What are the priority-setting approaches for HIV/AIDS, TB and malaria programmes in Ghana? A qualitative perspective from key informants.

Introduction: Worldwide, countries have the challenge of meeting the ever-increasing demand for healthcare amidst limited resources. While priority setting is necessary in all settings, it is especially critical in low- and middle-income countries because of their often-low budgetary allocations for health. Despite the long history of disease programmes supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in Ghana, there is limited evidence on the approaches used in priority setting for the three disease programmes. This study aimed at exploring the priority-setting approaches adopted by the GFATM-supported programmes in Ghana. Methods: In-depth interviews of ten key informants from the three disease programmes, the Ministry of Health and global health partners were conducted. Interviews were transcribed verbatim and analysed both inductively and deductively. Results: We identified four main approaches for priority setting: (1) identification of health needs, (2) stakeholder participation, (3) transparency of the process and (4) contextual factors. Priorities were identified through national health strategies and mandates, development/health partners and global mandates and internally generated data and surveillance. The main actors participating in the decision-making or priority setting were ministries and agencies, development partners, research institutions, committees and working groups. These actors had varying influences and power. The involvement of the general public was limited in the priority-setting process. The approaches were often documented and disseminated through various mediums. Contextual factors reported were mainly barriers that affected priority setting, and these included inadequate funding, aligning priorities with funders and interruptions in the priority-setting process. Conclusion: While explicit priority-setting approaches are being expanded globally to support resource allocation decisions in health more generally, evidence from our study suggests that their use in the three GFATM-supported programmes was limited.