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Background In fragile and conflict affected settings (FCAS) such as South Sudan, where health needs are immense, resources are scarce, health infrastructure is rudimentary or damaged, and government stewardship is weak, adequate health intervention priority-setting is especially important. There is a scarcity of research examining priority-setting in FCAS and the related political economy. Yet, capturing these dynamics is important to develop context-specific guidance for priority-setting. The objective of this study is to analyze the priority-setting practices in the Health Pooled Fund (HPF), a multi-donor fund that supports service delivery in South Sudan, using a political economy perspective. Methods A multi-method study was conducted combining document review, 30 stakeholder interviews, and an examination of service delivery. An adapted version of the Walt and Gilson policy analysis triangle guided the study’s design and analysis. Results Priority-setting in HPF occurs in a context of immense fragility where health needs are vast, service delivery remains weak, and external funding is essential. HPF's service package gives priority to the health of mothers and children, gender-sensitive programming, immunization services, and a community health initiative. HPF is structured by a web of actors at national and local levels with pronounced power asymmetries and differing vested interests and ideas about HPF’s role. Priority-setting takes place throughout program design, implementing partner (IP) contract negotiation, and implementation of the service package. In practice the BPHNS does not provide adequate guidance for priority-setting because it is too expansive and unrealistic given financial and health system constraints. At the local level, IPs must manage the competing interests of the HPF program and local health authorities as well as challenging contextual factors, including conflict and shortages of qualified health workers, which affect service provision. The resulting priority-setting process remains implicit, scarcely documented, and primarily driven by donors’ interests. Conclusion This study highlights power asymmetries between donors and national health authorities within a FCAS context, which drive a priority-setting process that is dominated by donor agendas and leave little room for government ownership. These findings emphasize the importance of paying attention to the influence of stakeholders and their interests on the priority-setting process in FCAS.

INTRODUCTION: Translation of knowledge into policy and practice is important to prevent sexual reproductive health and rights (SRHR)-related morbidity and mortality and ensure access to rights. Existing approaches to knowledge translation are often relatively rigid and implicitly assume linear processes, leading to time-consuming processes that are not tailored to countries' needs. APPROACH: SRHR knowledge platforms designed and implemented a collaborative rapid improvement model for knowledge translation (CRIM-KT) in Burundi, Bangladesh, Indonesia, and Jordan. The approach consisted of learning sessions and action periods aimed at improving policies and practices addressing the prevention of child marriage and teenage pregnancies. To evaluate the approach, a participatory action learning process took place throughout the implementation (September 2017 and January 2019). An end evaluation was conducted using a desk review of project documentation, in-depth interviews, and a focus group discussion to document the process, outcomes, and lessons learned. ACHIEVEMENTS: In Indonesia, a local government policy was changed that aims to prevent child marriage by avoiding misinterpretation of a local cultural practice. In Jordan, the cabinet endorsed a national action plan to prevent child marriage and changes in practice took place. In Burundi, no tangible changes in policy and practice in SRHR were observed. In Bangladesh, practice changed by strengthening coordination for collaboration and exchange among stakeholders to prevent child marriage. In all countries, the approach considerably strengthened participants' knowledge translation capacities. CONCLUSION: The CRIM-KT led to improvements in policy and practice in a relatively short time frame and different contexts. This can be explained by the systematic, structured, and participatory approach, allowing for contextual adaptation and involvement of stakeholders, as well as the cross-learning on 2 levels (international and country collaboration teams). The principles of the CRIM-KT may be further developed and applied in other fields in global health to strengthen knowledge translation processes.

Objective International guidelines recommend countries to expand antiretroviral therapy (ART) to all HIV-infected individuals and establish local-level priorities in relation to other treatment, prevention and mitigation interventions through fair processes. However, no practical guidance is provided for such priority-setting processes. Evidence-informed deliberative processes (EDPs) fill this gap and combine stakeholder deliberation to incorporate relevant social values with rational decision-making informed by evidence on these values. This study reports on the first-time implementation and evaluation of an EDP in HIV control, organised to support the AIDS Commission in West Java province, Indonesia, in the development of its strategic plan for 2014–2018. Methods Under the responsibility of the provincial AIDS Commission, an EDP was implemented to select priority interventions using six steps: (i) situational analysis; (ii) formation of a multistakeholder Consultation Panel; (iii) selection of criteria; (iv) identification and assessment of interventions’ performance; (v) deliberation; and (vi) selection of funding and implementing institutions. An independent researcher conducted in-depth interviews (n = 21) with panel members to evaluate the process. Results The Consultation Panel included 23 stakeholders. They identified 50 interventions and these were evaluated against four criteria: impact on the epidemic, stigma reduction, cost-effectiveness and universal coverage. After a deliberative discussion, the Consultation Panel prioritised a combination of several treatment, prevention and mitigation interventions. Conclusion The EDP improved both stakeholder involvement and the evidence base for the strategic planning process. EDPs fill an important gap which international guidelines and current tools for strategic planning in HIV control leave unaddressed.

