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cáo khoa học: " Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation | Maluka et al. Implementation Science 2011 6 11 http www.implementationscience.eom content 6 1 11 Implementation Science IMPLEMENTATION SCIENCE RESEARCH ARTICLE Open Access Implementing accountability for reasonableness framework at district level in Tanzania a realist evaluation ftor ilncir i K IMi ilz21 2Dofor k siTH I7rir21 í ii ii I Cl I Q r iQoh c f i r i2 lone Rx cbnix 3 RonaHir-t- MH 3 A i4 f7i cfain R Olean5 Stepiien Maiuka Peter I dinuz.uid Miguel SanSebastidn Jens Byskov Benedict iNddwi 0ystein E Olsen Anna-Karin Hurtig2 Abstract Background Despite the growing importance of the Accountability for Reasonableness A4R framework in priority setting worldwide there is still an inadequate understanding of the processes and mechanisms underlying its influence on legitimacy and fairness as conceived and reflected in service management processes and outcomes. As a result the ability to draw scientifically sound lessons for the application of the framework to services and interventions is limited. This paper evaluates the experiences of implementing the A4R approach in Mbarali District Tanzania in order to find out how the innovation was shaped enabled and constrained by the interaction between contexts mechanisms and outcomes. Methods This study draws on the principles of realist evaluation - a largely qualitative approach chiefly concerned with testing and refining programme theories by exploring the complex interactions of contexts mechanisms and outcomes. Mixed methods were used in data collection including individual interviews nonparticipant observation and document reviews. A thematic framework approach was adopted for the data analysis. Results The study found that while the A4R approach to priority setting was helpful in strengthening transparency accountability stakeholder engagement and fairness the efforts at integrating it into the current district health system were challenging. Participatory structures under the decentralisation framework central .