Invited Commentary: Legitimacy and fairness in priority setting in Tanzania

Abstract

Every health system has to make decisions about how to use limited resources to meet competing claims about diverse health needs. In all systems, national priority setting, including budgeting, generally imposes constraints on other levels of decision-making - be it in states or provinces, districts or cities, or local health authorities, hospitals, or health insurance plans. Decisions at any of these levels often are contested because they create winners and losers, sometimes on matters of life and death. Winners and losers have conflicting interests and claims. What is worse, we lack consensus on the distributive principles capable of resolving disputes about who should get what. Reasonable ethical disagreement thus surrounds these conflicts of claims and interests. In addition, our economic tools for resource allocation, such as costeffectiveness analysis have limited ethical acceptability, for they may controversially push us to maximize aggregate health benefits without adequate consideration of the fairness of the distribution that results.

(Published: 7 November 2011)

Citation: Global Health Action 2011, 4: 8472 - DOI: 10.3402/gha.v4i0.8472