Health Research Policy and Systems | |
The accountability for reasonableness approach to guide priority setting in health systems within limited resources – findings from action research at district level in Kenya, Tanzania, and Zambia | |
Øystein E Olsen6  Paul Bloch2  Benedict Ndawi8  Lillian N Nyandieka1  Charles Michelo9  Peter Kamuzora1,11  Astrid Blystad5  Anna-Karin Hurtig1,10  Salome A Bukachi3  Joseph M Zulu9  Stephen Maluka1,11  Bruno Marchal7  Jens Byskov4  | |
[1] Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), PO Box 20752, Nairobi 00202, Kenya;Steno Health Promotion Center, Steno Diabetes Center, Niels Steensens Vej 8, DK-2820 Gentofte, Denmark;Institute of Anthropology, Gender and African Studies University of Nairobi, PO Box 30197, Nairobi 00100, Kenya;DBL – Centre for Health Research and Development, Faculty of Health and Medical Sciences, University of Copenhagen, Thorvaldsensvej 57, DK 1871 Frederiksberg, Denmark;Department of Public Health and Primary Health Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway;Affiliated to Centre for International Health, University of Bergen, Årstadveien 21 5th floor, N-5009 Bergen, Norway;Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B 2000 Antwerpen, Belgium;Primary Health Care Institute, PO Box 235, Iringa, Tanzania;Department of Public Health, School of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia;Umeå International School of Public Health, Umeå University, SE 90185 Umea, Sweden;Institute of Development Studies, University of Dar Es Salaam, PO Box 35169, Dar Es Salaam, Tanzania | |
关键词: Zambia; Tanzania; Kenya; Health systems; Democratization; Decision making; Decentralization; Fairness; Priority setting; Accountability for reasonableness; | |
Others : 1177334 DOI : 10.1186/1478-4505-12-49 |
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received in 2013-04-01, accepted in 2014-08-03, 发布年份 2014 | |
【 摘 要 】
Background
Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT).
Methods
This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. An implementing action research team of core health team members and supporting researchers was formed to implement, and continually assess and improve the application of the four conditions. Researchers evaluated the intervention using qualitative and quantitative data collection and analysis methods.
Results
The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes.
Conclusions
District stakeholders were able to take greater charge of closing the gap between nationally set planning and the local realities and demands of the served communities within the limited resources at hand. This study thus indicates that the operationalization of the four broadly defined and linked conditions is both possible and seems to be responding to an actual demand. This provides arguments for the continued application and further assessment of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications.
【 授权许可】
2014 Byskov et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
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20150429091025372.pdf | 1470KB | download | |
Figure 2. | 219KB | Image | download |
Figure 1. | 36KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
【 参考文献 】
- [1]Martin D, Singer PA: A strategy to improve priority setting in health care institutions. Health Care Anal 2000, 11(1):59-68.
- [2]Murray CJL, Lopez A: Quantifying the burden of disease and injury attributable to ten major risk factors. In The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Edited by Murray CJL, Lopez AD. Cambridge, MA: Harvard University Press; 1996.
- [3]Hoedemaekkers R, Dekkers W: Justice and solidarity in priority setting in health care. Health Care Anal 2003, 11(4):325-343.
- [4]Maundy E, Kapiriri L, Norheim OF: Combining evidence and values in priority setting: testing the balance sheet method in a low-income country. BMC Health Serv Res 2007, 7:152. BioMed Central Full Text
- [5]Mshana S, Shemilu H, Ndawi B, Momburi R, Olsen OE, Byskov J, Martin DK: What do district health planners in Tanzania think about improving priority setting using ‘accountability for Reasonableness’? BMC Health Serv Res 2007, 7:180. BioMed Central Full Text
- [6]Olsen ØE, Ndeki S, Norheim OF: Human resources for emergency obstetric care in northern Tanzania: distribution of quantity or quality? Hum Resour Health 2005, 3:5. BioMed Central Full Text
- [7]Daniels N, Sabin J: Limits to health care: fair procedures, democratic deliberation, and the legitimacy problem for ensurers. Philosophy Public Affairs 1997, 26(4):303-350.
- [8]Daniels N, Sabin J: The ethics of accountability in managed care reform. Health Affairs (Millwood) 1998, 17:50-64.
- [9]Daniels N, Sabin J: Setting Limits Fairly: Can we Learn to Share Medical Resources?. New York: Oxford University Press; 2002.
- [10]Daniels N: Just Health: Meeting Health Needs Fairly. Cambridge: Cambridge University Press; 2008.
