Table 2 Example of a priority-setting approach

A Ministry’s decision-support unit offers the following range of supports to other Ministry staff:

1. A search for systematic reviews that address an issue (Timeline: 1 day; Number that can be provided per quarter: 24)

2. A summary of the take-home messages from quality-appraised systematic reviews addressing many facets of an issue (Timeline: 1 week; Number that can be provided per quarter: 12), and

3. A comprehensive assessment of the research evidence available to clarify a problem, frame options for addressing it, and address how an option will be implemented (Timeline: 1 month; Number that can be provided per quarter: 3)

The unit maintains an inventory of requests, in which each request is allocated a score of between 0 and 56. On receipt, a request is reviewed by two unit staff who assign it a rating of between 1 and 7 points (where a rating of 1 indicates ‘strongly disagree’ and 7 is ‘strongly agree’) for each of the following three criteria:

• The underlying problem(s), if properly addressed, could lead to health benefits, improvements in health equity or other positive impacts now or in the future,

• Viable options, if properly implemented, could affect the underlying problem(s), and hence lead to health benefits, improvements in health equity or other positive impacts, or could lead to reductions in harms, cost savings or increased value for money, and

• Political events could open (or political events may already have opened) windows of opportunity for change

The individual scores for the third criterion are doubled, as this is deemed to be twice as important as the other two (as a way of ensuring that the Minister’s priorities are given adequate consideration). A maximum of 14 points can be assigned to criterion 1, 14 points to criterion 2, and 28 point to criterion 3. One of the two unit staff will note the nature of the support requested (support types 1, 2 or 3 above). The basis for these assessments is the request description and justification submitted by other Ministry staff (after approval from their respective divisional director). The request must address each of the three criteria using available data and evidence (when available) and a discussion about the application of explicit criteria to the issues that are considered for prioritisation

At the beginning of each week, the unit manager, together with all divisional directors, reviews the rank-ordered list of priorities for each of support types 1, 2 and 3. Collectively, they confirm that the top two requests for support type 1 will proceed that week and that the top request for support type 2 will proceed. They also confirm that the top request for support type 3 is on track and that preparations are being made to begin a new assessment for the second-ranked request type 3 as soon as the current assessment is completed. The unit manager (who has training in health policy research) facilitates the meeting, taking care to elicit the rationale for any ranking changes and to ensure that any requests for comprehensive assessments are well thought through in terms of the provisional problem clarification, options framing, and implementation considerations. The unit manager then posts the decisions and rankings on the Ministry’s intranet and directs Ministry staff whose requests have not been addressed within one month of submission to submit an updated request.

Once a month, the unit manager reviews the unit’s monitoring data with the divisional directors. The monitoring data includes the number of appeals submitted by Ministry staff and their resolution. Once every year, the unit re-evaluates the scale of its outputs to determine if it can provide more support within shorter time frames. Once every three years, the unit commissions an evaluation of its impacts on the policymaking process.