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      Criteria for priority-setting in health care in Uganda: exploration of stakeholders' values Translated title: Criterios para el establecimiento de prioridades en la atención de salud en Uganda: estudio de los valores de los interesados directos Translated title: Critères de fixation des priorités en matière de soins de santé en Ouganda: échelle de valeurs

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          Abstract

          OBJECTIVE: To explore stakeholders' acceptance of criteria for setting priorities for the health care system in Uganda. METHODS: A self-administered questionnaire was used. It was distributed to health workers, planners and administrators working in all levels of the Ugandan health care system. It was also distributed to members of the public. Participants were asked how strongly they agreed or disagreed with 18 criteria that could be used to set priorities for allocating health care. A total of 408 people took part . Data were entered and analysed using SPSS statistical software. Predetermined cut-off points were used to rank the criteria into three different categories: high weight (>66% of respondents agreed), average weight (33-66% of respondents agreed) and low weight (<33% of respondents agreed). We also tested for associations between respondents' characteristics and their degree of agreement with the criteria. FINDINGS: High-weight criteria included severity of disease, benefit of the intervention, cost of the intervention, cost-effectiveness of the intervention, quality of the data on effectiveness, the patients age, place of residence, lifestyle, importance of providing equity of access to health care and the community's views. The average-weight criteria included the patient's social status, mental features, physical capabilities, political views, responsibilities for others and gender. Low-weight criteria included the patient's religion, and power and influence. There were few associations between respondents' characteristics and their preferences. CONCLUSION: There was a high degree of acceptance for commonly used disease-related and society-related criteria. There was less agreement about the patient-related criteria. We propose that average-weight criteria should be debated in Uganda and other countries facing the challenge of distributing scarce health care resources.

          Translated abstract

          OBJETIVO: Estudiar la aceptación por parte de los interesados directos de los criterios de establecimiento de prioridades para el sistema de atención sanitaria de Uganda. MÉTODOS: Se distribuyó un autocuestionario entre los trabajadores de salud, planificadores y administradores que trabajaban en todos los niveles del sistema de atención sanitaria de Uganda. El cuestionario se distribuyó también entre el público. Se preguntó a los participantes en qué medida estaban de acuerdo con 18 criterios de establecimiento de prioridades para distribuir la atención de salud. Participaron en total 408 personas. Los datos fueron introducidos y analizados mediante el software estadístico SPSS, y se usaron puntos críticos predeterminados para clasificar los criterios en tres categorías diferentes: ponderación alta (estaban de acuerdo más del 66% de los encuestados), ponderación media (estaba de acuerdo un 33%-66% de los encuestados) y ponderación baja (estaban de acuerdo menos del 33% de los encuestados). También analizamos la existencia de relaciones entre las características de los encuestados y su grado de coincidencia con los criterios. RESULTADOS: Consiguieron una ponderación alta los siguientes criterios: gravedad de las enfermedades, beneficios de la intervención, costo de la intervención, costoeficacia de la intervención, calidad de los datos de eficacia, edad del paciente, lugar de residencia, estilo de vida, importancia de asegurar la equidad del acceso a la atención de salud, y opiniones de la comunidad. Los criterios que consiguieron una ponderación media incluyeron el estatus social del paciente, su condición mental, su capacidad física, las opiniones políticas, sus responsabilidades para con otros, y el sexo. Los criterios con baja ponderación fueron la religión del paciente, y su poder e influencia. Se observó una escasa relación enrtre las características de los entrevistados y sus preferencias. CONCLUSIÓN: Se detectó un alto grado de aceptación para los criterios de uso común relacionados con las enfermedades y con la sociedad. Hubo menos acuerdo en cambio por lo que se refiere a los criterios relacionados con el paciente. Proponemos que los criterios de ponderación media sean objeto de debate en Uganda y en otros países que afrontan hoy el reto de distribuir unos recursos sanitarios escasos.

