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Purpose. The purpose of this study was to describe bedside rationing by health practitioners in a teaching hospital in Uganda. Methods. This was a case study involving in-depth interviews. A [...]

A panel of experts at the annual meeting of the American Association for the Advancement of Science has predicted that stem cell research will survive the fallout of the recent [...]

Abstract In August 2005, the Global Fund to fight AIDS, Tuberculosis and Malaria (the Global Fund) Secretariat suspended its five grants to Uganda following a PricewaterhouseCoopers audit report that exposed gross mismanagement in the Project Management Unit. How could this have been avoided? How can other countries avoid a similar pitfall? We argue that if a legitimate and fair decision-making process were used, the suspension of funding to Uganda could have been avoided, and that this lesson should be applied to other countries. The "accountability for reasonableness" framework of relevance, publicity, revisions and enforcement would help in implementing legitimate and fair decision-making processes, which would improve effectiveness, accountability and transparency in the implementation of Global Fund programmes, preventing future suspension of funding to any Global Fund projects. Bulletin of the World Health Organization 2006;84:576-580. Resume Comment aurait-on pu eviter la suspension des versements du Secretariat du Fonds mondial a l&apos;Ouganda? En aout 2005, le Secretariat du Fonds mondial de lutte contre le SIDA, la tuberculose et le paludisme a suspendu le versement de ses cinq subventions, destinees a l&apos;Ouganda, a la suite d&apos;un rapport d&apos;audit de PricewaterhouseCoopers qui faisait apparaitre de graves erreurs commises par l&apos;unite chargee de la gestion du projet. Comment une telle suspension aurait-elle pu etre evitee? Comment d&apos;autres pays peuvent-ils eviter le meme ecueil? On peut soutenir qu&apos;un processus de prise de decision juste et equitable aurait permis d&apos;eviter d&apos;en arriver la et qu&apos;il y a des enseignements a en tirer pour d&apos;autres pays. L&apos;application de l&apos;obligation redditionnelle raisonnable>>, comportant quatre conditions a remplir--en matiere de pertinence, de publicite, de revision et d&apos;execution--contribuerait a un processus de prise de decision juste et equitable de nature a ameliorer l&apos;efficacite, la responsabilisation et la transparence dans l&apos;application des programmes du Fonds mondial, ce qui permettrait a l&apos;avenir d&apos;eviter la suspension des versements aux projets du Fonds. Resumen Suspension de la financiacion a Uganda por la Secretaria dei Fondo Mundial: como podria haberse evitado? En agosto de 2005 la Secretaria del Fondo Mundial de Lucha contra el SIDA, la Tuberculosis y la Malaria (Fondo Mundial) suspendio sus cinco subvenciones a Uganda a raiz de los resultados de un informe de evaluacion de PricewaterhouseCoopers que puso de relieve graves problemas de mala gestiOn en la Unidad de Gestion del Proyecto. Como podria haberse evitado eso? Como podrian evitar otros paises problemas parecidos? Argumentamos que, si se hubieran seguido procedimientos decisorios legitimos y justos, se podia haber evitado la suspension de la financiacion a Uganda, y que esta leccion deberia aplicarse a otros paises. El marco de <> -pertinencia, publicidad, revisiones y cumplimiento- ayudaria a implementar procedimientos legitimos y justos de adopcion de decisiones, que redundarian en mejoras de la eficacia, la rendicion de cuentas y la transparencia en la ejecucion de los programas del Fondo Mundial, evitando asi en el futuro nuevas suspensiones de la financiacion de otros proyectos del Fondo. [TEXT NOT REPRODUCIBLE IN ASCII], Introduction The Global Fund to fight AIDS, Tuberculosis and Malaria (the Global Fund) was created to finance a dramatic turnaround in the fight against human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), [...]

Priority setting tends to take place in health care settings that are hierarchical and politically complex. Fair processes, as defined for example by Daniels' and Sabin's accountability for reasonableness framework, have been identified as essential for securing socially acceptable priority setting decisions. However, power differences in the decision-making context can pose a serious impediment to fair priority setting in health care organizations. Comparatively little attention has been paid to examining the institutional conditions within which priority setting decisions are made. We review a case study of priority setting in hospital operational planning in Toronto, which had been designed by executive leaders to be broadly inclusive of senior and middle-level clinical and administrative leaders. We report three power differences that arose as limiting factors on the inclusiveness of the priority setting process. We argue that these findings have significant theoretical implications for the accountability for reasonableness framework and propose a fifth condition, the 'empowerment condition', which states that there should be efforts to minimise power differences in the decision-making context and to optimise effective opportunities for participation in priority setting. Keywords: Health care priority setting; Resource allocation; Power differences; Accountability for reasonableness, Canada

Focus groups are increasingly being used to provide insights to researchers and policy makers. These data complement quantitative approaches to understanding the world. Unfortunately, quantitative and qualitative methodologies have often been viewed as antithetical, rather than complementary, strategies. While focus groups can clearly generate rich information that is unobtainable through other quantitative methods, it is important to determine the degree to which different raters can consistently extract information from transcripts. Thus, our goal was to quantify agreement in the interpretation of transcripts from patient and physician focus groups, using decision-making in ischemic heart disease as a model. We used data from focus groups with both patients and physicians that sought to identify factors affecting diagnostic and treatment decisions in ischemic heart disease. Three raters independently reviewed transcribed audiotapes from focus groups of patients with ischemic heart disease, as well as focus groups of physicians who care for these patients. We found that raters could not distinguish between major and minor factors reliably. More troubling, however, is that consistency regarding the apparently straightforward judgment as to the mere presence or absence of a factor was difficult to achieve. In particular, the three raters of each transcript failed to agree on between one third and one half of the factors. This reasonably high level of disagreement occurred despite the raters: (1) having generated the individual factors themselves based upon their reading a random sample of actual transcripts and (2) being trained in the use of rating forms (including standard definitions of themes). These data suggest that if a single rater evaluates focus group transcripts, as is commonly done, judgments may not be reproducible by other raters. Moreover, a single rater may not extract all important information contained in the transcripts. Key words - focus groups, consistency of rating, qualitative methods, racial variation

Scientific developments of the last 20 years have made the transplantation of cadaveric solid organs a viable and expected treatment alternative for patients suffering from various forms of End Stage Organ Disease. Of the number of organs that could be utilized for this, only a small percentage of them are actually made available. North American legislation explicitly categorizes the transfer of cadaveric organs as an anatomical or tissue 'gift'. The concept of the gift is mediated by transculturally consistent unwritten, but powerfully felt, rules of conduct. Among the most profound elements of the concept is the obligatory gift-exchange which is central to the gift-relationship. Obviously, neither of these are permitted by the organ transplant scenario. As a result, dissonance is created within the thought process of the individual which cannot be easily resolved, paralyzing many into inaction. We maintain that the present legal framework, designed to facilitate the transfer of organs, clashes with the human phenomenon of giving, and may actually prevent organs from being made available. In a search for a solution to this gift-relationship dilemma, giving organs is contrasted with taking organs as a basis upon which to ground ethically sound public policy. Liberty-limiting principles and the concept of harm are considered within this context.

The three-dimensional factor structure of a proposed activities of daily living (ADL) scale was replicated in the assessment of health and functional status of668 hospitalized patients to show the association between ADL dimension and cognitive function. Statistical analysis revealed four significant dimensions found to be similar with a previous study with a weak fourth dimension identified among the subjects.