Contains fulltext : 168069.pdf (Publisher’s version ) (Open Access) Priority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs) in their strive for universal health coverage (UHC). However, present initiatives on priority setting are mainly geared towards the development of more cost-effectiveness information, and this evidence does not sufficiently support countries to make optimal choices. The reason is that priority setting is in reality a value-laden political process in which multiple criteria beyond cost-effectiveness are important, and stakeholders often justifiably disagree about the relative importance of these criteria. Here, we propose the use of 'evidence-informed deliberative processes' as an approach that does explicitly recognise priority setting as a political process and an intrinsically complex task. In these processes, deliberation between stakeholders is crucial to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. Such processes then result in the use of a broader range of explicit criteria that can be seen as the product of both international learning ('core' criteria, which include eg, cost-effectiveness, priority to the worse off, and financial protection) and learning among local stakeholders ('contextual' criteria). We believe that, with these evidence-informed deliberative processes in place, priority setting can provide a more meaningful contribution to achieving UHC.

In Indonesia, priority setting questions have arisen in the context of HIV/AIDS control as it faces one of Asia's fastest growing HIV/AIDS epidemics and resources are scarce. In 2013, an estimated 610,000 people were living with HIV/AIDS (PLWHA) and it is estimated that this number will increase to 1,500,000 by 2020 if the right measures are not taken (1;2). While the government seems to have the epidemic among people who inject drugs (PWID) under control, the prevalence is increasing among female sex workers (FSW) and their clients, men having sex with men (MSM), and the general population. The budget for HIV/AIDS control is far from sufficient; in 2010, only US$ 69 million was spent on HIV/AIDS, while US$ 152 million was estimated to be needed (3;4). Both issues urge for a wise choice between HIV/AIDS interventions and allocation of resources. Based on the National AIDS Spending Assessment, most resources on national level were spent on curative services (36 percent compared with 28 percent on preventive services) in 2012 (5). At provincial and district level, the allocation of domestic resources is poorly reported and the process of priority setting of interventions could be improved (6). The AIDS commissions (established at national, provincial and district level) is challenged to coordinate the HIV/AIDS response among multiple stakeholders. It aims to develop strategic plans to guide the local planning board on how to allocate the local budget among different government offices. However, the involvement of stakeholders opinion in the strategic planning process could be improved. Also, while various criteria seemed to guide the HIV/AIDS priorities in Indonesia (for example, the impact of interventions on the HIV/AIDS epidemic, adherence to national guidelines and cultural and political acceptability) these remain implicit. Systematic analysis of how different stakeholders value the importance of various criteria could contribute to more systematic, transparent, and accountable priority setting of the HIV/AIDS response and thereby improve the allocation of resources. Most methods that were introduced to guide resource allocation decisions in health (that is, evidence-based medicine, cost-effectiveness analysis, burden of disease, and equity analysis, rely on one single criteria (mostly cost and cost-effectiveness), while in reality many criteria can play a role (for example, feasibility, equity, cultural, and political factors) (7). Therefore, multi-criteria decision analysis (MCDA) is put forward as one of the most important methods for priority setting, and it provides a systematic process for clarifying what is being taken into account (the “criteria”), how each of those criteria should be measured, and how much importance (“weight”) to put on each (7). It has been successful in various case studies, for example in Ghana, Nepal, and Thailand, where it contributed to transparent and accountable policy making and brought a step forward in rational decision making. However, only a few empirical priority setting studies have included the views of different stakeholders, such as patients and the general population, besides those of policy makers (8;9). In HIV/AIDS field, the recognition of multiple criteria has risen and is reflected in the WHO programmatic guidance for antiretroviral therapy (ART) that recommends taking besides health impact also equity and feasibility criteria into consideration (10). However, only a few studies have tried to measure explicitly the importance of multiple criteria for HIV/AIDS priority setting (11;12) and worldwide, the main focus remains on how to reduce new infections and AIDS related death. Against this background, this study aims to describe the views of multiple stakeholders on the importance of various criteria for priority setting in HIV/AIDS control in Indonesia.

