un sistema de salud, en el cual integra tres objetivos y cuatro funciones. El objetivo principal es la salud, la cual es medida con el indicador Expectativa de Vida Ajustada por Discapacidad (EVAD), los otros dos son Capacidad de Respuesta a las Expectativas No Medicas y la Equidad o Justicia Financiera. Esta última es una condición explícita de carácter económico. La economía tiene un papel creciente en los sistemas de salud y es importante que los actores principales del sistema, los profesionales médicos, estén al tanto de ello y logren comprender su dimensión. Las evaluaciones económicas, principalmente las de costo-efectividad de los programas de salud e intervenciones socio-sanitarias siguen siendo más complejas de realizar que las evaluaciones en otras áreas sociales, cuyo contexto es más restringido o específico. En la formulación de políticas de salud modernas, el objetivo declarado es siempre el de mejorar la calidad de los cuidados y de la atención médica. Sin embargo, ahora se hace insistiendo en que uno de los componentes esenciales de la calidad es la racionalidad económica de las intervenciones, tanto internas al propio programa, logrando eficiencia técnica, como al conjunto de la sociedad logrando eficiencia distributiva. Cuando se trata de evaluar Tecnologías Sanitarias, uno de sus componentes es la evaluación económica que integra costos con efectividad clínica y considera el perfilepidemiológico y las preferencias sociales. Estás últimas se pueden incorporar a través de la valoración de los estados de salud (en “outcomes” como Quality-Adjusted Life-Years -QALY) y en el uso de una tasa de descuento social. La determinación de las condiciones de salud incluidas en el Plan de Garantías en Salud (AUGE o GES) es un ejemplo de un proceso de Evaluación de Tecnologías Sanitarias (ETESA). En dicho proceso se hizo una aproximación a incluir explícitamente la evaluación económica, a través de los estudios de costo-efectividad, en la priorización para determinar las condiciones de salud que se integrarían al plan. Este es el primero de una serie de artículos sobre el ámbito de la evaluación económica de intervenciones de salud la que pretende entregar a la comunidad médica un conjunto de contenidos que dan luces sobre el desarrollo de la disciplina y sus conceptos principales, a la vez que sus aplicaciones posibles a las actividades de la salud en nuestro país.

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The purpose of this paper is to describe the national priority setting process for the public health system in Brazil, evaluating the process using the ethical framework Accountability for Reasonableness, and equity considerations highlighted in the 2008 WHO Commission on Social Determinants of Health. We searched the Brazilian Ministry of Health website for documents that described priority setting within the Brazilian Universal Health Care System (SUS). The National Health Conference (CNS) has been defined by the Ministry of Health as the democratic priority setting forum for SUS. The most recent such conference (13th CNS, 2007) is the subject of this paper. Our analysis suggests that the process of priority setting within SUS has not yet achieved the ethical standards of legitimacy and fairness, and that inequitable distribution of decision making power under- represents users in poor areas. The unmet need for hospital care for children in Brazil, which reflects a remarkable inequality of opportunity for human development, may be a product of poor priority setting processes and inequity in representation.

Este artículo pretende describir el establecimiento de prioridades nacionales en el proceso de cuidado del sistema de salud en Brasil, evaluando el proceso con el empleo del marco ético de Administración Razonable, y de consideraciones de equidad destacadas por la Comisión sobre Determinantes Sociales de la Salud de la Organización Mundial de la Salud (OMS). Buscamos documentos que describieran el establecimiento de prioridades dentro del Sistema Único de Salud brasileño (SUS) en el sitio del Ministerio de Salud Brasileño. La Conferencia Nacional sobre Salud (CNS) ha sido definida por el Ministerio de Salud como el foro del SUS para el establecimiento de prioridades democráticas. La 13¬ CNS, 2007 -la más reciente de dichas conferencias- constituye el tema de este artículo. Nuestro análisis sugiere que el proceso de establecimiento de prioridades dentro del SUS no ha alcanzado aún los patrones éticos de legitimidad y justicia, y que la distribución injusta de las instancias de poder de decisión no representa realmente a las áreas más pobres. La meta aún no alcanzada de necesidad de hospitales para niños en Brasil significa una notable falta de igualdad en las oportunidades para el desarrollo humano y puede que sea producto de la mala definición del proceso de prioridades y de la falta de equidad en la representación.

