The Value of Explicit, Deliberative, and Context-Specified Ethics Analysis for Health Technology Assessment: Evidence From a Novel Approach Piloted in South Africa

Krubiner, Carleigh; Tugendhaft, Aviva; DiStefano, Michael J.; Barsdorf, Nicola; Merritt, Maria W.; Goldstein, Susan; Mosam, Atiya; Potgieter, Sunita; Hofman, Karen; Faden, Ruth R.

doi:10.1016/j.vhri.2022.10.003

Cited by 5 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study findings indicate accrued benefits as a result of increased transparency, effective inclusion of stakeholders’ preferences, and value for money in decisions made [ 44 ]. A South African study on the application of context-specific ethics frameworks in decision-making revealed that deliberations enhanced appraisal quality and transparency [ 56 ]. The impact of implementing health technology assessment decision recommendations on SRHR included workforce strengthening and improved service delivery.…”

Section: Discussionmentioning

confidence: 99%

Health technology assessment for sexual reproductive health and rights benefits package design in sub-Saharan Africa: A scoping review of evidence-informed deliberative processes

Simangolwa,

Mbonigaba,

Govender

2024

PLoS ONE

View full text Add to dashboard Cite

Background Health technology assessment uses a multidisciplinary approach to support health benefits package design towards universal health coverage. The evidence-informed deliberative process framework has been used alongside Health technology assessment to enhance stakeholder participation and deliberations in health benefits package design. Applying the evidence-informed deliberative framework for Health assessment could support the morally diverse sexual reproductive health and rights (SRHR) benefits package design process. However, evidence on participation and deliberations for stakeholders in health technology assessment for SRHR benefits package design has not been curated in sub-Saharan Africa. This study synthesises literature to fill this gap. Methods This scoping review applies the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews, and deductive analysis following the evidence-informed deliberative processes framework. The search strategy uses the Guttmacher–Lancet Commission-proposed comprehensive definition of SRHR and the World Health Organisation’s universal health coverage compendium of SRHR interventions to generate search terms. Six databases and biographical hand searches were used to identify studies in Sub-Saharan Africa from 1994. Results A total of 14 studies met the inclusion criteria. Evidence for yearly public budgets and explicit SRHR health technology assessment processes was not found. In 12 of the studies reviewed, new advisory committees were set up specifically for health technology assessment for SRHR priority-setting and benefits package design. In all decision-making processes reviewed, the committee member roles, participation and deliberations processes, and stakeholder veto powers were not clearly defined. Patients, the public, and producers of health technology were often excluded in the health technology assessment for the SRHR benefits package design. Most health technology assessment processes identified at least one decision-making criterion but failed to use this in their selection and appraisal stages for SRHR benefits design. The identification, selection, and scoping stages in health technology assessment for SRHR were non-existent in most studies. In 11 of the 14 processes of the included studies, stakeholders were dissatisfied with the health policy recommendation from the appraisal process in health technology assessment. Perceived benefits for evidence-informed deliberative processes included increased stakeholder engagement and fairness in decision-making. Conclusion To support the integration of diverse social values in health technology assessment for fairer SRHR benefits package design, evidence from this review suggests the need to institutionalise health technology assessment, establish prioritisation decision criteria, involve all relevant stakeholders, and standardise the process and assessment methodological approaches.

show abstract

Section: Discussionmentioning

confidence: 99%

Health technology assessment for sexual reproductive health and rights benefits package design in sub-Saharan Africa: A scoping review of evidence-informed deliberative processes

Simangolwa,

Mbonigaba,

Govender

2024

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Although this may have some utility in some teaching practices, moral response is generative and requires open-ended questions that give room for moral imagination, reflection and contextualized deliberation. 8,36 Measurement of such aspects, however, is not automatic or direct and rarely if ever yields an exact number on a scale.…”