Summary points The ever-growing HIV treatment programs in sub-Saharan Africa (SSA) present local policy makers with complex decision dilemmas, as international guidelines emphasize the need for expanded access to antiretroviral therapy (ART), yet funding has flatlined. We argue that the current evidence base for prioritizing ART scale-up strategies results in recommendations that are theoretically optimal but practically infeasible to implement. Cost-effectiveness analyses (CEAs) of scaling up ART in SSA should be made more responsive to the needs of policy makers by taking into account the local health system. We provide suggestions for a better integration of health system constraints into CEA by integrating supply- and demand-side constraints in mathematical models and improving the dialogue between researchers and policy makers.

Contains fulltext : 176827.pdf (Publisher’s version ) (Open Access) Progressive realisation is invoked as the guiding principle for countries on their own path to universal health coverage (UHC). It refers to the governmental obligations to immediately and progressively move towards the full realisation of UHC. This paper provides procedural guidance for countries, that is, how they can best organise their processes and evidence collection to make decisions on what services to provide first under progressive realisation. We thereby use 'evidence-informed deliberative processes', a generic value assessment framework to guide decision making on the choice of health services. We apply this to the concept of progressive realisation of UHC. We reason that countries face two important choices to achieve UHC. First, they need to define which services they consider as high priority, on the basis of their social values, including cost-effectiveness, priority to the worse off and financial risk protection. Second, they need to make tough choices whether they should first include more priority services, first expand coverage of existing priority services or first reduce co-payments of existing priority services. Evidence informed deliberative processes can facilitate these choices for UHC, and are also essential to the progressive realisation of the right to health. The framework informs health authorities on how they can best organise their processes in terms of composition of an appraisal committee including stakeholders, of decision-making criteria, collection of evidence and development of recommendations, including their communication. In conclusion, this paper fills in an important gap in the literature by providing procedural guidance for countries to progressively realise UHC.

Health research priority-setting exercises aim to maximize the impact of investments in health research. An increasing number of priority-setting exercises for health research have taken place in the past two decades. These exercises have been conducted for various areas of health research and at various levels (global, regional, national, local and institutional). In this chapter, we discuss the similarities and differences between health research priority setting and health intervention priority setting, and we describe the current methodologies used in health research priority setting and the role of multi-criteria decision analysis (MCDA) therein. We provide three concrete suggestions for future methodological development in the field of health research priority setting: (1) recognize that many of the methodologies used to set health research priorities apply MCDA, (2) make use of well-established approaches or best practices for health research priority setting and (3) study in more detail the differences between health intervention and health research priority setting.

This chapter addresses three policy issues related to the application of multi-criteria decision analysis (MCDA) for priority setting of health interventions in low- and middle-income countries (LMICs), namely, stakeholder involvement, institutionalization, and the impact of MCDA on policy decisions. Based on a literature review, we evaluate 11 case studies in the light of these issues. We found that there is no systematic approach for the involvement of stakeholders. Only four case studies implemented MCDA in an institutional context, and three studies evaluated the impact of MCDA on policy decisions. A detailed case study that explicitly integrated MCDA in the policy-making process for HIV/AIDS control in Indonesia is presented, and enablers and barriers of such an approach with regard to the three policy issues are outlined. The final part of the chapter provides recommendations of the future application of MCDA in policy processes. It provides methodological guidance on which stakeholders to involved and why. Recommendations are given on the institutionalization of MCDA and to improve the evaluation of the impact of MCDA on policy decisions.

