Abstract
ObjectivePublic primary health care and district health systems play important roles in expanding healthcare access and promoting equity. This study explored and described accountability for this mandate as perceived and experienced by frontline health managers and providers involved in delivering maternal, newborn and child health (MNCH) services in a rural South African health district.MethodsThis was a qualitative study involving in-depth interviews with a purposive sample of 58 frontline public sector health managers and providers in the district office and two sub-districts, examining the meanings of accountability and related lived experiences. A thematic analysis approach grounded in descriptive phenomenology was used to identify the main themes and organise the findings.ResultsAccountability was described by respondents as both an organisational mechanism of answerability and responsibility and an intrinsic professional virtue. Accountability relationships were understood to be multidirectional - upwards and downwards in hierarchies, outwards to patients and communities, and inwards to the ‘self’. The practice of accountability was seen as constrained by organisational environments where impunity and unfair punishment existed alongside each other, where political connections limited the ability to sanction and by climates of fear and blame. Accountability was seen as enabled by open management styles, teamwork, good relationships between primary health care, hospital services and communities, investment in knowledge and skills development and responsive support systems. The interplay of these constraints and enablers varied across the facilities and sub-districts studied.ConclusionsProviders and managers have well-established ideas about, and a language of, accountability. The lived reality of accountability by frontline managers and providers varies and is shaped by micro-configurations of enablers and constraints in local accountability ecosystems. A ‘just culture’, teamwork and collaboration between primary health care and hospitals and community participation were seen as promoting accountability, enabling collective responsibility, a culture of learning rather than blame, and ultimately, access to and quality of care.
Highlights
Accountability in health systems is perceived as key to improving health outcomes in low and middle-income countries (LMICs) [1, 2]. This was highlighted in the Millennium Development Goals (MDGs) and reiterated in the Sustainable Development Goals (SDGs), which advocate for more accountability to targets and greater social accountability to communities and the public [3,4,5]
As part of a PhD study exploring the forms and functioning of accountability mechanisms for maternal, newborn and child health (MNCH), this paper explores the perceptions and daily working experiences of frontline public sector managers and providers regarding accountability in a South African health district, serving a rural community with a higher level of poverty relative to the rest of the country
South Africa has been regarded as a poor performer with respect to maternal and child health outcomes, and a number of accountability strategies were implemented in the health system to address this
Summary
Accountability in health systems is perceived as key to improving health outcomes in low and middle-income countries (LMICs) [1, 2]. Accountability is an essential and intrinsic component of health system governance arrangements, concerned with the management of relationships between various actors [7] In these relationships, meaningful accountability processes should address the systemic and structural drivers of inequity in health systems [8] in order to achieve universal health coverage (UHC). Meaningful accountability processes should address the systemic and structural drivers of inequity in health systems [8] in order to achieve universal health coverage (UHC) In this regard, UHC can only be achieved by fairness, accountability and transparency in the distribution of resources; by ensuring quality and access to healthcare, especially to marginalised communities; and by participation and building trust between health systems and the community. Accountability, understood as a driver and a ‘galvanizing force’, can improve health equity [8, 9]
Sign-in/Register to view highlights & summary 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
