Modelli deliberativi per l'allocazione delle risorse in sanità: il caso della dengue in Tanzania

In decision-making processes in support of health systems in developing countries, the predominant use of technical approaches (based on economic instruments) has been the main roadmap for identifying health priorities. However, these approaches reveal the limitations, from an ethical point of view, of failing to include an analysis of values and the cultural context and of being scarcely responsive to the real health demands of the population. They also conceal a significant conflict between the underlying values, such as efficiency and equity. Our analysis addresses the participated and deliberative models of resource allocation, and especially the approach developed by Norman Daniels - known as Accountability for Reasonableness (A4R) - with the aim of offering a method for identifying "correct" priorities, which are not defined on the basis of pre-established choices of values, but deriving from a legitimate decision- making process (transparent and negotiated between all the stakeholders involved). To test the enforceability in real circumstances (especially for low-income countries) of the A4R model, the article proposes the analysis of a case study. Specifically, a practical application of the A4R on the prioritisation of Dengue law enforcement interventions in Tanzania is being examined, in order to illustrate what was successful in this particular case, what difficulties were encountered and what reactions were generated by the population.