An ethical framework for evaluation of public health plans: a systematic process for legitimate and fair decision-making

OBJECTIVES: Given the increasing threats of communicable and non-communicable diseases, it is necessary for policy-makers and public health (PH) professionals to address ethical issues in health policies and plans. This study aimed to develop a practical framework for the ethical evaluation of PH programs. STUDY DESIGN: A multidisciplinary team developed an ethical framework to evaluate PH plans from 2015 to 2017. METHODS: In this study, the multi-method approach was used. First, a list of moral norms in PH policy and practice was drafted and completed in two interactive sessions. Then, the Delphi method was used for consensus about the structural components to be adopted in the framework. After developing the framework, its efficiency was assessed by evaluating Iran's Fourth Strategic Plan for HIV/AIDS Prevention and Control. RESULTS: The framework was developed in the following three sections: (i) determination of the general moral norms in PH practice and policy; (ii) five steps of evaluation; and (iii) a procedural evaluation step to ensure fair decision-making. The ratio of the ethical points of the PH plan increased by 46% after implementation of the framework, and the frequency of ethical points increased significantly after applying the framework (P = 0.001). CONCLUSION: The application of the framework for the ethical evaluation of various PH programs ensures a comprehensive and scientific-deliberative decision-making process, while also contributing to the development of the framework.