Healthcare priority setting in Kenya: a gap analysis applying the accountability for reasonableness framework
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Healthcare priority setting in Kenya : a gap analysis applying the accountability for reasonableness framework. / Bukachi, Salome A.; Onyango-Ouma, Washington; Siso, Jared Maaka; Nyamongo, Isaac K.; Mutai, Joseph K.; Hurtig, Anna Karin; Olsen, Øystein Evjen; Byskov, Jens.
In: International Journal of Health Planning and Management, Vol. 29, No. 4, 2014, p. 342-361.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Healthcare priority setting in Kenya
T2 - a gap analysis applying the accountability for reasonableness framework
AU - Bukachi, Salome A.
AU - Onyango-Ouma, Washington
AU - Siso, Jared Maaka
AU - Nyamongo, Isaac K.
AU - Mutai, Joseph K.
AU - Hurtig, Anna Karin
AU - Olsen, Øystein Evjen
AU - Byskov, Jens
N1 - Copyright © 2013 John Wiley & Sons, Ltd.
PY - 2014
Y1 - 2014
N2 - 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. Copyright © 2013 John Wiley & Sons, Ltd.
AB - 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. Copyright © 2013 John Wiley & Sons, Ltd.
KW - Former LIFE faculty
KW - Pirority setting
KW - Accountability for reasonableness
KW - Healthcare
KW - Kenya
U2 - 10.1002/hpm.2197
DO - 10.1002/hpm.2197
M3 - Journal article
C2 - 23775594
VL - 29
SP - 342
EP - 361
JO - International Journal of Health Planning and Management
JF - International Journal of Health Planning and Management
SN - 0749-6753
IS - 4
ER -
ID: 46428024