What do district health planners in Tanzania think about improving priority setting using 'Accountability for reasonableness'?
BACKGROUND
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 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?


METHODS
In 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.


RESULTS
The 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.


CONCLUSIONS
Both 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.
Mshana
Simon
S
Department of Health Policy, Management and Evaluation and the Joint Centre for Bioethics, University of Toronto, Toronto, Canada. douglas.martin@utoronto.ca
Shemilu
Haji
H
Ndawi
Benedict
B
Momburi
Roman
R
Olsen
Oystein Evjen
OE
Byskov
Jens
J
Martin
Douglas K
DK
D001291:Attitude of Health Personnel; D003659:Decision Making, Organizational; D004991:Ethics, Institutional; D006292:Health Priorities / Q000145:classification / Q000941:ethics*; D006801:Humans; D007407:Interviews as Topic; D009937:Organizational Objectives; D011050:Policy Making; D011635:Public Health Administration / Q000941:ethics*; D040841:Resource Allocation / Q000941:ethics*; D012935:Social Justice; D012941:Social Responsibility; D011795:Surveys and Questionnaires; D013636:Tanzania