          Translated abstract

          OBJECTIF: Evaluer auprès des intéressés le degré d'accord sur les critères de fixation des priorités concernant le système de soins de santé en Ouganda. MÉTHODES: Un questionnaire autoadministré a été distribué aux agents de santé, aux planificateurs et aux administrateurs sanitaires occupant des fonctions à tous les niveaux du système de soins de santé ougandais. Le questionnaire a été également distribué au grand public. Il a été demandé aux participants d'indiquer dans quelle mesure ils étaient d'accord ou non sur les 18 critères qui pourraient être utilisés pour fixer les priorités concernant la répartition des soins de santé. Au total, 408 personnes ont participé à l'étude. Les données ont été saisies et analysées en utilisant le logiciel statistique SPSS. On a préalablement déterminé des seuils pour classer les critères en trois catégories différentes : très importants (critères sur lesquels plus de 66 % des répondants étaient d'accord), moyennement importants (critères sur lesquels 33 à 66 % des répondants étaient d'accord) et peu importants (critères sur lesquels moins de 33 % des répondants étaient d'accord). On a également tenté d'établir des corrélations entre les caractéristiques des répondants et le degré d'accord sur les critères. RÉSULTATS: Parmi les critères importants figurent la gravité de la maladie, les avantages de l'intervention, le coût de l'intervention, le rapport coût/efficacité de l'intervention, la qualité des données sur l'efficacité, l'âge du patient, le lieu de résidence, le mode de vie, l'égalité des chances d'accès aux soins de santé et l'opinion de la communauté. Les critères moyennement importants comprennent le sexe, le statut social du patient, ses capacités mentales, ses capacités physiques, ses opinions politiques et ses responsabilités à l'égard d'autrui. La religion du patient, son pouvoir et l'influence qu'il peut exercer sont des critères peu importants. Les corrélations entre les caractéristiques des répondants et leurs préférences sont peu nombreuses. CONCLUSION: On a noté un très fort degré d'accord sur les critères les plus utilisés en rapport avec la maladie et la société. En revanche, il l'est moins pour les critères applicables aux patients. Nous proposons que les critères moyennement importants fassent l'objet d'un débat en Ouganda et dans d'autres pays confrontés au problème de la répartition des soins de santé lorsque ceux-ci sont insuffisants pour répondre à tous les besoins.

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          Disability-adjusted life years: a critical review

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            Health inequalities and the health of the poor: what do we know? What can we do?

            The contents of this theme section of the Bulletin of the World Health Organization on "Inequalities in health" have two objectives: to present the initial findings from a new generation of research that has been undertaken in response to renewed concern for health inequalities; and to stimulate movement for action in order to correct the problems identified by this research. The research findings are presented in the five articles which follow. This Critical Reflection proposes two initial steps for the action needed to alleviate the problem; other suggestions are given by the participants in a Round Table discussion which is published after these articles. The theme section concludes with extracts from the classic writings of the nineteenth-century public health pioneer, William Farr, who is widely credited as one of the founders of the scientific study of health inequalities, together with a commentary. This Critical Reflection contributes to the discussion of the action needed by proposing two initial steps for action. That professionals who give very high priority to the distinct but related objectives of poverty alleviation, inequality reduction, and equity enhancement recognize that their shared concern for the distributional aspects of health policy is far more important than any differences that may divide them. That health policy goals, currently expressed as societal averages, be reformulated so that they point specifically to conditions among the poor and to poor-rich differences. For example, infant mortality rates among the poor or the differences in infant mortality between rich and poor sectors would be more useful indicators than the average infant mortality rates for the whole population.
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              Intergenerational equity: an exploration of the 'fair innings' argument.

              Many different equity principles may need to be traded off against efficiency when prioritizing health care. This paper explores one of them: the concept of a 'fair innings'. It reflects the feeling that everyone is entitled to some 'normal' span of health (usually expressed in life years, e.g. 'three score years and ten') and anyone failing to achieve this has been cheated, whilst anyone getting more than this is 'living on borrowed time'. Four important characteristics of the 'fair innings' notion are worth noting: firstly, it is outcome based, not process-based or resource-based; secondly, it is about a person's whole life-time experience, not about their state at any particular point in time; thirdly, it reflects an aversion to inequality; and fourthly, it is quantifiable. Even in common parlance it is usually expressed in numerical terms: death at 25 is viewed very differently from death at 85. But age at death should be no more than a first approximation, because the quality of a person's life is important as well as its length. The analysis suggests that this notion of intergenerational equity requires greater discrimination against the elderly than would be dictated simply by efficiency objectives.
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                Author and article information

                Journal
                bwho
                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra, Genebra, Switzerland )
                0042-9686
                March 2004
                : 82
                : 3
                : 172-179
                Affiliations
                [01] Bergen orgnameUniversity of Bergen orgdiv1Department of Public Health and Primary Health Care orgdiv2Centre for International Health Norway
                Article
                S0042-96862004000300006 S0042-9686(04)08200306
                c16e00b0-0d97-4f85-840f-147f91a9a429

                History
                : 21 July 2003
                : 28 July 2003
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 48, Pages: 8
                Product

                SciELO Public Health

                Self URI: Full text available only in PDF format (EN)
                Categories
                Research

                Costos y análisis de costo,Ouganda,Justicia social,Health services accessibility,Patients,Uganda,Social justice,Accesibilidad a los servicios de salud,Health priorities,Indicadores de salud,Health status indicators,Prioridades en salud,Justice sociale,Costs and cost analysis,Factores epidemiológicos,Accessibilité service santé,Facteurs épidémiologiques,Epidemiologic factors,Coût et analyse coût,Pacientes,Indicateur état sanitaire,Malade,Priorités en santé

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