IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v91y2009i1p33-42.html
   My bibliography  Save this article

Is the selection of patients for anti-retroviral treatment in Uganda fair?: A qualitative study

Author

Listed:
  • Sofaer, Neema
  • Kapiriri, Lydia
  • Atuyambe, Lynn M.
  • Otolok-Tanga, Erasmus
  • Norheim, Ole Frithjof

Abstract

Objective To evaluate decisions selecting patients for anti-retroviral treatment (ART) in Uganda.Methods We held 39 semi-structured interviews with 41 health professionals holding various selection roles and 5 focus groups with 47 HIV/AIDS patients in diverse ART programs. Decisions were evaluated using accountability for reasonableness (A4R). A4R considers a decision fair when those whom it affects can know the decision and its complete rationale (Publicity), can consider the rationale relevant (Relevance) and can appeal against the decision (Appeals), and each of these conditions - Publicity, Relevance and Appeals - is enforced (Enforcement).Results All ART candidates were told whether, and many were also told why they could receive ART or not. Programs used various means to promote candidates' understanding. Many, but not all, rationales could be considered relevant. Appeal mechanisms existed but were not used to challenge selection decisions or criteria, which were considered unchangeable. There was enforcement of criteria but insufficient enforcement of Publicity and Relevance, and none of Appeals.Conclusion Decisions are insufficiently fair and legitimate. Effective mechanisms should be created for appeals, enforcement, and communication of complete rationales. Nonetheless, decisions and rationales are available, and criteria applied even-handedly. Such aspects are a benchmark for less adequate decision-making reported elsewhere.

