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The World Health Report 2000 in Geneva

the preliminary recommendations of a committee may be submitted to a larger public review or to request formal written comments from stakeholders. This is another way to increase involvement. Some have used citizens’ juries – panels intended to reflect societal viewpoints – as an input into technology appraisal processes.2

All of these approaches must be carefully managed so as to prevent undue influence from any particular group. As with any form of political governance, there will be a heightened perception of fairness if restrictions are placed on who can participate in decision making, how they are chosen and how long they serve.

Right to a fair and accountable proceeding

The process of arriving at a recommendation must also reflect underlying principles of justice – in this case, procedural justice.

There are three key principles of an ‘accountability for reasonableness’ framework (fair process):

  1. Transparency about the grounds for decisions – for HTA this might mean producing a summary document of reasons for a recommendation
  2. Appeals to rationales that all can accept as relevant to meeting health needs fairly – for HTA, this might mean having a confidential draft available for comment or allowing appeal once a recommendation is made
  3. Procedures for revising decisions in light of challenges to them – for HTA this might mean changing recommendations once stakeholder concerns have been heard and taken into account.

Right to information

Another best practice for creating recommendations is allowing people to view information even if they chose not to participate in the proceedings. Many HTA bodies now make the reports that led to their recommendations widely available on the internet and increasingly strive to explain why they have made the recommendations they have. However, this is not always the case and in some countries the use of HTA is still ‘behind closed doors’, with little transparency or possibility for wide stakeholder involvement.