Abstract
BackgroundPriority setting in every health system is complex and difficult. In less wealthy countries the dominant approach to priority setting has been Burden of Disease (BOD) and cost-effectiveness analysis (CEA), which is helpful, but insufficient because it focuses on a narrow range of values – need and efficiency – and not the full range of relevant values, including legitimacy and fairness. 'Accountability for reasonableness' is a conceptual framework for legitimate and fair priority setting and is empirically based and ethically justified. It connects priority setting to broader, more fundamental, democratic deliberative processes that have an impact on social justice and equity. Can 'accountability for reasonableness' be helpful for improving priority setting in less wealthy countries?MethodsIn 2005, Tanzanian scholars from the Primary Health Care Institute (PHCI) conducted 6 capacity building workshops with senior health staff, district planners and managers, and representatives of the Tanzanian Ministry of Health to discussion improving priority setting in Tanzania using 'accountability for reasonableness'. The purpose of this paper is to describe this initiative and the participants' views about the approach.ResultsThe approach to improving priority setting using 'accountability for reasonableness' was viewed by district decision makers with enthusiastic favour because it was the first framework that directly addressed their priority setting concerns. High level Ministry of Health participants were also very supportive of the approach.ConclusionBoth Tanzanian district and governmental health planners viewed the 'accountability for reasonableness' approach with enthusiastic favour because it was the first framework that directly addressed their concerns.
Highlights
Priority setting in every health system is complex and difficult
In wealthy countries the dominant approach to priority setting has been Health Technology Assessment (HTA) – evidence based medicine and cost-effectiveness – which is helpful, but insufficient because HTA focuses on only a narrow range of values – benefit and efficiency – and not the full range of values that are relevant to priority setting, including legitimacy and fairness[1]
'Accountability for reasonableness' is a conceptual framework for legitimate and fair priority setting. It was developed in the context of U.S Health Maintenance Organizations [4], and so is relevant to real-world priority setting; it is theoretically grounded in justice theories emphasizing democratic deliberation [5,6]
Summary
Priority setting in every health system is complex and difficult. In less wealthy countries the dominant approach to priority setting has been Burden of Disease (BOD) and costeffectiveness analysis (CEA), which is helpful, but insufficient because it focuses on a narrow range of values – need and efficiency – and not the full range of relevant values, including legitimacy and fairness. In wealthy countries the dominant approach to priority setting has been Health Technology Assessment (HTA) – evidence based medicine and cost-effectiveness – which is helpful, but insufficient because HTA focuses on only a narrow range of values – benefit and efficiency – and not the full range of values that are relevant to priority setting, including legitimacy and fairness[1]. 'Accountability for reasonableness' is a conceptual framework for legitimate and fair priority setting It was developed in the context of U.S Health Maintenance Organizations [4], and so is relevant to real-world priority setting; it is theoretically grounded in justice theories emphasizing democratic deliberation [5,6]. Participation by the full range of stakeholders can ensure that the full range of relevant reasons are brought to the deliberations
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