Este artigo pretende descrever a definição de prioridades nacionais no processo de cuidado do sistema de saúde no Brasil, avaliando o processo com o emprego do marco ético de Administração Razoável e de considerações sobre a equidade, destacadas pela Comissão sobre Determinantes Sociais da Saúde da Organização Mundial da Saúde (OMS). Buscamos documentos que descreveram o estabelecimento de prioridades dentro do Sistema Único de Saúde brasileiro (SUS) no site do Ministério da Saúde brasileiro na web. A Conferência Nacional de Saúde (CNS) foi definida pelo Ministério da Saúde como o fórum do SUS para o estabelecimento de prioridades democráticas. A 13a CNS, 2007 -a mais recente das citadas conferências- constitui o tema deste artigo. Nossa análise sugere que o processo de estabelecimento de prioridades dentro do SUS não alcançou ainda os padrões éticos de legitimidade e justiça e que a distribuição injusta das instâncias do poder de decisão não alcança realmente as áreas mais pobres. A meta ainda não alcançada da necessidade de hospitais infantis no Brasil, o que significa uma notável falta de igualdade de oportunidades para o desenvolvimento humano e pode ser produto de uma má definição do processo de prioridades e da falta de equidade na representação.

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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 approach was used in analyzing the data. Results: Priorities are primarily determined at the Department of Health. The committee which is supposed to set priorities within the hospital was thought not to have much influence. Decisions were based on government policies and objectives, personal relationships, economic, political, historical and arbitrary reasons. Decisions at the DOH were publicized through internet; however, apart from the tenders and a general budget, details of hospital decisions were not publicized. CATA provided an accessible but ineffective forum for appeals. There were no clear mechanisms for appeals and leadership to ensure adherence to a fair process. Conclusions: In spite of their efforts to ensure fairness, Priority setting in the study hospital did not meet all the four conditions of a fair process. Policy discussions on improving legitimacy and fairness provided an opportunity for improving fairness in the hospital and Accountability for Reasonableness might be a useful framework for analysis and for identifying and improving strategies.

Propósito: Describir y evaluar el establecimiento de prioridades en un hospital de cuidados intensivos en Argentina, empleando la Administración Razonable como marco ético para una justa asignación. Métodos: Estudio de un Caso que incluía entrevistas a un informante y revisión de documentos. Se identificó a treinta participantes empleando la estrategia de muestras tipo "bola de nieve". Al analizar los datos, se empleó un enfoque temático modificado. Resultados: Las prioridades se determinan principalmente en el Departamento de Salud. El comité que, se supone, debe establecer las prioridades dentro del hospital no tiene mayor influencia. Las decisiones se basan en políticas y objetivos gubernamentales, relaciones personales, razones económicas, políticas, históricas e, incluso, arbitrarias. Las decisiones del Departamento de Salud se publicitan a través de Internet; sin embargo, fuera de las propuestas y del presupuesto general, no se publicitan las decisiones del hospital. CATA proporciona un foro accesible pero ineficaz para apelar. No existen mecanismos claros para apelar ni para un liderazgo que asegure un proceso justo. Conclusiones: A pesar de los esfuerzos por asegurar la equidad, el establecimiento de prioridades del hospital no cumple las cuatro condiciones de un proceso justo. Las discusiones acerca de políticas de mejoramiento, legitimidad y equidad dan oportunidad para mejorar la equidad en el hospital, y el marco ético "Administración Razonable" podría constituir un marco útil para el análisis así como para identificar y mejorar las estrategias.

Propósito: Descrever e avaliar o estabelecimento de prioridades em um hospital de cuidados intensivos na Argentina, empregando a Administração Razoável como marco ético para uma justa destinação de recursos. Métodos: Estudo de um caso que incluía entrevistas a um informante e revisão de documentos. Foram identificados trinta participantes empregando a estratégia de amostras tipo bola de neve. Ao analisar os dados, se empregou um enfoque temático modificado. Resultados: As prioridades são determinadas principalmente no Departamento de Saúde. O comitê que, se supõe, deve estabelecer as prioridades dentro do hospital não tem maior influência. As decisões se baseiam em políticas e objetivos governamentais, relações pessoais, razões econômicas, políticas, históricas e, inclusive, arbitrárias. As decisões do Departamento de Saúde são divulgadas por meio da Internet; no entanto, além das propostas e do orçamento geral, não se divulgam as decisões do hospital. CATA proporciona uma instância acessível, porém ineficaz para apelar. Não existem mecanismos claros para apelar nem para uma liderança que assegure um processo justo. Conclusões: Apesar dos esforços para assegurar a equidade, o estabelecimento de prioridades do hospital não cumpre as quatro condições de um processo justo. As discussões sobre políticas de melhoria, legitimidade e equidade dão oportunidade para melhorar a equidade no hospital e no marco ético "Administração Razoável" poderia constituir um marco útil para a análise assim como para identificar e melhorar as estratégias.