Contains fulltext : 109845.pdf (Publisher’s version ) (Open Access) OBJECTIVE: To evaluate the impact of health insurance on resource mobilization, financial protection, service utilization, quality of care, social inclusion and community empowerment in low- and lower-middle-income countries in Africa and Asia. METHODS: A systematic search for randomized controlled trials, quasi-experimental and observational studies published before the end of 2011 was conducted in 20 literature databases, reference lists of relevant studies, web sites and the grey literature. Study quality was assessed with a quality grading protocol. FINDINGS: Inclusion criteria were met by 159 studies - 68 in Africa and 91 in Asia. Most African studies reported on community-based health insurance (CBHI) and were of relatively high quality; social health insurance (SHI) studies were mostly Asian and of medium quality. Only one Asian study dealt with private health insurance (PHI). Most studies were observational; four had randomized controls and 20 had a quasi-experimental design. Financial protection, utilization and social inclusion were far more common subjects than resource mobilization, quality of care or community empowerment. Strong evidence shows that CBHI and SHI improve service utilization and protect members financially by reducing their out-of-pocket expenditure, and that CBHI improves resource mobilization too. Weak evidence points to a positive effect of both SHI and CBHI on quality of care and social inclusion. The effect of SHI and CBHI on community empowerment is inconclusive. Findings for PHI are inconclusive in all domains because of insufficient studies. CONCLUSION: Health insurance offers some protection against the detrimental effects of user fees and a promising avenue towards universal health-care coverage.

Contains fulltext : 170051.pdf (Publisher’s version ) (Closed access)

Contains fulltext : 153730.pdf (Publisher’s version ) (Closed access) BACKGROUND: Indonesia has insufficient resources to adequately respond to the HIV/AIDS epidemic, and thus faces a great challenge in prioritizing interventions. In many countries, such priority setting processes are typically ad hoc and not transparent leading to unfair decisions. Here, we evaluated the priority setting process in HIV/AIDS control in West Java province against the four conditions of the accountability for reasonableness (A4R) framework: relevance, publicity, appeals and revision, and enforcement. METHODS: We reviewed government documents and conducted semi-structured qualitative interviews based on the A4R framework with 22 participants of the 5-year HIV/AIDS strategy development for 2008-13 (West Java province) and 2007-11 (Bandung). RESULTS: We found that criteria for priority setting were used implicitly and that the strategies included a wide range of programmes. Many stakeholders were involved in the process but their contribution could be improved and particularly the public and people living with HIV/AIDS could be better engaged. The use of appeal and publicity mechanisms could be more transparent and formally stated. Public regulations are not yet installed to ensure fair priority setting. CONCLUSIONS: To increase fairness in HIV/AIDS priority setting, West Java should make improvements on all four conditions of the A4R framework.

Contains fulltext : 154897.pdf (Publisher’s version ) (Open Access) BACKGROUND: We report an economic analysis of Human Immunodeficiency Virus (HIV) care and treatment in Indonesia to assess the options and limitations of costs reduction, improving access, and scaling up services. METHODS: We calculated the cost of providing HIV care and treatment in a main referral hospital in West Java, Indonesia from 2008 to 2010, differentiated by initiation of treatment at different CD4 cell count levels (0-50, 50-100, 100-150, 150-200, and >200 cells/mm(3)); time of treatment; HIV care and opportunistic infections cost components; and the costs of patients for seeking and undergoing care. DISCUSSION: Before antiretroviral treatment (ART) initiation, costs were dominated by laboratory tests (>65 %), and after initiation, by antiretroviral drugs (>/=60 %). Average treatment costs per patient decreased with time on treatment (e.g. from US$580 per patient in the first 6 month to US$473 per patient in months 19-24 for those with CD4 cell counts under 50 cells/mm(3)). Higher CD4 cell counts at initiation resulted in lower laboratory and opportunistic infection treatment costs. Transportation cost dominated the costs of patients for seeking and undergoing care (>40 %). CONCLUSIONS: Costs of providing ART are highest during the early phase of treatment. Costs reductions can potentially be realized by early treatment initiation and applying alternative laboratory tests with caution. Scaling up ART at the community level in certain high prevalence settings may improve early uptake, adherence, and reduce transportation costs.

Introduction About half a million people in South Africa are deprived of antiretroviral therapy (ART), and there is little systematic knowledge on who they are – e.g. by severity of disease, sex, or socio-economic status (SES). We performed a systematic review to determine the current quantitative evidence-base on equity in utilization of ART among HIV-infected people in South Africa. Method We conducted a literature search based on the Cochrane guidelines. A study was included if it compared for different groups of HIV infected people (by sex, age, severity of disease, area of living, SES, marital status, ethnicity, religion and/or sexual orientation (i.e. equity criteria)) the number initiating/adhering to ART with the number who did not. We considered ART utilization inequitable for a certain criterion (e.g. sex) if between groups (e.g. men versus women) significant differences were reported in ART initiation/adherence. Results Twelve studies met the inclusion criteria. For sex, 2 out of 10 studies that investigated this criterion found that men are less likely than women to utilize ART, while the other 8 found no differences. For age, 4 out of 8 studies found inequities and reported less utilization for younger people. For area of living, 3 out of 4 studies showed that those living in rural areas or certain provinces have less access and 2 out of 6 studies looking at SES found that people with lower SES have less access. One study which looked at the marital status found that those who are married are less likely to utilize ART. For severity of disease, 5 out of 6 studies used more than one outcome measure for disease stage and reported within their study contradicting results. One of the studies reported inconclusive findings for ethnicity and no study had looked at religion and sexual orientation. Conclusion It seems that men, young people, those living in certain provinces or rural areas, people who are unemployed or with a low educational level, and those being unmarried have less access to ART. As studies stem from different contexts and use different methods conclusions should be taken with caution.

