The politics of priority setting for reproductive health: breast and cervical cancer in Ghana.

Priority setting for reproductive health is affected by health sector reform policies, the often politically charged nature of issues such as abortion, decreasing funding for reproductive health activities and the broad agenda of the ICPD Programme of Action. This paper examines the influence of political and organizational factors on national priority setting for reproductive health and argues that existing priority setting tools such as disability-adjusted life years and cost-effectiveness analysis do not consider the influence of politics on the priority setting process or account for the interpretation of evidence in priority setting. It suggests that priority setting tools can be strengthened by incorporating empirical measures of political and organizational attention to an issue, and through a new measure--policy priority. The paper applied this new measure to a case study of attention to breast and cervical cancer in Ghana from 1990-97, illustrating how traditional priority setting methods cannot explain the priority given to breast cancer in Ghana. It demonstrates how local politics can trump scientific and economic evidence and suggests that the priority setting process can have unforeseen equity and social implications. It concludes by arguing that the policy priority measure provides a more complete picture of reproductive health priorities and is useful for better understanding the implications of the priority setting process for reproductive health.