Resource allocation is the distribution of resources, usually financial, among competing groups of people or programs (Brock. 2003).  A number of ethical questions arise when discussing healthcare resource allocation, to mention the few:

• If healthcare resources are scarce, how should they be distributed?
• Distribution choices will benefit some and not others. How should choices be made? What values should guide these choices?
• Is the current distribution of healthcare resources fair and equitable?

According to Brock (2003), when we talk about allocation of funds for healthcare, we need to consider three distinct levels of decision-making.

Level 1: Allocating resources to healthcare versus other social needs.

Level 2: Allocating resources within the healthcare sector.

Level 3: Allocating resources among individual patients.

My focus will be on level 3 which is allocating resources among individual patients.

Most communities have policies and guidelines to insure fairness in these situations. Decisions at this level include who gets the next available heart for transplant? And, who sees the doctor first when there are many people waiting in an emergency room?

According to Ramasamy and Shrivastava (2014), to ensure appropriate handling and management of victims when the quantity and severity of injuries exceed the operative capacity of health facilities, the triage approach has been employed. Triage is a color coded approach under which patients are rapidly classified based on the severity of their injuries and the likelihood of their survival with prompt medical interventions. It enables health professionals to take the best possible decision for the individual victim, within the available resources at times of disaster. It generally employs four color codes, namely red tag (for critical patients demanding immediate action), yellow tag (for patients between critical and minor categories requiring urgent action), green tag (for ambulatory patients who need minor care), and black tag (refers to dead persons)

In the public health sector, where the aim is to improve the health indicators of the general population as a whole, application of color coding not only enables diagnosis of important health condition but even serves as a rationale to start an appropriate line of management. Multiple applications of color-coding have been identified in the health sector. In conclusion, color coding in health care has the immense scope to ensure delivery of quality assured services, especially in low resource settings. Nevertheless, there is a crucial need to implement this approach universally to expand its range of benefits to both patients and healthcare professionals (Ramasamy and Shrivastava, 2014).

However the triage somehow involves balancing conflict to the claim of one of the Batho Pele principles which clearly state that All citizens should have equal access to the services to which they are entitled.   Batho Pele, a Sesotho word, which means “People First”, is an initiative that was launched in 1997 to transform the Public Service at all levels. Batho Pele was launched because democratic South Africa inherited a Public Service that was not people-friendly and lacked the skills and attitudes to meet the developmental challenges facing the country. In the struggle to transform the Public Service, the old culture has to be changed to ensure that our people are served properly, that all staff work to their full capacity and treat state resources with respect (Mokgoro, 2013). My question then arises to how do you treat or give all citizens equal access to services with inadequate resources? Is the color coding the one that can rescue the clinicians?

This information led to me thinking of the incident that once happened when I was placed in Tygerberg Hospital for my Cardiothoracic ICU block. Normally people are booked prior for their surgeries and are put in a long waiting list, however if there is an emergency where a particular patient was stabbed or was involved in a traumatic injury and needs a cardiothoracic surgery, those that are on the waiting list will be asked to move their dates up because there is no enough ventilator machines to assist them after surgery. Some patients would be hurt as they travel from very far and they want to leave hospital as soon as possible and moving dates for them increases the hospital stay and delays the process of healing.  This other time we had 2 emergencies but there was only one ventilator machine available.  The other patient was a young man who was still in varsity who was stabbed a week ago and needed a surgery to be done immediately but the other patient was the old man who had arrived the previous day with shortness of breath and was placed on the emergency list for the surgery to be done the following day. It came to the facilities attention that they did not have enough resources and surgeons to do the operation on that day so the decision was taken that the young man must be treated first.  I asked myself why the bible says we are equal in front of the Lord’s eyes but we are not treated equally when it comes to our health needs. This is where clinicians face ethical dilemmas.

With this piece I have learnt that your judgemental call should not be influenced by my own personal cultural/regional beliefs but should be always ethical justifiable and resource accommodating. I have also learnt that taking the patient and family members through counselling after taking such decisions is very vital to make them understand what has really happened and fore them not to feel less important. Color coding has been used to minimize common diagnostic or therapeutic errors and even enhances parental understanding about different attributes related to health (Ramasamy and Shrivastava, 2014).

References

(PDF) Implementation of Batho Pele Principles in an Educational District Office. Available from: https://www.researchgate.net/publication/271104661_Implementation_of_Batho_Pele_Principles_in_an_Educational_District_Office [accessed Oct 08 2018].