Contains fulltext : 125394.pdf (Publisher’s version ) (Open Access) South Africa, the country with the largest HIV epidemic worldwide, has been scaling up treatment since 2003 and is rapidly expanding its eligibility criteria. The HIV treatment programme has achieved significant results, and had 1.8 million people on treatment per 2011. Despite these achievements, it is now facing major concerns regarding (i) efficiency: alternative treatment policies may save more lives for the same budget; (ii) equity: there are large inequalities in who receives treatment; (iii) feasibility: still only 52% of the eligible population receives treatment.Hence, decisions on the design of the present HIV treatment programme in South Africa can be considered suboptimal. We argue there are two fundamental reasons to this. First, while there is a rapidly growing evidence-base to guide priority setting decisions on HIV treatment, its included studies typically consider only one criterion at a time and thus fail to capture the broad range of values that stakeholders have. Second, priority setting on HIV treatment is a highly political process but it seems no adequate participatory processes are in place to incorporate stakeholders' views and evidences of all sorts.We propose an alternative approach that provides a better evidence base and outlines a fair policy process to improve priority setting in HIV treatment. The approach integrates two increasingly important frameworks on health care priority setting: accountability for reasonableness (A4R) to foster procedural fairness, and multi-criteria decision analysis (MCDA) to construct an evidence-base on the feasibility, efficiency, and equity of programme options including trade-offs. The approach provides programmatic guidance on the choice of treatment strategies at various decisions levels based on a sound conceptual framework, and holds large potential to improve HIV priority setting in South Africa.

to evaluate the costs-effectiveness of scaling up community-based VCT in West-Java.the Asian epidemic model (AEM) and resource needs model (RNM) were used to calculate incremental costs per HIV infection averted and per disability-adjusted life years saved (DALYs). Locally monitored demographic, epidemiological behavior and cost data were used as model input.scaling up community-based VCT in West-Java will reduce the overall population prevalence by 36% in 2030 and costs US$248 per HIV infection averted and US$9.17 per DALY saved. Cost-effectiveness estimation were most sensitive to the impact of VCT on condom use and to the population size of clients of female sex workers (FSWs), but were overall robust. The total costs for scaling up community-based VCT range between US$1.3 and 3.8 million per year and require the number of VCT integrated clinics at public community health centers to increase from 73 in 2010 to 594 in 2030.scaling up community-based VCT seems both an effective and cost-effective intervention. However, in order to prioritize VCT in HIV/AIDS control in West-Java, issues of budget availability and organizational capacity should be addressed.

Background In rationing decisions in health, many criteria like costs, effectiveness, equity and feasibility concerns play a role. These criteria stem from different disciplines that all aim to inform health care rationing decisions, but a single underlying concept that incorporates all criteria does not yet exist. Therefore, we aim to develop a conceptual mapping of criteria, based on the World Health Organization’s Health Systems Performance and Health Systems Building Blocks frameworks. This map can be an aid to decision makers to identify the relevant criteria for priority setting in their specific context. Methods We made an inventory of all possible criteria for priority setting on the basis of literature review. We categorized the criteria according to both health system frameworks that spell out a country’s health system goals and input. We reason that the criteria that decision makers use in priority setting exercises are a direct manifestation of this. Results Our map includes thirty-one criteria that are distributed among five categories that reflect the goals of a health system (i.e. to improve level of health, fair distribution of health, responsiveness, social & financial risk protection and efficiency) and leadership/governance one category that reflects feasibiliy based on the health system building blocks (i.e. service delivery, health care workforce , information, medical products, vaccines & technologies, financing and). Conclusions This conceptual mapping of criteria, based on well-established health system frameworks, will further develop the field of priority setting by assisting decision makers in the identification of multiple criteria for selection of health interventions.

