A qualitative appraisal of stakeholder reactions to a tool for burden of disease–based health system budgeting in Ghana

Background In 2010, the Ghana Health Service launched a program of cooperation with the Tanzania Ministry of Health and Social Welfare that was designed to adapt Tanzania's PLANREP budgeting and reporting tool to Ghana's primary health care program. The product of this collaboration is a system of budgeting, data visualization, and reporting that is known as the District Health Planning and Reporting Tool (DiHPART). Objective This study was conducted to evaluate the design and implementation processes (technical, procedures, feedback, maintenance, and monitoring) of the DiHPART tool in northern Ghana. Design This paper reports on a qualitative appraisal of user reactions to the DiHPART system and implications of pilot experience for national scale-up. A total of 20 health officials responsible for financial planning operations were drawn from the national, regional, and district levels of the health system and interviewed in open-ended discussions about their reactions to DiHPART and suggestions for systems development. Results The findings show that technical shortcomings merit correction before scale-up can proceed. The review makes note of features of the software system that could be developed, based on experience gained from the pilot. Changes in the national system of financial reporting and budgeting complicate DiHPART utilization. This attests to the importance of pursuing a software application framework that anticipates the need for automated software generation. Conclusions Despite challenges encountered in the pilot, the results lend support to the notion that evidence-based budgeting merits development and implementation in Ghana.

[1]  Andreas Holzinger,et al.  The fine art of user-centered software development , 2015, Software Quality Journal.

[2]  J. Awoonor-Williams,et al.  Lessons learned from scaling up a community-based health program in the Upper East Region of northern Ghana , 2013, Global Health: Science and Practice.

[3]  C. Victora.  LiST: using epidemiology to guide child survival policymaking and programming. , 2010, International journal of epidemiology.

[4]  A. Mills,et al.  Financing of health systems to achieve the health Millennium Development Goals in low-income countries , 2010, The Lancet.

[5]  Lydia Kapiriri,et al.  Setting priorities for health interventions in developing countries: a review of empirical studies , 2009, Tropical medicine & international health : TM & IH.

[6]  Julio Frenk,et al.  Reinventing primary health care: the need for systems integration , 2009, The Lancet.

[7]  Douglas K. Martin,et al.  Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making? , 2009, Social science & medicine.

[8]  Helvi Kyngäs,et al.  The qualitative content analysis process. , 2008, Journal of advanced nursing.

[9]  H. Burkom,et al.  Syndromic Surveillance: Adapting Innovations to Developing Settings , 2008, PLoS medicine.

[10]  Alan D. Lopez,et al.  Interim measures for meeting needs for health sector data: births, deaths, and causes of death , 2007, The Lancet.

[11]  R. Baltussen,et al.  Priority setting of health interventions: the need for multi-criteria decision analysis , 2006, Cost effectiveness and resource allocation : C/E.

[12]  Sumi Mehta,et al.  Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries , 2005, BMJ : British Medical Journal.

[13]  Todd R. Johnson,et al.  A user-centered framework for redesigning health care interfaces , 2005, J. Biomed. Informatics.

[14]  M. Jacobs,et al.  Human resources for health: overcoming the crisis , 2004, The Lancet.

[15]  F. Binka,et al.  Monitoring future impact on malaria burden in sub-saharan Africa. , 2004, The American journal of tropical medicine and hygiene.

[16]  A. Rothberg.  Making Choices in Health: WHO Guide to Cost Effectiveness Analysis , 2008 .

[17]  Ole Frithjof Norheim,et al.  Criteria for priority-setting in health care in Uganda: exploration of stakeholders' values. , 2004, Bulletin of the World Health Organization.

[18]  Ole Frithjof Norheim,et al.  Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda , 2004 .

[19]  Rob Baltussen,et al.  Making Choices in Health: WHO Guide to Cost Effectiveness Analysis , 2003 .

[20]  P. Dolan,et al.  Public views on health care rationing: a group discussion study. , 1999, Health policy.

[21]  C Ham,et al.  Priority setting in health care: learning from international experience. , 1997, Health policy.

[22]  D. Sullivan,et al.  A single index of mortality and morbidity. , 1971, HSMHA health reports.

[23]  D. Savigny,et al.  District Health Expenditure Mapping: A Budget Analysis Tool for Council Health Management Teams , 2001 .