Background: There are few studies on the process of priority setting in some low- and middle-income Countries (LMICs). There are no reviews of the actual process of priority setting in these countries, specifically, reviews aimed at understanding the approaches employed and its impact on healthcare decision making in the published literature. Hence the need for this review of primary research papers on health care prioritisation in low- and middle-income countries.

Objectives: The aim of this review was to describe the approaches used, identify facilitators and barriers and to identify outcomes or impacts of the process of prioritisation.

Methods: A systematic review was carried out with articles obtained from searches in fifteen databases including grey literature, between October 2015 and December 2015. The intervention sort for was any priority setting method in any level of healthcare provision in a low- or middle-income country with an aim of improving health service, developing policy or allocating health resource. The QARI instrument by Joan Briggs institute was used for quality appraisal. A thematic data extraction was done. The extracted data were analysed descriptively.

Results: Only 9 studies were identified. The use of policy guidance, cost and burden of disease consideration were identified as the commonest approach to health care prioritisation. The barriers and facilitators were similar across the studies, and were grouped into 6 domains - political, technical, organizational, financial, contextual and process factors. The influence of each domain differed based on organisational level not necessarily based on countries. None of the identified studies achieved a perfect outcome, with one study recording a failure in implementation.

Conclusions: The findings from the review, suggests that there is a need for proper integration of the priority setting process specific to the contextual setting and organisational context to ensure its efficient use. Furthermore, most perceived barriers could be effectively transformed to facilitators when appropriately managed.