Principles for the Allocation of Scarce Healthcare Resource During the Covid-19 Pandemic: Public Preference in Comparison with Ethicists’ Recommendations in Greater Accra.

Abstract

Background Allocating scare healthcare resources became significantly challenging during the COVID-19 pandemic, as decisions had to be made on a very short timeline where important evidence was incomplete or limited (Steele and Duthie, 2021). The perception of unfair allocation of scare healthcare resources was a major ethical challenge for healthcare providers during the COVID-19 pandemic. On one hand, Ethicists developed and recommended ethical principles for the allocation of scarce healthcare resources during COVID-19. On the other hand, there is the view of the public on how to allocate scarce healthcare resources during pandemics which may not overlap with that of ethicists (Lee et al, 2021). Clarifying the divergent views in health policies will enhance receptivity and success of health policies in pandemic situation like COVID-19. Objective: To explore the preferences of the public concerning the ethical principles for allocating scarce medical resources during the Covid-19 pandemic in Ghana. Methods The study used a retrospective cross-sectional study design that employed an online survey. . Questionnaires were used to gather data on the socio-demographic characteristics and preferences of participants regarding the principles for allocating scarce healthcare resource for healthcare decision making in the Greater Accra Region. Convenience sampling was used to select participants for the study Results The study included 198 male (51.4%) and 187 female (48.6%) participants. The age of the participants ranged from18 to 69 years with a mean age of 31.4 and standard deviation of 11.4. Majority (55%) were between 18 and 29 years. The respondents prioritized ‘Save the most lives’ (mean rank of 1.99, standard deviation of 1.54) as the most preferred allocation principle. ‘Reciprocity’ (mean rank =6.98, standard deviation =1.33) was the least preferred ethical principle for scarce resource allocation. ‘Save the most lives’ which is the most prioritized allocation principle recommended by ethicists is the same principle prioritized by respondents. The respondent preferred to prioritize those that are worst off (sickest first) at the second level, but the experts propose that the benefits of scarce resources should be continuously maximized by preferring prognosis (maximizing ‘life-years’). ‘Reciprocity’ which is highly favored by expert was least preferred by respondents .Study findings indicate that marital status (p=0.002), work status (p= 0.010), belief in the efficacy of traditional medicine (p= 0.033), honesty (p=0.001), health rating (p= 0.004) and the frequency of having medical checkup (p=0.001), had significant association with the preferences of allocation principles Conclusion The preference of the Ghanaian public is that scarce healthcare resources should be allocated to save the most lives. Study findings are partly at variance with the recommendation of expert ethicists. There is a gap between what experts have proposed and the public’s preference. Cultural, socio-economic and health factors influence the preferences of individuals. Ethicist must seek the input of every stakeholder within the healthcare system to formulate context specific guidelines for the allocation of scarce healthcare resources.