- [11]Martin DK, Giacomini M, Singer PA: Fairness, accountability for reasonableness, and the views of priority setting decision-makers. Health Policy 2002, 61:279-290.
- [12]Martin DK, Reeleder D, Keresztes C, Singer PA: What do hospital decision makers in Ontario, Canada, have to say about their fairness of priority setting in their institutions? BMC Health Serv Res 2005, 5:8. BioMed Central Full Text
- [13]Walton NA, Martin DK, Peter EH, Pingle DM, Singer PA: Priority setting and cardiac surgery: a qualitative case study. Health Policy 2007, 80(3):444-458.
- [14]Jansson S: Implementing accountability for reasonableness-the case of pharmaceutical reimbursement in Sweden. Health Economics Policy Law 2007, 2:153-171.
- [15]Kapiriri L, Martin DK: Priority setting in developing countries health care institutions: the case of a Ugandan hospital. BMC Health Serv Res 2006, 6:127. BioMed Central Full Text
- [16]Kapiriri L, Martin DK: Bedsides rationing by health practitioners in a context of extreme resource constraints: the case of Uganda. Med Decis Mak 2007, 27:44-52.
- [17]Johansson KA, Jerene D, Norheim OF: National HIV treatment guidelines in Tanzania and Ethiopia: are they legitimate rationing tools? J Med Ethics 2008, 34:478-483.
- [18]Kapiriri L, Norheim F, Martin D: Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda. Health Policy 2007, 82(1):78-94.
- [19]Friedman A: Beyond accountability for reasonableness. Bioethics 2008, 22:101-112.
- [20]Lippert-Rasmussen K, Lauridsen S: Justice and the allocation of healthcare resources: should indirect, non-health effects count? Med Healthcare Philosophy 2010, 13(3):237-246.
- [21]Hipgrave DB, Alderman KB, Anderson I, Soto EJ: Health sector priority setting at meso-level in lower and middle income countries: lessons learned, available options and suggested steps. Soc Sci Med 2014, 102:190e200.
- [22]Baltussen R, Mikkelsen E, Tromp N, Hurtig A-K, Byskov J, Olsen OE, Bærøe K, Hontelez JA, Singh J, Norheim OF: Balancing efficiency, equity and feasibility of HIV treatment in South Africa – development of programmatic guidance. Cost Effect Res Allocation 2013, 11:26. BioMed Central Full Text
- [23]Gibson JL, Martin DK, Singer PA: Priority setting in hospitals: fairness, inclusiveness, and the problem of institutional power differences. Soc Sci Med 2005, 61:2355-2362.
- [24]Byskov J, Bloch P, Blystad A, Hurtig A-K, Fylkesnes K, Kamuzora P, Kombe Y, Kvåle G, Marchal B, Martin DK, Michelo C, Ndawi B, Ngulube TJ, Nyamongo I, Olsen ØE, Onyango-Ouma W, Sandøy IF, Shayo EH, Silwamba G, Songstad NG, Tuba M: Accountable priority setting for trust in health systems – the need for research into a new approach for strengthening sustainable health action in developing countries. Health Res Policy Systems 2009, 7:7. BioMed Central Full Text
- [25]Bukachi SA, Onyango-Ouma W, Siso JM, Nyamongo IK, Mutai JK, Hurtig A-K, Olsen ØE, Byskov J: Healthcare priority setting in Kenya: a gap analysis applying the accountability for reasonableness framework. Int J Health Plann Manag 2013. In press
- [26]Zulu JM, Michelo C, Msoni C, Hurtig A-K, Byskov J, Blystad A: Increased fairness in priority setting processes within the health sector: the case of Kapiri-Mposhi District, Zambia. BMC Health Serv Res 2014, 14:75. BioMed Central Full Text
- [27]Maluka S, Kamuzora P, San Sebastiån M, Byskov J, Olsen ØE, Shayo E, Ndawi B, Hurtig AK: Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework. Soc Sci Med 2010, 71(4):751-759.
