Community accountability at peripheral health facilities: a review of the empirical literature and development of a conceptual framework

Abstract

Public accountability has re-emerged as a top priority for health systems all over the world, and particularly in developing countries where governments have often failed to provide adequate public sector services for their citizens. One approach to strengthening public accountability is through direct involvement of clients, users or the general public in health delivery, here termed ‘community accountability’. The potential benefits of community accountability, both as an end in itself and as a means of improving health services, have led to significant resources being invested by governments and non-governmental organizations. Data are now needed on the implementation and impact of these initiatives on the ground. A search of PubMed using a systematic approach, supplemented by a hand search of key websites, identified 21 papers from low- or middle-income countries describing at least one measure to enhance community accountability that was linked with peripheral facilities. Mechanisms covered included committees and groups (n = 19), public report cards (n = 1) and patients’ rights charters (n = 1). In this paper we summarize the data presented in these papers, including impact, and factors influencing impact, and conclude by commenting on the methods used, and the issues they raise. We highlight that the international interest in community accountability mechanisms linked to peripheral facilities has not been matched by empirical data, and present a conceptual framework and a set of ideas that might contribute to future studies.

Anchoring contextual analysis in health policy and systems research: A narrative review of contextual factors influencing health committees in low and middle income countries

“…Previous reviews examined the effectiveness of HCs on health outcomes (McCoy et al, 2012) and their roles in community accountability (Molyneux et al, 2012). While they both discuss contextual factors relevant to HCs, we expanded on their work by developing a framework specific to contextual factors.…”

“…We initially followed a realist perspective to understanding the role of HCs in improving local well-being and therefore used the following categories for abstraction: (a) general information; (b) mechanisms and processes (c) contextual features; and (d) outcomes. However, we decided to narrow our focus to (c) contextual features in order to build most effectively upon two recent reviews (McCoy et al, 2012;Molyneux et al, 2012). Following a narrative review of the literature (Popay et al, 2006), we synthesized key findings and reviewed gaps in the literature based on our theory of how contextual features influence HCs role and capacity (Fig.…”

“…Health committees (HCs) are one of the better documented mechanisms in an incipient empirical evidence base on community accountability in health systems (Molyneux et al, 2012). In many countries, they are a familiar fixture of health systems, and can be effective in improving quality and coverage of health care, as well as improving health (McCoy et al, 2012).…”

The politics of reducing malnutrition: building commitment and accelerating progress

“…Empirical evidence about the eff ect of such accountability mechanisms on the quality of care and health facilities is weak, but encouraging. 58,59 A trial of community-based monitoring of health service provision in Uganda showed a 33% reduction in mortality in children younger than 5 years and a significant 0·14 increase in weight-for-age Z score. 60 …”

The community is just a small circle: citizen participation in the free maternal and child healthcare programme of Enugu State, Nigeria

“…Social accountability initiatives, such as patient complaints procedures, health facility committees (HFCs), provider report cards and patients’ rights charters [10–13], may inspire users to participate in management of health facilities, complement government-led supervision and regulation, and improve the quality of healthcare decisions by government [4,6,14]. These accountability initiatives may improve the capacity of policymakers and providers to make changes to services based on citizens’ expectations [12,15], promote transparency in service entitlement and enhance health system outcomes [2,16]. …”