HIV priorities and health distributions in a rural region in Tanzania: a qualitative study.
BACKGROUND
International and national agencies play a major role in setting HIV care-and-treatment priorities in low-income-countries. Little is known about priority setting at lower health-system levels. The objective of this article is to explore experiences of HIV priority decisions, at what levels these decisions are made and how they might influence the distribution of health benefits in a high-endemic region in Tanzania.


METHODS
This is a qualitative study using observations, key documents and semistructured focus-group and individual interviews (43) with health workers, patients and administrators at one regional and one district hospital. The analysis was based on an editing analysis style.


RESULTS
Health workers did not perceive themselves as bedside rationing agents and they reported following national recommendations and felt they have little impact on important priority decisions. Health benefit distributions were largely determined by priority decisions made at a national level. External factors, such as eligibility criteria, inadequate funding and barriers to access seemed to play a major role in the actual distribution of health services and benefits in the region. Patient groups who were actually given high priority were the sickest patients, those living near a facility and those who could afford long journeys and frequent visits. Low-priority groups were those experiencing other co-morbidities or treatment failure, children, asymptomatic patients and the poorest.


CONCLUSIONS
The interaction of priority setting across health-system levels and their impact on distribution of health outcomes in the population has been underestimated. The distributional pattern of health outcomes calls for further normative assessment.
University of Bergen, Department of Public Health and Primary Health Care, PB 7804, 5020 Bergen, Norway. kjell.johansson@isf.uib.no
Kjell Arne
KA
Johansson
Ingrid
I
Miljeteig
Hamisi
H
Kigwangalla
Ole Frithjof
OF
Norheim
D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use*; D003657:Decision Making / Q000941:ethics*; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D015276:Health Care Rationing / Q000941:ethics / Q000458:organization & administration*; D006292:Health Priorities / Q000941:ethics / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000941:ethics / Q000458:organization & administration*; D006801:Humans; D036301:Qualitative Research; D012423:Rural Health; D013636:Tanzania
D044966:Anti-Retroviral Agents