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Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees

BACKGROUND: Social accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services. In many countries, health facility committees (HFCs) provide the accountability interface between health providers and citizens or users of health se...

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Autores principales: Lodenstein, Elsbet, Mafuta, Eric, Kpatchavi, Adolphe C., Servais, Jean, Dieleman, Marjolein, Broerse, Jacqueline E. W., Barry, Alpha Amadou Bano, Mambu, Thérèse M. N., Toonen, Jurrien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470232/
https://www.ncbi.nlm.nih.gov/pubmed/28610626
http://dx.doi.org/10.1186/s12913-017-2344-7
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author Lodenstein, Elsbet
Mafuta, Eric
Kpatchavi, Adolphe C.
Servais, Jean
Dieleman, Marjolein
Broerse, Jacqueline E. W.
Barry, Alpha Amadou Bano
Mambu, Thérèse M. N.
Toonen, Jurrien
author_facet Lodenstein, Elsbet
Mafuta, Eric
Kpatchavi, Adolphe C.
Servais, Jean
Dieleman, Marjolein
Broerse, Jacqueline E. W.
Barry, Alpha Amadou Bano
Mambu, Thérèse M. N.
Toonen, Jurrien
author_sort Lodenstein, Elsbet
collection PubMed
description BACKGROUND: Social accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services. In many countries, health facility committees (HFCs) provide the accountability interface between health providers and citizens or users of health services. This article explores the social accountability practices facilitated by HFCs in Benin, Guinea and the Democratic Republic of Congo. METHODS: The paper is based on a cross-case comparison of 11 HFCs across the three countries. The HFCs were purposefully selected based on the (past) presence of community participation support programs. The cases were derived from qualitative research involving document analysis as well as interviews and focus group discussions with health workers, citizens, committee members, and local authorities. RESULTS: Most HFCs facilitate social accountability by engaging with health providers in person or through meetings to discuss service failures, leading to changes in the quality of services, such as improved health worker presence, the availability of night shifts, the display of drug prices and replacement of poorly functioning health workers. Social accountability practices are however often individualised and not systematic, and their success depends on HFC leadership and synergy with other community structures. The absence of remuneration for HFC members does not seem to affect HFC engagement in social accountability. CONCLUSIONS: Most HFCs in this study offer a social accountability forum, but the informal and non-systematic character and limited community consultation leave opportunities for the exclusion of voices of marginalised groups. More inclusive, coherent and authoritative social accountability practices can be developed by making explicit the mandate of HFC in the planning, monitoring, and supervision of health services; providing instruments for organising local accountability processes; strengthening opportunities for community input and feedback; and strengthening links to formal administrative accountability mechanisms in the health system.
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spelling pubmed-54702322017-06-19 Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees Lodenstein, Elsbet Mafuta, Eric Kpatchavi, Adolphe C. Servais, Jean Dieleman, Marjolein Broerse, Jacqueline E. W. Barry, Alpha Amadou Bano Mambu, Thérèse M. N. Toonen, Jurrien BMC Health Serv Res Research Article BACKGROUND: Social accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services. In many countries, health facility committees (HFCs) provide the accountability interface between health providers and citizens or users of health services. This article explores the social accountability practices facilitated by HFCs in Benin, Guinea and the Democratic Republic of Congo. METHODS: The paper is based on a cross-case comparison of 11 HFCs across the three countries. The HFCs were purposefully selected based on the (past) presence of community participation support programs. The cases were derived from qualitative research involving document analysis as well as interviews and focus group discussions with health workers, citizens, committee members, and local authorities. RESULTS: Most HFCs facilitate social accountability by engaging with health providers in person or through meetings to discuss service failures, leading to changes in the quality of services, such as improved health worker presence, the availability of night shifts, the display of drug prices and replacement of poorly functioning health workers. Social accountability practices are however often individualised and not systematic, and their success depends on HFC leadership and synergy with other community structures. The absence of remuneration for HFC members does not seem to affect HFC engagement in social accountability. CONCLUSIONS: Most HFCs in this study offer a social accountability forum, but the informal and non-systematic character and limited community consultation leave opportunities for the exclusion of voices of marginalised groups. More inclusive, coherent and authoritative social accountability practices can be developed by making explicit the mandate of HFC in the planning, monitoring, and supervision of health services; providing instruments for organising local accountability processes; strengthening opportunities for community input and feedback; and strengthening links to formal administrative accountability mechanisms in the health system. BioMed Central 2017-06-13 /pmc/articles/PMC5470232/ /pubmed/28610626 http://dx.doi.org/10.1186/s12913-017-2344-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Lodenstein, Elsbet
Mafuta, Eric
Kpatchavi, Adolphe C.
Servais, Jean
Dieleman, Marjolein
Broerse, Jacqueline E. W.
Barry, Alpha Amadou Bano
Mambu, Thérèse M. N.
Toonen, Jurrien
Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees
title Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees
title_full Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees
title_fullStr Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees
title_full_unstemmed Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees
title_short Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees
title_sort social accountability in primary health care in west and central africa: exploring the role of health facility committees
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470232/
https://www.ncbi.nlm.nih.gov/pubmed/28610626
http://dx.doi.org/10.1186/s12913-017-2344-7
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