Abstract
BackgroundDespite calls for improved accountability in global health systems, and a set of clear and consistent theoretical accountability frameworks, empirical descriptions of how accountability is experienced and enacted in low- and middle- income country (LMIC) settings is limited. Therefore, we sought to characterize how managers at all levels of Ethiopia’s primary healthcare system experience accountability in their daily practice.MethodsWe conducted in-depth key informant interviews with 41 key stakeholders across 4 regions (Amhara, Oromia, Southern Nations Nationalities and Peoples, and Tigray) in the context of the Primary Healthcare Transformation Initiative (PTI). Consistent with the principles of grounded theory, our team used the constant comparative method to identify emergent themes related to concrete areas that could be targeted to allow an overall culture of accountability to flourish.ResultsEmergent themes were: development of a shared understanding of system-wide accountability, streamlining of managerial reporting lines, strengthening of medico-legal knowledge and systems, and development of mechanisms for bottom-up accountability.ConclusionsFindings may be valuable to policymakers seeking to create more effective national accountability frameworks; practitioners and development partners seeking to strengthen implementation of evidence-based accountability systems and practices; and researchers aiming to develop meaningful, practical measures of accountability in public health.
Highlights
Despite calls for improved accountability in global health systems, and a set of clear and consistent theoretical accountability frameworks, empirical descriptions of how accountability is experienced and enacted in low- and middle- income country (LMIC) settings is limited
We identified 4 emergent themes related to concrete areas that could be targeted to promote overall culture of accountability (Table 2): development of a shared understanding of system-wide accountability, streamlining of managerial reporting lines, strengthening of medicolegal knowledge and systems, and development of mechanisms for bottom-up accountability
We have identified 4 emergent themes related to concrete areas that could be targeted to promote an overall culture of accountability: Development of a shared understanding of system-wide accountability, streamlining managerial reporting lines, strengthening medico-legal knowledge and systems, and developing mechanisms for bottom-up accountability
Summary
Despite calls for improved accountability in global health systems, and a set of clear and consistent theoretical accountability frameworks, empirical descriptions of how accountability is experienced and enacted in low- and middle- income country (LMIC) settings is limited. Fetene et al BMC Family Practice (2020) 21:261 responsiveness to requests and grievances [4, 5] These building blocks are not necessarily distinct; significant overlap exists, as robustness in one domain cannot be achieved without a similar investment and level of attention to the others [2, 6]. Despite calls for improved accountability in global health systems [8], and a set of clear and consistent theoretical frameworks to support development of accountability, empirical descriptions of how accountability is experienced and enacted in low- and middle- income country (LMIC) settings are limited [9]. Promising mechanisms to promote external accountability in LMIC settings are emerging (including, for example, the use of community scorecards and health facility committees), but uneven implementation requires greater attention [13, 14] and practical tools to promote accountability are lacking
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