Section: Difficulties In Assessing Virtuementioning

confidence: 99%

“…Among the factors behind the trend towards measurement on the ethical level is the emergence of new challenges of a moral kind due largely to the development of technology 7 and its various applications, significant among which is the health field, 8,9 as well as a concern for the professionalization and improvement of patient care. 10 Also noteworthy is the unexpected confluence between the concern for scientificity and empirical research on the human reality of psychology and the reflective method of deep inquiry from philosophy, which has brought about a fruitful encounter between psychologists and philosophers.…”

Section: Introductionmentioning

confidence: 99%

The complexity of ethical assessment: Interdisciplinary challenge for character education

Fuentes,

Sánchez-Pérez

2023

Nurs Ethics

View full text Add to dashboard Cite

The assessment of learning in the ethical domain is one of the most complex aspects to attend in the educational context. In recent years, character education has contributed greatly to different social disciplines, such as education or nursing. However, the development of this approach has run up against several obstacles and limitations, as there is little evidence regarding its long-term effectiveness or its evaluation. This essay aims to identify some of the main difficulties to assess learning in the ethical domain, as obstacles and possible constraints to Aristotelian-based character education. Methodology is analytical and of a philosophical-educational nature, based on which an argumentative analysis is constructed from the bibliographical review of the contributions of classical and contemporary authors. Results show the existence of four major problems and ten associated subproblems, both of an external nature linked to the contextual factors of assessment, and of an internal nature that affect the essence of the process itself, which highlight the difficulty of carrying out assessments of an ethical kind. Far from proposing a pessimistic position, we argue a realistic vision that allows educators at different educational levels to be aware of the limits and critical points of evaluation in the ethical domain.

show abstract

“…As an example of what such a process can look like, the South African Values and Ethics for Universal Health Coverage (SAVE-UHC) project recently developed a context-specific ethics framework for HTA analysis and appraisal in support of National Health Insurance in South Africa that is the product of multi-stakeholder deliberations grounded in reviews of both policy documents and relevant moral frameworks and concepts. 6 Second, the goals of deliberation may differ when focused on moral versus social values. The authors write the following about the goals of EDPs:…”

Section: Social Versus Moral Valuesmentioning

confidence: 99%

“…After developing the provisional ethics framework, researchers convened simulated appraisal committees to test the application of the ethics framework in structured deliberations aimed at reaching coverage recommendations for several hypothetical health technology cases. 6 …”

Section: Social Versus Moral Valuesmentioning

confidence: 99%

Moral and Social Values in Evidence-Informed Deliberative Processes for Health Benefit Package Design; Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide"

DiStefano

2022

Int J Health Policy Manag

Self Cite

View full text Add to dashboard Cite

An evidence-informed deliberative process (EDP) is defined as "a practical and stepwise approach for HTA bodies to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values." In this commentary, I discuss some considerations for EDPs that arise from acknowledging the difference between social and moral values. First, the best practices for implementing EDPs may differ depending on whether the approach is grounded in moral versus social values. Second, the goals of deliberation may differ when focused on moral versus social values. I conclude by offering some considerations for future research to support the use of EDPs in practice, including the need to assess how different approaches to appraisal (e.g. more quantitative versus qualitative) impact perceptions of the value of deliberation itself.

show abstract

The Value of Explicit, Deliberative, and Context-Specified Ethics Analysis for Health Technology Assessment: Evidence From a Novel Approach Piloted in South Africa

Cited by 5 publications

References 19 publications

Health technology assessment for sexual reproductive health and rights benefits package design in sub-Saharan Africa: A scoping review of evidence-informed deliberative processes

Health technology assessment for sexual reproductive health and rights benefits package design in sub-Saharan Africa: A scoping review of evidence-informed deliberative processes

The complexity of ethical assessment: Interdisciplinary challenge for character education

Moral and Social Values in Evidence-Informed Deliberative Processes for Health Benefit Package Design; Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide"

Contact Info

Product

Resources

About