Abstract:
BACKGROUND : The “Accountability for Reasonableness” (A4R) framework has been widely adopted in working
towards equity in health for sub-Saharan Africa (SAA). Its suitability for equitable health policy in Africa hinges, at
least in part, on its considerable successes in the United States and it being among the most comprehensive
ethical approaches in addressing inequitable access to healthcare. Yet, the conceptual match is yet to be examined
between A4R and communal responsibility as a common fundamental ethic in SAA.
METHODOLOGY : A4R and its applications toward health equity in sub-Saharan Africa were conceptually examined by
considering the WHO’s “3-by-5” and the REACT projects for their accounting for the communal responsibility ethic
in pursuit of health equity.
RESULTS : Some of the challenges that these projects encountered may be ascribed to an incongruity between the
underpinning ethical principle of A4R and the communitarian ethical principle dominant in sub-Saharan Africa.
These are respectively the fair equality of opportunity principle derived from John Rawls’ theory, and the African
communal responsibility principle.
CONCLUSION : A health equity framework informed by the African communal responsibility principle should enhance
suitability for SAA contexts, generating impetus from within Africa alongside the affordances of A4R.
Description:
The paper is partly an output of a doctoral research conducted at the
University of Central Lancashire, Preston, United Kingdom, and further developed during a postdoctoral research fellowship at the University of
Pretoria, South Africa. The paper was also presented at the Brocher
Foundation Workshop, “African perspectives on the Human Right to Health”
Geneva, January 29th-31st, 2020.