Suggested Citation

  • Sofaer, Neema & Kapiriri, Lydia & Atuyambe, Lynn M. & Otolok-Tanga, Erasmus & Norheim, Ole Frithjof, 2009. "Is the selection of patients for anti-retroviral treatment in Uganda fair?: A qualitative study," Health Policy, Elsevier, vol. 91(1), pages 33-42, June.
    • Handle: RePEc:eee:hepoli:v:91:y:2009:i:1:p:33-42
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168-8510(08)00237-6
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. McGough, L.J. & Reynolds, S.J. & Quinn, T.C. & Zenilman, J.M., 2005. "Which patients first? Setting priorities for antiretroviral therapy where resources are limited," American Journal of Public Health, American Public Health Association, vol. 95(7), pages 1173-1180.
    2. Kapiriri, Lydia & Norheim, Ole Frithjof & Martin, Douglas K., 2007. "Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda," Health Policy, Elsevier, vol. 82(1), pages 78-94, June.
    3. Martin, Douglas K. & Hollenberg, Daniel & MacRae, Sue & Madden, Shannon & Singer, Peter, 2003. "Priority setting in a hospital drug formulary: a qualitative case study and evaluation," Health Policy, Elsevier, vol. 66(3), pages 295-303, December.
    4. Walton, Nancy A. & Martin, Douglas K. & Peter, Elizabeth H. & Pringle, Dorothy M. & Singer, Peter A., 2007. "Priority setting and cardiac surgery: A qualitative case study," Health Policy, Elsevier, vol. 80(3), pages 444-458, March.
    5. Daniels, Norman & Sabin, James E., 2002. "Setting Limits Fairly: Can we learn to share medical resources?," OUP Catalogue, Oxford University Press, number 9780195149364.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Razavi, S. Donya & Kapiriri, Lydia & Wilson, Michael & Abelson, Julia, 2020. "Applying priority-setting frameworks: A review of public and vulnerable populations’ participation in health-system priority setting," Health Policy, Elsevier, vol. 124(2), pages 133-142.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. 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.
    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. 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.
    4. Kapiriri, Lydia & Razavi, Donya, 2017. "How have systematic priority setting approaches influenced policy making? A synthesis of the current literature," Health Policy, Elsevier, vol. 121(9), pages 937-946.
    5. Mitton, Craig R. & McMahon, Meghan & Morgan, Steve & Gibson, Jennifer, 2006. "Centralized drug review processes: Are they fair?," Social Science & Medicine, Elsevier, vol. 63(1), pages 200-211, July.
    6. Regier, Dean A. & Bentley, Colene & Mitton, Craig & Bryan, Stirling & Burgess, Michael M. & Chesney, Ellen & Coldman, Andy & Gibson, Jennifer & Hoch, Jeffrey & Rahman, Syed & Sabharwal, Mona & Sawka, , 2014. "Public engagement in priority-setting: Results from a pan-Canadian survey of decision-makers in cancer control," Social Science & Medicine, Elsevier, vol. 122(C), pages 130-139.
    7. Gregory Merlo & Katie Page & Pauline Zardo & Nicholas Graves, 2019. "Applying an Implementation Framework to the Use of Evidence from Economic Evaluations in Making Healthcare Decisions," Applied Health Economics and Health Policy, Springer, vol. 17(4), pages 533-543, August.
    8. Cappelen, Alexander W. & Norheim, Ole Frithjof, 2006. "Responsibility, fairness and rationing in health care," Health Policy, Elsevier, vol. 76(3), pages 312-319, May.
    9. Askildsen, Jan Erik & Holmås, Tor Helge & Kaarboe, Oddvar, 2010. "Prioritization and patients' rights: Analysing the effect of a reform in the Norwegian hospital sector," Social Science & Medicine, Elsevier, vol. 70(2), pages 199-208, January.
    10. Dale, Elina & Peacocke, Elizabeth F. & Movik, Espen & Voorhoeve, Alex & Ottersen, Trygve & Kurowski, Christoph & Evans, David B. & Norheim, Ole Frithjof & Gopinathan, Unni, 2023. "Criteria for the procedural fairness of health financing decisions: a scoping review," LSE Research Online Documents on Economics 119799, London School of Economics and Political Science, LSE Library.
    11. Wilson, Nicholas, 2016. "Antiretroviral therapy and demand for HIV testing: Evidence from Zambia," Economics & Human Biology, Elsevier, vol. 21(C), pages 221-240.
    12. Michael Drummond & Adrian Towse, 2014. "Orphan drugs policies: a suitable case for treatment," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(4), pages 335-340, May.
    13. Jenny von Platten & Karl de Fine Licht & Mikael Mangold & Kristina Mjörnell, 2021. "Renovating on Unequal Premises: A Normative Framework for a Just Renovation Wave in Swedish Multifamily Housing," Energies, MDPI, vol. 14(19), pages 1-32, September.
    14. Chris Sampson & Bernarda Zamora & Sam Watson & John Cairns & Kalipso Chalkidou & Patricia Cubi-Molla & Nancy Devlin & Borja García-Lorenzo & Dyfrig A. Hughes & Ashley A. Leech & Adrian Towse, 2022. "Supply-Side Cost-Effectiveness Thresholds: Questions for Evidence-Based Policy," Applied Health Economics and Health Policy, Springer, vol. 20(5), pages 651-667, September.
    15. Katharina Böhm & Claudia Landwehr & Nils Steiner, 2017. "What Explains Generosity in the Public Financing of High-Tech Drugs? An Empirical Investigation for 25 OECD Countries and 11 Controversial Drugs," Working Papers 1708, Gutenberg School of Management and Economics, Johannes Gutenberg-Universität Mainz.
    16. Jennifer Whitty & Paul Scuffham & Sharyn Rundle-Thielee, 2011. "Public and decision maker stated preferences for pharmaceutical subsidy decisions," Applied Health Economics and Health Policy, Springer, vol. 9(2), pages 73-79, March.
    17. Erik Nord & Anja Undrum Enge & Veronica Gundersen, 2010. "QALYs: is the value of treatment proportional to the size of the health gain?," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 596-607, May.
    18. Ahumada-Canale, Antonio & Jeet, Varinder & Bilgrami, Anam & Seil, Elizabeth & Gu, Yuanyuan & Cutler, Henry, 2023. "Barriers and facilitators to implementing priority setting and resource allocation tools in hospital decisions: A systematic review," Social Science & Medicine, Elsevier, vol. 322(C).
    19. Hipgrave, David B. & Alderman, Katarzyna Bolsewicz & Anderson, Ian & Soto, Eliana Jimenez, 2014. "Health sector priority setting at meso-level in lower and middle income countries: Lessons learned, available options and suggested steps," Social Science & Medicine, Elsevier, vol. 102(C), pages 190-200.
    20. Brayan V. Seixas & François Dionne & Craig Mitton, 2021. "Practices of decision making in priority setting and resource allocation: a scoping review and narrative synthesis of existing frameworks," Health Economics Review, Springer, vol. 11(1), pages 1-11, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:91:y:2009:i:1:p:33-42. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.