Background: Social accountability encompasses a variety of strategies that enable citizens to express their concerns about the performance of health-care services. Community dialogues provide a forum for community engagement and participation in the health care system. However, there is little documentation on how it is used to improve social accountability within government community health structures. The purpose of this study was to determine the influence of community dialogues on social accountability in Nairobi County, Kenya.Methods: A qualitative study was conducted that included in-depth interviews with key stakeholders purposively selected. A total of three focus group discussions with 23 participants, eight key informant interviews and document review of minutes were conducted. Data analysis was done using thematic analysis.Results: Findings showed that community dialogues were held quarterly. The forums were mostly used for education purposes with little evidence on community engagement. Minutes showed what the community health assistant and community health volunteer said to the community with minimal input from the community members. Feedback was a challenge because the health management team hardly attended community dialogues due to logistic and workload issues.Conclusions: There is need of practical strengthening community dialogues through use of tools like chalk board and community scorecard as advocated in the community health policy. However, in practice, these tools were hardly used resulting to missed opportunity for the community to voice their opinions on health services.
Background: Community Health Volunteers position in the health system allow them to act as community mouthpieces, fighting inequities and advocating for community rights and needs to government structures. However, questions about how they carry out this role, specifically how they present community concerns to the health system and vice versa, remain unanswered. The purpose of this study was to evaluate the practices of community health volunteers that promote social accountability.
Methods: The study used a cross-sectional research design across two sub-counties that were purposefully chosen due to their health indicators status. The quantitative data sample size was 180 Community Health Volunteers (Embakasi North 90, Embakasi Central 90) who were sampled using stratified sampling. Focus group discussions, key informant interviews and document review were used to collect qualitative data.
Results: In Embakasi North and Embakasi Central, respectively, the study found that 66 (73.3 %) and 64 (71.1 %) of Community Health Volunteers rarely recorded complaints, 68 (75.6 %) and 53 (58.9 %) of Community Health Volunteers always reported complaints to the Community Health Assistant, and 67 (74.4 %) and 47 (52.2 %) of Community Health Volunteers always provided feedback to clients on the complaints raised.
Conclusion: There was sub-optimal and inconsistent implementation of social accountability practices by the Community Health Volunteers in the two sub-counties. This was influenced by inadequate information on their mandate in social accountability, a lack of reporting indicators targeting social accountability and a lack of awareness about formal channels of complaint handling mechanisms at community health systems.
Keywords: Social Accountability, Community Health Volunteers, Community Health Systems
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