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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Main Authors: Jens Byskov (Author), Stephen Oswald Maluka (Author), Bruno Marchal (Author), Elizabeth H. Shayo (Author), Salome Bukachi (Author), Joseph M. Zulu (Author), Erik Blas (Author), Charles Michelo (Author), Benedict Ndawi (Author), Anna-Karin Hurtig (Author)
Format: Book
Published: Kerman University of Medical Sciences, 2017-02-01T00:00:00Z.
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042 |a dc 
100 1 0 |a Jens Byskov  |e author 
700 1 0 |a Stephen Oswald Maluka  |e author 
700 1 0 |a Bruno Marchal  |e author 
700 1 0 |a Elizabeth H. Shayo  |e author 
700 1 0 |a Salome Bukachi  |e author 
700 1 0 |a Joseph M. Zulu  |e author 
700 1 0 |a Erik Blas  |e author 
700 1 0 |a Charles Michelo  |e author 
700 1 0 |a Benedict Ndawi  |e author 
700 1 0 |a Anna-Karin Hurtig  |e author 
245 0 0 |a The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes; Comment on "Expanded HTA: Enhancing Fairness and Legitimacy" 
260 |b Kerman University of Medical Sciences,   |c 2017-02-01T00:00:00Z. 
500 |a 10.15171/ijhpm.2016.106 
500 |a 2322-5939 
500 |a 2322-5939 
520 |a 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. 
546 |a EN 
690 |a Accountability 
690 |a Health Systems 
690 |a Values 
690 |a Fairness 
690 |a Legitimacy 
690 |a Sustainability 
690 |a Democratic Development 
690 |a Public aspects of medicine 
690 |a RA1-1270 
655 7 |a article  |2 local 
786 0 |n International Journal of Health Policy and Management, Vol 6, Iss 2, Pp 115-118 (2017) 
787 0 |n http://www.ijhpm.com/article_3252_b9f2e625d1caa0d401124df4b2536c9a.pdf 
787 0 |n https://doaj.org/toc/2322-5939 
787 0 |n https://doaj.org/toc/2322-5939 
856 4 1 |u https://doaj.org/article/f0edd604e4f64a6bb3ac9aae28a9fb1a  |z Connect to this object online.