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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 setting processes can empower people, foster social learning, improve the quality of the decisions, enhance compliance with policy decisions, and increase public confidence in the hospital.

El propósito de este estudio fue describir, a través del uso de métodos cualitativos en un estudio de caso, y evaluar, siguiendo la estructura ética de "Administración Razonable", el proceso de priorización en salud en un hospital de Chile. En el contexto de las políticas públicas ha dominado históricamente la centralización de la autoridad, especialmente cuando los recursos son limitados. Un proceso justo de priorización en salud puede empoderar a las personas, mejorar y aumentar el proceso de aprendizaje social, mejorar la calidad de las decisiones, aumentar el grado de adherencia y satisfacción de las políticas desarrolladas y aumentar la confianza pública en el hospital.

O propósito deste estudo foi descrever, por métodos qualitativos em um estudo de caso, e avaliar, seguindo a estrutura ética de "administração razoável", o processo de priorização em saúde em um hospital chileno. No contexto das políticas públicas onde tem dominado historicamente a centralização da autoridade, especialmente quando os recursos são limitados, um processo justo de priorização em saúde pode empoderar as pessoas, melhorar e aumentar o processo de aprendizagem social, melhorar a qualidade das decisões, aumentar o grau de aderência e satisfação das políticas desenvolvidas e a confiança pública no hospital.

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Objetivo Evaluar el proceso de priorización de investigaciones en salud llevado a cabo en el país a partir de las metodologías internacionales y desde la perspectiva de los grupos de investigación en salud, categoría A, ubicados en Bogotá. Métodos: A partir de un enfoque cualitativo, se realizaron 14 entrevistas semies­tructuradas a líderes de los grupos seleccionados a través de una muestra propositiva. Con el programa de análisis de información cualitativa Atlas Ti se generaron categorías para comparación. Resultados Cada grupo posee diferentes experiencias en investigación en el campo de la salud. Algunos manifestaron sus propias concepciones sobre la salud y sobre la priorización a partir de sus marcos epistemológicos. Diferentes líderes de los grupos expresaron que hay una fuerte orientación biomédica en los procesos de priorización y de las metodologías utilizadas para tal fin. Un número importante de ellos ha reconocido la importancia de la participación de otros actores sociales en la definición de las prioridades para la investigación en salud, además de los mismos investigadores, dentro de un escenario de dialogo y de concertación. Por último, los líderes entrevistados plantearon algunos cuestionamientos frente a la definición de prioridades y sugirieron la importancia de fomentar un proceso más participativo e incluyente comenzando por los mismos investigadores en salud. Discusión Los hallazgos muestran la enorme heterogeneidad de posiciones frente a la temática de la priorización de investigaciones en salud y las dificultades para alcanzar consensos entre los mismos investigadores.

Objective Assessing how priorities are established in Colombia in line with international methodologies and from the perspective of Bogotá-based Category A health research groups. Methods This study used a qualitative approach; 14 leaders from groups selected via a propositive sample were given semi-structured interviews to obtain a compre­hensive interpretation of priority-setting in Colombia. ATLAS Ti software was used for organising information and producing categories from transcripts. Results Each group had a different research background and came from health research areas such as basic science, clinical science and the wide field of public health. Some talked about their own definitions of health and establishing priorities as related to their own epistemological frameworks. Other leaders stressed that a bio­medical approach still predominated in health research, priority-setting and the inter­national methodologies used for such end. Many recognised the importance of differ­ent social actors (i.e. apart from researchers) becoming involved in defining health research priorities within a scenario emphasising dialogue and coming to agreement. The leaders criticised the national health science and technology system raising questions regarding defining priorities; they stated that dialogue and involvement must be promoted. Discussion These findings revealed enormous heterogeneity regarding prioritising health research as every researcher has a different point of view due to their experi­ence and backgrounds and the difficulties in researchers' reaching consensus.

Assuntos