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Deliberative engagement methods on health care priority-setting in a rural South African community.
Tugendhaft, Aviva; Hofman, Karen; Danis, Marion; Kahn, Kathleen; Erzse, Agnes; Twine, Rhian; Gold, Marthe; Christofides, Nicola.
Afiliación
  • Tugendhaft A; SAMRC/Wits Centre for Health Economics and Decision Science- PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
  • Hofman K; SAMRC/Wits Centre for Health Economics and Decision Science- PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
  • Danis M; Department of Bioethics, National Institutes of Health, Bethesda, MD, USA.
  • Kahn K; MRC/Wits Rural Public Health and Health Transitions Research Unit -Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • Erzse A; SAMRC/Wits Centre for Health Economics and Decision Science- PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
  • Twine R; MRC/Wits Rural Public Health and Health Transitions Research Unit -Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • Gold M; New York Academy of Medicine, New York City, NY, USA.
  • Christofides N; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Health Policy Plan ; 36(8): 1279-1291, 2021 Sep 09.
Article en En | MEDLINE | ID: mdl-34051093
Public engagement in priority-setting for health is increasingly recognized as a means to ensure more ethical, inclusive and legitimate decision-making processes, especially in the context of Universal Health Coverage where demands outweigh the available resources and difficult decisions need to be made. Deliberative approaches are often viewed as especially useful in considering social values and balancing trade-offs, however, implementation of deliberative engagement tools for priority-setting is scant, especially in low- and middle-income settings. In order to address this gap, we implemented a context-specific public deliberation tool in a rural community in South Africa to determine priorities for a health services package. Qualitative data were analysed from seven group deliberations using the engagement tool. The analysis focused on understanding the deliberative process, what the participants prioritized, the reasons for these selections and how negotiations took place within the groups. The deliberations demonstrated that the groups often considered curative services to be more important than primary prevention which related to the perceived lack of efficacy of existing health education and prevention programmes in leading to behaviour change. The groups engaged deeply with trade-offs between costly treatment options for HIV/AIDS and those for non-communicable disease. Barriers to healthcare access were considered especially important by all groups and some priorities included investing in more mobile clinics. This study demonstrates that deliberative engagement methods can be successful in helping communities balance trade-offs and in eliciting social values around health priorities. The findings from such deliberations, alongside other evidence and broader ethical considerations, have the potential to inform decision-making with regard to health policy design and implementation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Población Rural / Prioridades en Salud Tipo de estudio: Prognostic_studies / Qualitative_research Aspecto: Determinantes_sociais_saude / Ethics Límite: Humans Idioma: En Revista: Health Policy Plan Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2021 Tipo del documento: Article País de afiliación: Sudáfrica Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Población Rural / Prioridades en Salud Tipo de estudio: Prognostic_studies / Qualitative_research Aspecto: Determinantes_sociais_saude / Ethics Límite: Humans Idioma: En Revista: Health Policy Plan Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2021 Tipo del documento: Article País de afiliación: Sudáfrica Pais de publicación: Reino Unido