title: Healthcare priority setting in Kenya: a gap analysis applying the accountability for reasonableness framework.
abstract: In resource-poor settings, the accountability for reasonableness (A4R) has been identified as an important advance in priority setting that helps to operationalize fair priority setting in specific contexts. The four conditions of A4R are backed by theory, not evidence, that conformance with them improves the priority setting decisions. This paper describes the healthcare priority setting processes in Malindi district, Kenya, prior to the implementation of A4R in 2008 and evaluates the process for its conformance with the conditions for A4R. In-depth interviews and focus group discussions with key players in the Malindi district health system and a review of key policy documents and national guidelines show that the priority setting process in the district relies heavily on guidelines from the national level, making it more of a vertical, top-down orientation. Multilateral and donor agencies, national government, budgetary requirements, traditions and local culture influence the process. The four conditions of A4R are present within the priority setting process, albeit to varying degrees and referred to by different terms. There exists an opportunity for A4R to provide a guiding approach within which its four conditions can be strengthened and assessed to establish whether conformance helps improve on the priority setting process.
authors.affiliation: Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya.
authors.forename: Salome A
authors.initials: SA
authors.lastname: Bukachi
authors.forename: Washington
authors.initials: W
authors.lastname: Onyango-Ouma
authors.forename: Jared Maaka
authors.initials: JM
authors.lastname: Siso
authors.forename: Isaac K
authors.initials: IK
authors.lastname: Nyamongo
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Mutai
authors.forename: Anna Karin
authors.initials: AK
authors.lastname: Hurtig
authors.forename: Oystein Evjen
authors.initials: OE
authors.lastname: Olsen
authors.forename: Jens
authors.initials: J
authors.lastname: Byskov
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D017144:Focus Groups; D006291:Health Policy; D006292:Health Priorities; D006295:Health Resources; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D012040:Regional Health Planning; D012941:Social Responsibility
keywords: Kenya; accountability for reasonableness; healthcare; priority setting