IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v71y2010i4p751-759.html
   My bibliography  Save this article

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

Author

Listed:
  • 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.

Suggested Citation

  • 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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(10)00384-9
    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. 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.
    2. Martin, Douglas K. & Giacomini, Mita & Singer, Peter A., 2002. "Fairness, accountability for reasonableness, and the views of priority setting decision-makers," Health Policy, Elsevier, vol. 61(3), pages 279-290, September.
    3. Gibson, Jennifer L. & Martin, Douglas K. & Singer, Peter A., 2005. "Priority setting in hospitals: Fairness, inclusiveness, and the problem of institutional power differences," Social Science & Medicine, Elsevier, vol. 61(11), pages 2355-2362, December.
    4. Gruskin, S. & Daniels, N., 2008. "Process is the point - Justice and human rights: Priority setting and fair deliberative process," American Journal of Public Health, American Public Health Association, vol. 98(9), pages 1573-1577.
    5. Reeleder, David & Goel, Vivek & Singer, Peter A. & Martin, Douglas K., 2006. "Leadership and priority setting: The perspective of hospital CEOs," Health Policy, Elsevier, vol. 79(1), pages 24-34, November.
    6. 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.
    7. Abelson, Julia, 2001. "Understanding the role of contextual influences on local health-care decision making: case study results from Ontario, Canada," Social Science & Medicine, Elsevier, vol. 53(6), pages 777-793, September.
    8. Daniels, Norman & Sabin, James E., 2002. "Setting Limits Fairly: Can we learn to share medical resources?," OUP Catalogue, Oxford University Press, number 9780195149364.
    9. 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.
    10. Menon, Devidas & Stafinski, Tania & Martin, Douglas, 2007. "Priority-setting for healthcare: Who, how, and is it fair?," Health Policy, Elsevier, vol. 84(2-3), pages 220-233, December.
    11. Mitton, Craig & Donaldson, Cam, 2002. "Setting priorities in Canadian regional health authorities: a survey of key decision makers," Health Policy, Elsevier, vol. 60(1), pages 39-58, April.
    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. 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. 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).
    5. 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.
    6. 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.

    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. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. Gallagher, Siun & Little, Miles, 2019. "Procedural justice and the individual participant in priority setting: Doctors' experiences," Social Science & Medicine, Elsevier, vol. 228(C), pages 75-84.
    7. 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.
    8. 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.
    9. Reeleder, David & Goel, Vivek & Singer, Peter A. & Martin, Douglas K., 2006. "Leadership and priority setting: The perspective of hospital CEOs," Health Policy, Elsevier, vol. 79(1), pages 24-34, November.
    10. Madden, Shannon & Martin, Douglas K. & Downey, Sarah & Singer, Peter A., 2005. "Hospital priority setting with an appeals process: a qualitative case study and evaluation," Health Policy, Elsevier, vol. 73(1), pages 10-20, July.
    11. Petricca, Kadia & Bekele, Asfaw & Berta, Whitney & Gibson, Jennifer & Pain, Clare, 2018. "Advancing methods for health priority setting practice through the contribution of systems theory: Lessons from a case study in Ethiopia," Social Science & Medicine, Elsevier, vol. 198(C), pages 165-174.
    12. 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.
    13. Kleinhout-Vliek, Tineke & de Bont, Antoinette & Boer, Bert, 2017. "The bare necessities? A realist review of necessity argumentations used in health care coverage decisions," Health Policy, Elsevier, vol. 121(7), pages 731-744.
    14. Pivik, Jayne & Rode, Elisabeth & Ward, Christopher, 2004. "A consumer involvement model for health technology assessment in Canada," Health Policy, Elsevier, vol. 69(2), pages 253-268, August.
    15. Abelson, Julia & Forest, Pierre-Gerlier & Eyles, John & Casebeer, Ann & Martin, Elisabeth & Mackean, Gail, 2007. "Examining the role of context in the implementation of a deliberative public participation experiment: Results from a Canadian comparative study," Social Science & Medicine, Elsevier, vol. 64(10), pages 2115-2128, May.
    16. Robinson, Suzanne & Williams, Iestyn & Dickinson, Helen & Freeman, Tim & Rumbold, Benedict, 2012. "Priority-setting and rationing in healthcare: Evidence from the English experience," Social Science & Medicine, Elsevier, vol. 75(12), pages 2386-2393.
    17. Malcolm Oswald, 2015. "In a democracy, what should a healthcare system do? A dilemma for public policymakers," Politics, Philosophy & Economics, , vol. 14(1), pages 23-52, February.
    18. Smith, Neale & Mitton, Craig & Hall, William & Bryan, Stirling & Donaldson, Cam & Peacock, Stuart & Gibson, Jennifer L. & Urquhart, Bonnie, 2016. "High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context," Social Science & Medicine, Elsevier, vol. 162(C), pages 185-192.
    19. Rosenberg-Yunger, Zahava R.S. & Bayoumi, Ahmed M., 2014. "Transparency in Canadian public drug advisory committees," Health Policy, Elsevier, vol. 118(2), pages 255-263.
    20. Gallego, Gisselle & Taylor, Susan Joyce & Brien, Jo-anne Elizabeth, 2007. "Priority setting for high cost medications (HCMs) in public hospitals in Australia: A case study," Health Policy, Elsevier, vol. 84(1), pages 58-66, November.

    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:socmed:v:71:y:2010:i:4:p:751-759. 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 (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    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.