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Improving district ...
Improving district level health planning and priority setting in Tanzania through implementing accountability for reasonableness framework : perceptions of stakeholders
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- Maluka, Stephen, 1978- (author)
- Umeå universitet,Epidemiologi och global hälsa,Institute of Development Studies, University of Dar Es Salaam, P.O. Box 35169 Dar Es Salaam, Tanzania
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- Kamuzora, Peter (author)
- Institute of Development Studies, University of Dar Es Salaam, P.O. Box 35169 Dar Es Salaam, Tanzania
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- San Sebastian, Miguel (author)
- Umeå universitet,Epidemiologi och global hälsa
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- Byskov, Jens (author)
- DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Thorvaldsensvej 57, DK 1871 Frederiksberg, Denmark
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- Ndawi, Benedict (author)
- Primary Health Care Institute (PHCI), P.O. Box 235, Iringa, Tanzania
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- Hurtig, Anna-Karin (author)
- Umeå universitet,Epidemiologi och global hälsa
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(creator_code:org_t)
- 2010-12-01
- 2010
- English.
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In: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 10, s. Article nr 322-
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Abstract
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- BACKGROUND: In 2006, researchers and decision-makers launched a five year project, Response to Accountable Priority Setting for Trust in Health Systems (REACT) to improve planning and priority setting through implementing the Accountability for Reasonableness framework in Mbarali District in Tanzania. The objective of this paper is to explore the acceptability of Accountability for Reasonableness from perspectives of the Council Health Management Team, local government officials, health workforce and members of user boards and committees.METHODS: Individual interviews were carried out with different categories of actors and stakeholders in the district. The interview guide consisted of a series of questions asking respondents to describe their perceptions regarding the applicability and feasibility of each condition of the Accountability for Reasonableness framework to priority setting. Interviews were analysed using thematic framework analysis. Documentary data was used to support, verify and highlight key issues that emerged.RESULTS: Almost all stakeholders viewed Accountability for Reasonableness as an important and feasible approach for improving priority setting and health service delivery in their context. However, a few aspects of the Accountability for Reasonableness framework were seen as difficult to implement given the socio-political conditions and traditions in Tanzania. Respondents mentioned budget ceilings and guidelines, low level of public awareness, unreliable and untimely funding as well as limited capacity of the district to generate local resources as the major contextual factors that hamper the full implementation of the framework in their context.CONCLUSION: This study was one of the first assessments of the applicability of Accountability for Reasonableness in health care priority setting in Tanzania. The analysis, overall, suggests that the Accountability for Reasonableness framework could be an important tool for improving priority-setting process in the contexts of resource poor settings. However, the full implementation of Accountability for Reasonableness framework would require a proper capacity-building plan to all relevant stakeholders, particularly members of the community since public accountability is the ultimate aim, and it is the public that will live with the consequences of priority setting decisions.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
Keyword
- Public health science
- Folkhälsovetenskap
- Public health
- folkhälsa
Publication and Content Type
- ref (subject category)
- art (subject category)
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