- [28]Ng’anjo Phiri S, Kiserud T, Kvåle G, Byskov J, Evjen-Olsen B, Michelo C, Echoka E, Fylkesnes K: Factors associated with health facility childbirth in districts of Kenya, Tanzania and Zambia: a population based survey. BMC Pregnancy Childbirth 2014, 14:219. BioMed Central Full Text
- [29]Sandøy IF, Blystad A, Shayo EH, Maundy E, Michelo C, Zulu J, Byskov J: Condom availability in high risk places and condom use: a study at district level in Kenya, Tanzania and Zambia. BMC Public Health 2012, 12:1030. BioMed Central Full Text
- [30]Tuba M, Sandoy IF, Bloch P, Byskov J: Fairness and legitimacy of decisions during delivery of malaria services and ITN interventions in Zambia. Malar J 2010, 9:309. BioMed Central Full Text
- [31]Echoka E, Kombe Y, Dubourg D, Makokha A, Evjen-Olsen B, Mwangi M, Byskov J, Olsen OE, Mutisya R: Existence and functionality of emergency obstetric care services at district level in Kenya: theoretical coverage versus reality. BMC Health Serv Res 2013, 13:113. BioMed Central Full Text
- [32]Njeru MK, Blystad A, Shayo EH, Nyamongo IK, Fylkesnes K: Practicing provider-initiated HIV testing in high prevalence settings: Consent concerns and missed preventive opportunities. BMC Health Services Research 2011, 11:87. doi:10.1186/1472-6963-11-87. Also included and supplemented in: Njeru MK: Determinants, Experiences and Responsiveness of HIV Testing Services in Kenya, Tanzania and Zambia. PhD Thesis. University in Bergen; 2011 [https://bora.uib.no/bitstream/handle/1956/4837/Dr.thesis_Mercy%20K.%1666%2020Njeru.pdf;jsessionid=F5CC2289DA52585E7CB06E31CC161E5B.bora-uib_worker?sequence=1 webcite] BioMed Central Full Text
- [33]Shayo EH, Norheim OF, Mboera LEG, Byskov J, Maluka S, Kamuzora P, Blystad A: Challenges to fair decision-making processes in the context of health careservices: a qualitative assessment from Tanzania. Int J Equity Health 2012, 11:30. BioMed Central Full Text
- [34]WHO: Declaration of Alma-Ata International Conference on Primary Health Care. USSR: Alma-Ata; 1978.
- [35]Maluka S, Kamuzora P, San Sebastian M, Byskov J, Ndawi B, Olsen ØE, Hurtig A-K: Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation. Implement Sci 2011, 6:11. BioMed Central Full Text
- [36]Pearce J, Branyiczki I, Bigley G: Insufficient bureaucracy: trust and commitment in particularistic organisations. Organ Sci 2000, 11:148-162.
- [37]Gould-Williams J: The importance of HR practices and workplace trust in achieving superior performance: a study of public sector institutions. Int J Human Res Manag 2003, 1:28-54.
- [38]Gilson L, Palmer N, Schneider H: Trust and health worker performance: exploring a conceptual framework using South African evidence. Soc Sci Med 2005, 61(7):1418-1429.
- [39]Kamuzora P, Maluka S, Ndawi B, Byskov J, Hurtig A-K: Promoting community participation in priority setting in district health systems: experiences from Mbarali district, Tanzania. Glob Health Action 2013, 6:22669.
- [40]Maluka S, Kamuzora P, Ndawi B, Hurtig A-K: Involving decision-makers in the research process: challenges of implementing the accountability for reasonableness approach to priority setting at the district level in Tanzania. Glob Public Health 2014, 9(7):760-772.
- [41]National Institute for Medical Research: Tanzania Health Research Priorities, 2006-2010. Tanzania: NIMR; 2006. [http://www.nimr.or.tz/wp-content/uploads/2013/07/TANZANIA-HEALTH-RESEARCH-PRIORITIES-2006.pdf webcite]
- [42]Primary Health Care Institute: AFR Training Packages. Iringa, Tanzania: PHCI; 2010.
- [43]WHO: The World Health Report 2008: Primary Health Care (Now More Than Ever). Geneva: WHO; 2008:2008.
- [44]WHO: Systems Thinking for Health Systems Strengthening. WHO: Geneva; 2009.
- [45]Milat AJ, King L, Newson R, Wolfenden L, Rissel C, Bauman A, Redman S: Increasing the scale and adoption of population health interventions: experiences and perspectives of policy makers, practitioners, and researchers. Health Res Policy Systems 2014, 12:18. BioMed Central Full Text
- [46]WHO: The World Health Report: Health Systems Financing: The Path to Universal Coverage. Geneva: WHO; 2010.
- [47]Loewenson R, Flores W, Shukla A, Kagis M, Baba A, Ryklief A, Mbwili-Muleya C, Kakde D: Raising the profile of participatory action research at the 2010 global symposium on health systems research. MEDICC Rev 2011, 13(3):35-38.
- [48]Biehl S, Petryna A: When People Come First, Critical Studies in Global Health. Princeton, NJ: Princeton University Press; 2013.