Abstract
BackgroundSocial accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services. In many countries, health facility committees (HFCs) provide the accountability interface between health providers and citizens or users of health services. This article explores the social accountability practices facilitated by HFCs in Benin, Guinea and the Democratic Republic of Congo.MethodsThe paper is based on a cross-case comparison of 11 HFCs across the three countries. The HFCs were purposefully selected based on the (past) presence of community participation support programs. The cases were derived from qualitative research involving document analysis as well as interviews and focus group discussions with health workers, citizens, committee members, and local authorities.ResultsMost HFCs facilitate social accountability by engaging with health providers in person or through meetings to discuss service failures, leading to changes in the quality of services, such as improved health worker presence, the availability of night shifts, the display of drug prices and replacement of poorly functioning health workers. Social accountability practices are however often individualised and not systematic, and their success depends on HFC leadership and synergy with other community structures. The absence of remuneration for HFC members does not seem to affect HFC engagement in social accountability.ConclusionsMost HFCs in this study offer a social accountability forum, but the informal and non-systematic character and limited community consultation leave opportunities for the exclusion of voices of marginalised groups. More inclusive, coherent and authoritative social accountability practices can be developed by making explicit the mandate of HFC in the planning, monitoring, and supervision of health services; providing instruments for organising local accountability processes; strengthening opportunities for community input and feedback; and strengthening links to formal administrative accountability mechanisms in the health system.
Highlights
Social accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services
This paper explores the activities health facility committees (HFC) currently perform in providing a social accountability interface only (4th “outward role” in Table 2) that are summarised in four steps: information/data collection, dialogue/forum, consequences and counter-feedback to users [15]
This study aimed to explore the role of Health Facility Committees (HFC) in providing a forum for social accountability in Benin, Guinea and Democratic Republic of Congo (DRC)
Summary
Social accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services. Since the 1978 Alma-Ata Declaration on Primary Health Care, participation has been a central theme of health policy and programming. While the Alma-Ata Declaration expressed the key principles of Primary Health Care, the Bamako Initiative operationalized the principle of community participation in the organisation of health services. The Bamako Initiative (BI) is a policy statement, adopted in 1987 by African health ministers in Bamako, Mali. It was developed in the context of economic crises and negative effects of adjustment programmes in many Sub-Saharan countries. Formulated by UNICEF and WHO, the initiative aimed to promote universal access to primary health care
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