Table 4.

A synthesis of the desired features and process

Pre-requisites for contextualisation, sustainability and institutionalisation • PS process must be owned and led by the country itself; should eventually be integrated into the National Health Strategic plan • Governments should appoint formal health research PS institutions such as NHRA – capable of leading PS processes • Aim to involve technical and non-technical but critical stakeholders at all levels of decision-making and involving multi-sectoral consultations • Include capacity-building for the PS institutions and public sensitisation
Phase	Process and activities
Preparation	• Determine ownership and leadership; preferably this should be country led and owned • The NHRAs should work with a TWG to lead the process (with clear rationale for the selection), perform a systematic review/literature scan; the TWG should be temporary, depending on the issue under investigation • Decide on level of PS and participants; National PS should cater for the decentralised system, so PS if possible, should start from the bottom-up, i.e. from the district/province to the national level • Identify sources and types of evidence/information/data required Perform a situation analysis • Environment scan (social, economic, political, cultural and global context), decision-maker receptivity and capacity to use the priorities set as a result of the PS process • Determine available resources, e.g. human, financial, availability of experts, in order to inform the choice of method; is there existing capacity to do PS? • Health systems analysis: what other activities in the health system may influence PS? Do these activities support or facilitate the PS process? Do they present specific challenges or hindrances? • Enlist public values either empirically or as identified in the national health research plan (if available) for PS • Conduct a stakeholder analysis and rationale for selection of participants (broad representation of researchers, funders, decision-makers, public) in the PS process • Determine the stakeholder engagement methods (preferably mixed methods tailored to the different stakeholders) • Have an appeals mechanism to ensure procedural fairness • Have a communication strategy to disseminate information • Have an evaluation plan (to evaluate the PS process and the implementation of the priorities • Prior to the face-to-face meeting, send the PS materials (necessary evidence and the details of the PS approachesa) to the stakeholders involved in the PS process
Actual PS (preferably face-to-face)	• Present and discuss the evidence collected in the situation analysis • Present and discuss the current approaches used in health research PS • Collectively select the approach and process to guide the PS based on the presented information Considerations for determining the PS methods; the selected PS approach should: • Align with existing Ministry of Health processes and infrastructure • Have potential for institutionalisation and sustainability • Have potential for integration, e.g. with the national strategic plan for health • Facilitate capacity-building (local capacity for setting/leading processes) • Be feasible, with attention to costs (financial, time, human resource skills requirements) • Be adaptable, flexible and easily applied to different issues and levels ▪ Have the ability to produce short- and long-term goals ▪ Be responsive to emerging needs, and be time sensitive ▪ Be participatory (all stakeholders should have an input and views should be respected) • Have explicit criteria (and weighting) for ranking of the research options; already existing criteria should be validated within the local contexts • Define process for actual deciding/ranking of the priorities (if face-to-face, the Nominal Group Technique would be most favourable) Create outputs • This could be a long list of both long- and short-term research priorities • Identify a shorter list, for example ‘the Top 10’
After PS	• Conduct participatory evaluation of the PS process with the stakeholders directly involved in the process, immediately after the PS exercise; use results for improving the next PS cycle • Validate the identified priorities with the relevant stakeholders • Publicise the PS process, the criteria and the validated priorities using appropriate communication mechanisms for different audiences (include international stakeholders) • Implement the priorities: secure and allocate funding for the top 10 research priorities • Under the leadership of the NHRA, annually monitor the implementation of the identified priorities; this should involve comparing funded research within the countries to the identified list of priorities • Evaluate the impact of PS, preferably using a standardised framework; the evaluation should also aim to facilitate institutional capacity strengthening for health research PS

^a Kapiriri L et al.’s reference manual synthesizing the literature and demonstrating the potential use would be appropriate [41]

NHRA National Health Research Authorities, PS priority-setting, TWG Technical Working Groups