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Decentralized health care priority-setting in Tanzania: Evaluating against the accountability for reasonableness framework

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  • Maluka, Stephen
  • Kamuzora, Peter
  • Sebastiån, Miguel San
  • Byskov, Jens
  • Olsen, Øystein E.
  • Shayo, Elizabeth
  • Ndawi, Benedict
  • Hurtig, Anna-Karin

Abstract

Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level in the contexts of low-income countries. Second, it provides guidance to decision-makers on how to improve fairness, legitimacy, and sustainability of the priority-setting process.

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  • Maluka, Stephen & Kamuzora, Peter & Sebastiån, Miguel San & Byskov, Jens & Olsen, Øystein E. & Shayo, Elizabeth & Ndawi, Benedict & Hurtig, Anna-Karin, 2010. "Decentralized health care priority-setting in Tanzania: Evaluating against the accountability for reasonableness framework," Social Science & Medicine, Elsevier, vol. 71(4), pages 751-759, August.
    • Handle: RePEc:eee:socmed:v:71:y:2010:i:4:p:751-759
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    1. Kapiriri, Lydia & Norheim, Ole F. & Martin, Douglas K., 2009. "Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making?," Social Science & Medicine, Elsevier, vol. 68(4), pages 766-773, February.
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    1. Pratt, Bridget & Merritt, Maria & Hyder, Adnan A., 2016. "Towards deep inclusion for equity-oriented health research priority-setting: A working model," Social Science & Medicine, Elsevier, vol. 151(C), pages 215-224.
    2. Salome A. Bukachi & Washington Onyango-Ouma & Jared Maaka Siso & Isaac K. Nyamongo & Joseph K. Mutai & Anna Karin Hurtig & Øystein Evjen Olsen & Jens Byskov, 2014. "Healthcare priority setting in Kenya: a gap analysis applying the accountability for reasonableness framework," International Journal of Health Planning and Management, Wiley Blackwell, vol. 29(4), pages 342-361, October.
    3. Zacharia S. Masanyiwa & Anke Niehof & Catrien J. A. M. Termeer, 2015. "A gendered users′ perspective on decentralized primary health services in rural Tanzania," International Journal of Health Planning and Management, Wiley Blackwell, vol. 30(3), pages 285-306, July.
    4. Enisha Sarin & Nitin Bisht & Jaya Swarup Mohanty & Naresh Chandra Joshi & Arvind Kumar & Surajit Dey & Harish Kumar, 2021. "Putting the local back into planning‐experiences and perceptions of state and district health functionaries of seven aspirational districts in India on an innovative planning capacity building approac," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(6), pages 2248-2262, November.
    5. Mohammed Rafique Moosa & Jonathan David Maree & Maxwell T Chirehwa & Solomon R Benatar, 2016. "Use of the ‘Accountability for Reasonableness’ Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-16, October.
    6. Schoon, Rebecca & Chi, Chunhuei, 2022. "Integrating Citizens Juries and Discrete Choice Experiments: Methodological issues in the measurement of public values in healthcare priority setting," Social Science & Medicine, Elsevier, vol. 309(C).

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