Reviewer's report
Title:From papers to practices: District level priority setting practices, attitudes
and criteria for family planning, maternal, newborn and child health interventions
in Tanzania
Version: 2Date:27 June 2011
Reviewer: Nancy Walton
Reviewer's report:
Major Compulsory Revisions
1. In the section on Research Ethics, you note that, as a research team, you kept
information confidential that was deemed important to be so. Were the group
discussion participants informed of the limitations of confidentiality that are
inherent in any group discussion? i.e. that researchers will maintain
confidentiality but they cannot promise this on behalf of other participants,
although it would have been requested? Please comment.
2. There are some very concerning (and interesting!) findings in the results and
discussion section, regarding priority setting processes in this context. Yet there
are few recommendations for improving the processes. While the goal of the
paper is a descriptive one, would it not be helpful to at least outline next steps in
terms of research or possible improvement of processes? This would give the
paper some significant added value, to identify some clear recommendations for
next steps in either examining or making attempts to improve the priority setting
processes.
3. No limitations noted. Only 3 of the 8 districts were randomly selected for
inclusion. Is this a possible limitation? Would it perhaps skew the results in any
way? The authors should note any limitations of the study.
Minor Essential Revisions
1. On page 4, "emphasising" should be correctly spelled "emphasizing".
2. On page 4, the phrase "good policy contents" needs to be corrected.
3. On page 5, the phrase "District councils as national policies implementing
agencies are required" should be reworded as "District councils act as national
policy implementing agencies and are required".
4. On page 6, "the National average" should be "the national average"
5. There are a great deal of acronyms in the paper. Of course, this is typical of
many scientific publications, but it can be difficult to read at times. Example, on
page 6, the following sentence is quite awkward to read: "Given the current
FMNCH status indicators, there is much concern if Mwanza and Tanzania in
general is going to achieve universal access to RH as stipulated in the MDGs."
With 3 acronyms in one sentence, it can be somewhat difficult for readers to
capture the importance of this statement. Recommend that you use acronyms
more judiciously.
6. On page 7, "inputs" should be "input".
7. On page 8, "eightiii" should be "eight".
8. On page 9, you note "Explanations were given as to what it means and its
objectives." It is unclear what the subject "it" is, in this statement.
9. On page 11, "arbitrary" should be "arbitrarily".
10. Again, by page 13, the use of acronyms makes the text difficult to read. The
very interesting results at the outset (lack of participation by key actors) is
somewhat lost in the use of so many acronyms. The direct quotation used on
page 13 is extremely acronym-heavy. For readers outside of the local area, it will
be challenging to read and constantly be checking what the acronyms stand for. I
would strongly recommend that you use acronyms more judiciously and if there
is a single word that can substitute for an acronym that captures what the term
means, that you should use this instead of the use of so many acronyms.
11. On page 20, "donated fund" should be corrected.
12. On page 20, "some donors have their priorities different from the district
priorities." is awkwardly worded and should be corrected.
13. On page 20, "in some occasions," should be reworded.
Discretionary Revisions
1. On page 7, you begin to explain the district health system planning process.
You provide some important procedural information but it would be more helpful
to explain this a little more, in more accessible and straightforward language.
2. Your method includes, essentially, the use of "focus groups". While you do not
use that term, it is well understood by many and might be a good term to use to
characterize the group interviews to facilitate optimal understanding of your
methods.
3. You note on page 9, the introductory statement provided to participants in the
group interviews. It would be more helpful to include a focus group guide in the
appendices - including any other questions or statements that were provided to
the focus groups.
4. It would be very interesting to hear more about what kinds of criteria are
actually considered important by key stakeholders, who are "on the ground". It is
noted that some key criteria that should be considered are not - however it would
be helpful and interesting to hear about what is actually used as criteria....
5. You have cited a number of important priority setting publications over the last
few years. However, you do not cite Daniels ("Accountability for
Reasonableness") which is the foundational framework for some of the articles
you cited and speaks to institutional priority setting and decision making. It would
add to your discussion to perhaps refer to Daniels' work.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.