The Response to Accountable Priority Setting for Trust in health systems (REACT) initiative in Tanzania brought together community members and medical professionals to determine priorities and establish a system for implementing the Accountability for Reasonableness (AFR) framework in Tanzania with mixed results.¹ The decentralized nature of the health system in Tanzania was a significant enabler of implementation during this project. Pre-existing Council Health Management Teams (CHMTs) were responsible for planning and budgeting and formed the foundation of the AFR intervention. The CHMTs collaborated with research teams to conduct participatory research evaluating the existing priority-setting practices, training for CHMT to restructure priority-setting and development of strategies to address AFR. The CHMT was ultimately responsible for spreading AFR values throughout the district.¹ There was initial resistance to the inclusion of special interest groups and community members in the CHMT despite community engagement and transparency being a central component of AFR. Critics felt that community members often did not have adequate knowledge or skills to contribute to these exercises. After a few years, the CHMTs acclimated to the inclusion of special groups and recruited community members into their planning and budgeting process. Thus, the evaluation found that successful integration of community perspectives in priority-setting required external support to sensitize health professionals towards the utility of community input, an important consideration for health systems seeking to integrate community members into priority-setting exercises.¹

The program experienced some logistical challenges that should be considered by others attempting to replicate this process, including lack of financial support to effectively carry out roles and insufficient time for pre-planning, discussion of priorities, and meeting preparation. Thus, countries working towards incorporating community voices and values in priority-setting should ensure that they devote adequate time and financial resources to community engagement during planning. Despite these shortcomings, this approach was successful at improving health outcomes, including marginalized groups, and appropriately orienting priorities to local needs. The process resulted in better identification of needs and priorities, increased community knowledge about priority-setting, greater transparency, improved trust, and improved perceived accessibility of services.¹