Rennie Stuart, Gilbertson Adam, Hallfors Denise, Luseno Winnie K
UNC Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Med Ethics. 2020 Nov 4. doi: 10.1136/medethics-2020-106293.
The use of targets to direct public health programmes, particularly in global initiatives, has become widely accepted and commonplace. This paper is an ethical analysis of the utilisation of targets in global public health using our fieldwork on and experiences with voluntary medical male circumcision (VMMC) initiatives in Kenya. Among the many countries involved in VMMC for HIV prevention, Kenya is considered a success story, its programmes having medically circumcised nearly 2 million men since 2007. We describe ethically problematic practices in Kenyan VMMC programmes revealed by our fieldwork, how the problems are related to the pursuit of targets and discuss possible approaches to their management. Although the establishment and pursuit of targets in public health can have many benefits, assessments of target-driven programmes tend to focus on quantifiable outcomes rather than the processes by which the outcomes are obtained. However, in order to speak more robustly about programmatic 'success', and to maintain community trust, it is vital to ethically evaluate how a public health initiative is actually implemented in the pursuit of its targets.
利用目标来指导公共卫生项目，尤其是在全球倡议中，已被广泛接受且司空见惯。本文运用我们在肯尼亚自愿男性医学包皮环切术（VMMC）倡议方面的实地调查和经验，对全球公共卫生中目标的运用进行伦理分析。在众多参与VMMC以预防艾滋病毒的国家中，肯尼亚被视为一个成功案例，自2007年以来，其项目已为近200万男性进行了医学包皮环切术。我们描述了实地调查揭示的肯尼亚VMMC项目中存在的伦理问题，这些问题与目标追求的关联方式，并讨论了可能的管理方法。尽管在公共卫生中设定和追求目标可能有诸多益处，但对目标驱动项目的评估往往侧重于可量化的结果，而非取得这些结果的过程。然而，为了更有力地谈论项目的“成功”，并维持社区信任，从伦理角度评估公共卫生倡议在追求目标时的实际实施方式至关重要。
