Inequitable Access to Healthcare in Africa: Reconceptualising the “Accountability for Reasonableness Framework” to Reflect Indigenous Principles

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Abstract BackgroundThe “Accountability for Reasonableness” (A4R) framework has been widely adopted in working towards equity in health for sub-Saharan Africa. 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 current literature in addressing inequitable access to healthcare. Methodology/FindingThis article considers applications of A4R towards health equity in sub-Saharan Africa – including the WHO’s “3-by-5” and the REACT projects – and ascribes some of the challenges that these projects encountered 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. ConclusionA health equity framework informed by the latter, we contend, should be more suitable for African contexts, generating impetus from within Africa alongside the affordances of A4R.

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