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

Research output: Contribution to journalJournal articleResearchpeer-review

Standard

Decentralized health care priority-setting in Tanzania : evaluating against the accountability for reasonableness framework. / Maluka, Stephen; Kamuzora, Peter; Sebastiån, Miguel San; Byskov, Jens; Olsen, Øystein Evjen; Shayo, Elizabeth; Ndawi, Benedict; Hurtig, Anna-Karin.

In: Social Science & Medicine, Vol. 71, No. 4, 2010, p. 751-759.

Research output: Contribution to journalJournal articleResearchpeer-review

Harvard

Maluka, S, Kamuzora, P, Sebastiån, MS, Byskov, J, Olsen, ØE, Shayo, E, Ndawi, B & Hurtig, A-K 2010, 'Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework', Social Science & Medicine, vol. 71, no. 4, pp. 751-759. https://doi.org/10.1016/j.socscimed.2010.04.035

APA

Maluka, S., Kamuzora, P., Sebastiån, M. S., Byskov, J., Olsen, Ø. E., Shayo, E., ... Hurtig, A-K. (2010). Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework. Social Science & Medicine, 71(4), 751-759. https://doi.org/10.1016/j.socscimed.2010.04.035

Vancouver

Maluka S, Kamuzora P, Sebastiån MS, Byskov J, Olsen ØE, Shayo E et al. Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework. Social Science & Medicine. 2010;71(4):751-759. https://doi.org/10.1016/j.socscimed.2010.04.035

Author

Maluka, Stephen ; Kamuzora, Peter ; Sebastiån, Miguel San ; Byskov, Jens ; Olsen, Øystein Evjen ; Shayo, Elizabeth ; Ndawi, Benedict ; Hurtig, Anna-Karin. / Decentralized health care priority-setting in Tanzania : evaluating against the accountability for reasonableness framework. In: Social Science & Medicine. 2010 ; Vol. 71, No. 4. pp. 751-759.

Bibtex

@article{d298dd00d08711df825b000ea68e967b,
title = "Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework",
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.",
keywords = "Former LIFE faculty, Decentralization, Priority-setting, Accountability for reasonableness, Tanzania, Health systems",
author = "Stephen Maluka and Peter Kamuzora and Sebasti{\aa}n, {Miguel San} and Jens Byskov and Olsen, {{\O}ystein Evjen} and Elizabeth Shayo and Benedict Ndawi and Anna-Karin Hurtig",
note = "(c) 2010 Elsevier Ltd. All rights reserved.",
year = "2010",
doi = "10.1016/j.socscimed.2010.04.035",
language = "English",
volume = "71",
pages = "751--759",
journal = "Social Science & Medicine",
issn = "0277-9536",
publisher = "Pergamon Press",
number = "4",

}

RIS

TY - JOUR

T1 - Decentralized health care priority-setting in Tanzania

T2 - evaluating against the accountability for reasonableness framework

AU - Maluka, Stephen

AU - Kamuzora, Peter

AU - Sebastiån, Miguel San

AU - Byskov, Jens

AU - Olsen, Øystein Evjen

AU - Shayo, Elizabeth

AU - Ndawi, Benedict

AU - Hurtig, Anna-Karin

N1 - (c) 2010 Elsevier Ltd. All rights reserved.

PY - 2010

Y1 - 2010

N2 - 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.

AB - 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.

KW - Former LIFE faculty

KW - Decentralization

KW - Priority-setting

KW - Accountability for reasonableness

KW - Tanzania

KW - Health systems

U2 - 10.1016/j.socscimed.2010.04.035

DO - 10.1016/j.socscimed.2010.04.035

M3 - Journal article

VL - 71

SP - 751

EP - 759

JO - Social Science & Medicine

JF - Social Science & Medicine

SN - 0277-9536

IS - 4

ER -

ID: 22360701