Developing accountability mechanisms in NGOs in providing health services

Abstract

ABSTRACT Purpose: The aim of this study is to evaluate NGOs’ accountability in delivering sub-district (upazila) health services in Bangladesh Methodology: The approach of this study is qualitative and 85 respondents, including two focus group participants (each focus group consists of 8 respondents) from rural and urban areas, have been selected for the interview to collect data for understanding accountability mechanisms and NGOs in health care delivery. Findings: The study found that the staff members of NGOs ensure their accountability to their higher officials and the conditions of fund-receiving agencies. Field data demonstrate that NGOs have poor accountability to the government and the local elected representatives because of their poor coordination, lack of policy, and an inadequate legal framework. In addition, NGOs work with limited clients in a particular area, but they have no direct accountability to service users as the policy of the organization does not allow being accountable. The mechanism of supervision is cooperative and supportive which closely guides the staff to contribute to the effective and efficient health care. NGOs have limited capacity and resources for promoting health care although they use their available resources efficiently, with strong monitoring and supervision to provide satisfactory health service delivery. In addition, the positive behavior of NGO health care providers, the minimal amount of time needed in getting services, friendly insurance schemes, freedom from politics and greater fairness all contribute to the effective and efficient health care delivery. Practical Implications: The evidence of this research will promote health care management and ensure good governance in health service delivery as NGOs in supervision mechanism and resource management are highly appreciated and could be a good example for health service managers. Also, this research can be a policy guideline for health care managers for future improvement for many developing countries. Originality/value: This paper demonstrates that managerial efficiency, intensive supervision, need-based motivation, commitment and positive ethos contribute to promoting NGOs’ health service accountability and the quality health care. The ideas on accountability mechanisms promote good governance in the health service organizations and can be a valuable understanding for international health care managers around the world. Abbreviations: BRAC: Bangladesh Rural Advancement Committee; CC: community clinics; GK: Gonoshasthaya Kendra; NGOs: Non-governmental Organizations; PNC: Post natal care; TB: tuberculosis; UHC: Upazila health complex; UPHCP: urban primary health care project (UPHCP)