Ethical considerations in research priority setting on health: a review of Philippine research priority-setting cases

<ns3:p>Background Setting priorities for research is an essential function of health systems management and policy development. In the Philippines, national policy mandates the establishment of a research agenda as a prerequisite for securing government-supported funding, or for receiving foreign aid. While the process for research priority setting (RPS) is well established, its ethical dimensions have not been systematically assessed. Our study aims to fill this gap by conducting an interpretive review of all RPS exercises designed and implemented by the Alliance for Improving Health Outcomes between 2016 and 2024. Methods We conducted a documentary (public reports, research agendas, and principal investigator documents) analysis of the RPS exercised using the REPRISE reporting guideline and WHO's ethics guidance for health RPS, covering four ethical dimensions (fair procedures, social value, special obligations, and harm assessment and justification) and the principle of proportionality. Two reviewers extracted and cross-verified data, with discrepancies resolved by discussion. Results Seven RPS exercises were analyzed across national, institutional, and network levels. Under fair procedures, more recent exercises demonstrated broader stakeholder inclusion, clearer prioritization criteria, and improved transparency, though conflict-of-interest management and use of REPRISE remained limited. Regarding social value, priorities increasingly reflect public health needs and equity considerations. Special obligations to sustain implementation and evaluation were acknowledged but rarely fulfilled. Few exercises explicitly assessed or justified potential harms, while proportionality between scope, time, and resources varied widely. Conclusion Philippine RPS processes have become more structured and transparent over time. Embedding ethics and equity more deliberately through better documentation, proportional budgeting, and clearer expectations can make future RPS processes fairer and more credible. This offers practical lessons for other low- and middle-income settings.</ns3:p>