Contains fulltext : 137483.pdf (Publisher’s version ) (Open Access) BACKGROUND: The objective of this study was to develop a rating tool for policy makers to prioritize breast cancer interventions in low- and middle- income countries (LMICs), based on a simple multi-criteria decision analysis (MCDA) approach. The definition and identification of criteria play a key role in MCDA, and our rating tool could be used as part of a broader priority setting exercise in a local setting. This tool may contribute to a more transparent priority-setting process and fairer decision-making in future breast cancer policy development. METHODS: First, an expert panel (n = 5) discussed key considerations for tool development. A literature review followed to inventory all relevant criteria and construct an initial set of criteria. A Delphi study was then performed and questionnaires used to discuss a final list of criteria with clear definitions and potential scoring scales. For this Delphi study, multiple breast cancer policy and priority-setting experts from different LMICs were selected and invited by the World Health Organization. Fifteen international experts participated in all three Delphi rounds to assess and evaluate each criterion. RESULTS: This study resulted in a preliminary rating tool for assessing breast cancer interventions in LMICs. The tool consists of 10 carefully crafted criteria (effectiveness, quality of the evidence, magnitude of individual health impact, acceptability, cost-effectiveness, technical complexity, affordability, safety, geographical coverage, and accessibility), with clear definitions and potential scoring scales. CONCLUSIONS: This study describes the development of a rating tool to assess breast cancer interventions in LMICs. Our tool can offer supporting knowledge for the use or development of rating tools as part of a broader (MCDA based) priority setting exercise in local settings. Further steps for improving the tool are proposed and should lead to its useful adoption in LMICs.

Contains fulltext : 97648.pdf (Publisher’s version ) (Open Access) BACKGROUND: Many studies have found discrepancies in valuations for health states between the general population (healthy people) and people who actually experience illness (patients). Such differences may be explained by referring to various cognitive mechanisms. However, more likely most of these observed differences may be attributable to the methods used to measure these health states. We explored in an experimental setting whether such discrepancies in values for health states exist. It was hypothesized that the more the measurement strategy was incorporated in measurement theory, the more similar the responses of patients and healthy people would be. METHODS: A sample of the general population and two patient groups (cancer, rheumatoid arthritis) were included. All three study groups judged the same 17 hypothetical EQ-5D health states, each state comprising the same five health domains. The patients did not know that apart from these 17 states their own health status was also included in the set of states they were assessing. Three different measurement strategies were applied: 1) ranking of the health states; 2) placing all the health states simultaneously on a visual analogue scale (VAS); 3) separately assessing the health states with the time trade-off (TTO) technique. Regression analyses were performed to determine whether differences in the VAS and TTO can be ascribed to specific health domains. In addition, effect of being member of one of the two patient groups and the effect of the assessment of the patients' own health status was analyzed. RESULTS: Except for some moderate divergence, no differences were found between patients and healthy people for the ranking task or for the VAS. For the time trade-off technique, however, large differences were observed between patients and healthy people. The regression analyses for the effect of belonging to one of the patient groups and the effect of the value assigned to the patients' own health state showed that only for the TTO these patient-specific parameters did offer some additional information in explaining the 17 hypothetical EQ-5D states. CONCLUSIONS: Patients' assessment of health states is similar to that of the general population when the judgments are made under conditions that are defended by modern measurement theory.

Correction After the publication of this article [1], we became aware that two last sentences in the paragraph relied on original ideas following personal communication with a researcher, and should not have been presented here. Consequently, the reference number 9 which was cited for the removed issue should be taken from the article. The correct paragraph is provided below: The explicit weighing of criteria analyzed from DCE may improve the consistency of priority setting across contexts and over time, but does not solve the more fundamental problem that views of stakeholders, and therefore their expressed weights, may diverge. This is acknowledged by the ‘Accountability for Reasonableness’ (A4R) framework [2,3] which is based on the believe that any consensus on priority setting weights and subsequent results may be difficult to achieve because of these distinct perspectives of stakeholders. Instead of attempting to resolve the problem of diverse stakeholders’ views, the A4R framework proposes to concentrate on a fair priority setting process. On this basis, when conditions of reasonableness, publicity, appeal and enforcement are satisfied, it would lead to decisions that are considered fair and acceptable to stakeholders. In our view, exploring how stakeholders’ divergent perspectives on the weighting of criteria can be met fairly, is an object for further research. We regret any inconvenience that these corrections might have caused.