Browsing by Author "Michelo, Charles"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    The Accountability for Reasonableness Approach to Guide Priority Setting in Health Systems Within Limited Resources – Findings From Action Research at District Level in Kenya, Tanzania, and Zambia
    (2014-12) Byskov, Jens; Marchal, Bruno; Maluka, Stephen; Zulu, Joseph M.; Bukachi, Salome A.; Hurtig, Anna-Karin; Blystad, Astrid; Kamuzora, Peter; Michelo, Charles; Nyandieka, Lilian N.; Ndawi, Benedict; Bloch, Paul; Olsen, Øystein E.; Consortium, React
    Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT).
  • Thumbnail Image
    Item
    Accountable Priority Setting for Trust in Health Systems - the Need for Research into a New Approach for Strengthening sustainable Health Action in Developing Countries
    (BioMed Central, 2009) ByskovEmail, Jens; Bloch, Paul; Blystad, Astrid; Hurtig, Anna-Karin; Fylkesnes, Knut; Kamuzora, Peter; Kombe, Yeri; Kvåle, Gunnar; Marchal, Bruno; Martin, Douglas K; Michelo, Charles; Ndawi, Benedict; Ngulube, Thabale J; Nyamongo, Isaac; Olsen, Øystein E; Onyango-Ouma, Washington; Sandøy, Ingvild F; Shayo, Elizabeth H; Silwamba, Gavin; Songstad, Nils G; Tuba, Mary
    Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed. Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must identify and consider the full range of relevant values. AFR consists of four conditions: i) relevance to the local setting, decided by agreed criteria; ii) publicizing priority-setting decisions and the reasons behind them; iii) the establishment of revisions/appeal mechanisms for challenging and revising decisions; iv) the provision of leadership to ensure that the first three conditions are met. REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study started in 2006, which is testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. The objectives of REACT are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by AFR and to measure their effect on quality, equity and trust indicators. Effects are monitored within selected disease and programme interventions and services and within human resources and health systems management. Qualitative and quantitative methods are being applied in an action research framework to examine the potential of AFR to support sustainable improvements to health systems performance. This paper reports on the project design and progress and argues that there is a high need for research into legitimate and fair priority setting to improve the knowledge base for achieving sustainable improvements in health outcomes.
  • Thumbnail Image
    Item
    A systems perspective on the importance of global health strategy developments for accomplishing today’s Sustainable Development Goals
    (Oxford University Press, 2019-07-30) Byskov, Jens; Maluka, Stephen; Marchal, Bruno; Shayo, Elizabeth; Blystad, Astrid; Bukachi, Salome; Zulu, Joseph; Michelo, Charles; Hurtig, Anna-Karin; Bloch, Paul
    Priority setting within health systems has not led to accountable, fair and sustainable solutions to improving population health. Providers, users and other stakeholders each have their own health and service priorities based on selected evidence, own values, expertise and preferences. Based on a historical account, this article analyses if contemporary health systems are appropriate to optimize population health within the framework of cross cutting targets of the Sustainable Development Goals (SDGs). We applied a scoping review approach to identify and review literature of scientific databases and other programmatic web and library-based documents on historical and contemporary health systems policies and strategies at the global level. Early literature supported the 1977 launching of the global target of Health for All by the year 2000. Reviewed literature was used to provide a historical overview of systems components of global health strategies through describing the conceptualizations of health determinants, user involvement and mechanisms of priority setting over time, and analysing the importance of historical developments on barriers and opportunities to accomplish the SDGs. Definitions, scope and application of health systems-associated priority setting fluctuated and main health determinants and user influence on global health systems and priority setting remained limited. In exploring reasons for the identified lack of SDG-associated health systems and priority setting processes, we discuss issues of accountability, vested interests, ethics and democratic legitimacy as conditional for future sustainability of population health. To accomplish the SDGs health systems must engage beyond their own sector boundary. New approaches to Health in All Policies and One Health may be conducive for scaling up more democratic and inclusive priority setting processes based on proper process guidelines from successful pilots. Sustainable development depends on population preferences supported by technical and managerial expertise.