The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”
The accountability for reasonableness (AFR) concept has been developed and discussed for over two decades. Its interpretation has been studied in several ways partly guided by the specific settings and the researchers involved. This has again influenced the development of the concept, but not led to...
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| Format: | Article |
| Language: | English |
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Kerman University of Medical Sciences
2017-02-01
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| Series: | International Journal of Health Policy and Management |
| Subjects: | |
| Online Access: | http://www.ijhpm.com/article_3252_b9f2e625d1caa0d401124df4b2536c9a.pdf |
| _version_ | 1819032990112546816 |
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| author | Jens Byskov Stephen Oswald Maluka Bruno Marchal Elizabeth H. Shayo Salome Bukachi Joseph M. Zulu Erik Blas Charles Michelo Benedict Ndawi Anna-Karin Hurtig |
| author_facet | Jens Byskov Stephen Oswald Maluka Bruno Marchal Elizabeth H. Shayo Salome Bukachi Joseph M. Zulu Erik Blas Charles Michelo Benedict Ndawi Anna-Karin Hurtig |
| author_sort | Jens Byskov |
| collection | DOAJ |
| description | The accountability for reasonableness (AFR) concept has been developed and discussed for over two decades. Its interpretation has been studied in several ways partly guided by the specific settings and the researchers involved. This has again influenced the development of the concept, but not led to universal application. The potential use in health technology assessments (HTAs) has recently been identified by Daniels et al as yet another excellent justification for AFR-based process guidance that refers to both qualitative and a broader participatory input for HTA, but it has raised concerns from those who primarily support the consistency and objectivity of more quantitative and reproducible evidence. With reference to studies of AFR-based interventions and the through these repeatedly documented motivation for their consolidation, we argue that it can even be unethical not to take AFR conditions beyond their still mainly formative stage and test their application within routine health systems management for their expected support to more sustainable health improvements. The ever increasing evidence and technical expertise are necessary but at times contradictory and do not in isolation lead to optimally accountable, fair and sustainable solutions. Technical experts, politicians, managers, service providers, community members, and beneficiaries each have their own values, expertise and preferences, to be considered for necessary buy in and sustainability. Legitimacy, accountability and fairness do not come about without an inclusive and agreed process guidance that can reconcile differences of opinion and indeed differences in evidence to arrive at a by all understood, accepted, but not necessarily agreed compromise in a current context - until major premises for the decision change. AFR should be widely adopted in projects and services under close monitoring and frequent reviews. |
| first_indexed | 2024-12-21T07:10:43Z |
| format | Article |
| id | doaj.art-f0edd604e4f64a6bb3ac9aae28a9fb1a |
| institution | Directory Open Access Journal |
| issn | 2322-5939 2322-5939 |
| language | English |
| last_indexed | 2024-12-21T07:10:43Z |
| publishDate | 2017-02-01 |
| publisher | Kerman University of Medical Sciences |
| record_format | Article |
| series | International Journal of Health Policy and Management |
| spelling | doaj.art-f0edd604e4f64a6bb3ac9aae28a9fb1a2022-12-21T19:11:59ZengKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59392322-59392017-02-016211511810.15171/ijhpm.2016.106The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”Jens Byskov0Stephen Oswald Maluka1Bruno Marchal2Elizabeth H. Shayo3Salome Bukachi4Joseph M. Zulu5Erik Blas6Charles Michelo7Benedict Ndawi8Anna-Karin Hurtig9Department of Public Health, University of Zambia, Lusaka, ZambiaInstitute of Development Studies, University of Dar Es Salaam, Dar Es Salaam, TanzaniaDepartment of Public Health, Institute of Tropical Medicine, Antwerpen, BelgiumNational Institute of Medical Research (NIMR), Dar Es Salaam, TanzaniaInstitute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, KenyaDepartment of Public Health, School of Medicine, University of Zambia, Lusaka, ZambiaInternational Public Health Consultant, Copenhagen, DenmarkDepartment of Public Health, School of Medicine, University of Zambia, Lusaka, ZambiaPrimary Health Care Institute (PHCI), Iringa, TanzaniaUmeå International School of Public Health, Umeå University, Umeå, SwedenThe accountability for reasonableness (AFR) concept has been developed and discussed for over two decades. Its interpretation has been studied in several ways partly guided by the specific settings and the researchers involved. This has again influenced the development of the concept, but not led to universal application. The potential use in health technology assessments (HTAs) has recently been identified by Daniels et al as yet another excellent justification for AFR-based process guidance that refers to both qualitative and a broader participatory input for HTA, but it has raised concerns from those who primarily support the consistency and objectivity of more quantitative and reproducible evidence. With reference to studies of AFR-based interventions and the through these repeatedly documented motivation for their consolidation, we argue that it can even be unethical not to take AFR conditions beyond their still mainly formative stage and test their application within routine health systems management for their expected support to more sustainable health improvements. The ever increasing evidence and technical expertise are necessary but at times contradictory and do not in isolation lead to optimally accountable, fair and sustainable solutions. Technical experts, politicians, managers, service providers, community members, and beneficiaries each have their own values, expertise and preferences, to be considered for necessary buy in and sustainability. Legitimacy, accountability and fairness do not come about without an inclusive and agreed process guidance that can reconcile differences of opinion and indeed differences in evidence to arrive at a by all understood, accepted, but not necessarily agreed compromise in a current context - until major premises for the decision change. AFR should be widely adopted in projects and services under close monitoring and frequent reviews.http://www.ijhpm.com/article_3252_b9f2e625d1caa0d401124df4b2536c9a.pdfAccountabilityHealth SystemsValuesFairnessLegitimacySustainabilityDemocratic Development |
| spellingShingle | Jens Byskov Stephen Oswald Maluka Bruno Marchal Elizabeth H. Shayo Salome Bukachi Joseph M. Zulu Erik Blas Charles Michelo Benedict Ndawi Anna-Karin Hurtig The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy” International Journal of Health Policy and Management Accountability Health Systems Values Fairness Legitimacy Sustainability Democratic Development |
| title | The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy” |
| title_full | The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy” |
| title_fullStr | The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy” |
| title_full_unstemmed | The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy” |
| title_short | The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy” |
| title_sort | need for global application of the accountability for reasonableness approach to support sustainable outcomes comment on expanded hta enhancing fairness and legitimacy |
| topic | Accountability Health Systems Values Fairness Legitimacy Sustainability Democratic Development |
| url | http://www.ijhpm.com/article_3252_b9f2e625d1caa0d401124df4b2536c9a.pdf |
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