Social Accountability Framework Research Articles

Community members’ perspective on social accountability in the health system: a cross- sectional study from Tanzania

Introduction: Social accountability initiatives are considered a way to address inefficiencies and improve overall health system performance. Tanzania has introduced Health Facility Governing Committees (HFGCs) to improve social accountability of the health system. However, information on how communities perceive these committees is lacking. This study aimed to assess the prevalence and social determinants of the HFGCs accountability from the community perspective in Tanzania. Methods: The research employed a cross-sectional survey design in two Tanzanian districts (Handeni and Mbarali) selected for their contrasting health performance. Data collection took place from July to October 2022, involving 1184 households in 31 villages/mitaa. The study measured social accountability through a set of six questions, focusing on community support, sensitization, feedback, trust, engagement, and overall accountability of HFGCs. Socio-demographic data such as sex, age, education, occupation, type of health facility and district were also collected and analyzed using linear regression to identify factors influencing perceptions of accountability. Results: The findings revealed a low prevalence of social accountability as measured by the variables of community awareness and engagement with the HFGCs. Only a small percentage of respondents felt adequately informed or involved in the activities of these committees. Social determinants such as higher education levels and certain occupations, such as business and retirement and those living in Handeni district, correlated positively with a better perception of social accountability. Conclusion: The study highlights significant challenges in the operational effectiveness of HFGCs in Tanzania, with a notable disconnect between these bodies and the communities they serve. Despite the theoretical framework for social accountability, actual community engagement remains low, impacting the overall efficacy of health governance at the local level. Future research should focus on improving community awareness and participation in these committees to improve their functionality and accountability, thereby aligning with national health objectives and local needs.

Mapping health, social and health system issues and applying a social accountability inventory to a problem based learning medical curriculum

ABSTRACT Social accountability is a powerful concept. It is applied to medical education to encourage future doctors to take action to address health inequalities and overlooked health needs of disadvantaged populations. Problem-based learning (PBL) provides an ideal setting to teach medical students about these topics. The objective of this study is to explore how well the components of social accountability are covered in a pre-clinical PBL medical curriculum and to determine the usefulness of an adapted validated social accountability framework. We identified Irish health needs and social issues through a literature review. The retrieved documents were aligned to four values (relevance, equity, cost-effectiveness and quality) from a validated social accountability inventory, to generate a map of social accountability values present in the Irish health system and population. We then used the adapted validated social accountability inventory to evaluate the content of the PBL medical curriculum at an Irish medical school. We identified 45 documents, which upon analysis lead to the identification of health and social issues related to social accountability. 66 pre-clinical PBL cases included demographic, health and psychosocial issues similar to the local population. Analysing along the four social accountability values, the PBL cases demonstrated room for improvement in the equity and relevance domains. Topics for expansion are Traveller health, LGBTI health, alcohol use, climate change and more. Medical educators can use the paper as an example of how to apply this methodology to evaluate PBL cases. Adapting and applying a validated framework is a useful pedagogical exercise to understand established societal values related to social accountability to inform a medical curriculum. We identified opportunities to improve the PBL cases to depict emerging global and social issues.

An Integrative Dynamic Framework of Social Accountability: Determinants, Initiatives, and Outcomes

Existing conceptualizations of social accountability lack a comprehensive approach linking the determinants, initiatives, and performance outcomes of social accountability initiatives (SAIs). The present paper attempts to address this gap by developing an integrative dynamic framework of social accountability. The framework posits that the performance outcomes of SAIs influence not only the legitimacy of the SAIs but also shape the interaction effects of determinants on the existing as well as future SAIs. The proposed framework will potentially serve as a springboard to guide future research in better understanding the mechanisms of SAIs.

A Curriculum for Achieving Universal Health Care: A Case Study of Ateneo de Zamboanga University School of Medicine.

Introduction: Universal Health Care requires equal distribution of a health workforce equipped with competencies appropriate for local population needs. While health inequities persist in the Philippines, the Ateneo de Zamboanga University School of Medicine (ADZU-SOM) in Zamboanga Peninsula – an impoverished and underserved region – has demonstrated significant success retaining graduates and improving local health statistics. This study describes the qualitative evidence of ADZU-SOM students and graduates having positive impacts on local health services and communities, and the contextual factors associated with the school's socially-accountable mission and curriculum that contribute to these impacts.Methods: This qualitative study involved 41 one-on-one or group interviews conducted across seven participant groups (faculty, graduates, final-year students, health professionals, health workers, community members, community leaders). Gale et al's method for analyzing qualitative data in multi-disciplinary health research, WHO's “6 Building Blocks for quality health systems” framework and THEnet's social-accountability framework were used to organize and interpret data.Results: Local community members, community leaders, and health staff consistently reported examples of ADZU-SOM students and graduate doctors developing health infrastructure and providing health education, health promotion, and disease prevention activities accessible to all population groups. Students and graduates suggested these impacts were due to a number of factors, including how ADZU-SOM's sandwich model of longitudinal community-engagement culminating in 10-months continuous community placement in the final year helped them develop a strong motivation for community service, the teachings and curriculum activities that focused on public health and the social determinants of health, and faculty's commitment and ability to operationalize ADZU-SOM's mission and values. Staff also reported impacts were driven by integration of regional and national health priorities as core curriculum, and involving local stakeholders in curriculum development.Conclusions: This study provides qualitative evidence that ADZU-SOM's curriculum content and immersive community placements are training a medical workforce that is strengthening local health systems and health infrastructure across all 6 WHO “Building Blocks for quality health systems.” These findings suggest ADZU-SOM has managed to evolve a consciousness toward community service among final year students and graduates, adding evidence to the assertion it is a fully socially-accountable health professions institution.

Fifteen Years of a PBRFS in New Zealand: Incentives and Outcomes

AbstractThis article examines the transformation of New Zealand universities following the introduction in 2003 of a performance‐based research fund system. The analysis, based on a social accounting framework, utilises longitudinal researcher data available from three full assessment rounds, in 2003, 2012 and 2018. This enables identification of the entry, exit and quality transformation of researchers and their contribution to changes in university and discipline research quality. Changes in the discipline composition of universities made a negligible contribution compared to improvements in the quality of researchers. The dynamics are closely related to the new incentives created by the system.

Recasting social workers as frontline in a socially accountable COVID-19 response

The COVID-19 pandemic has seen the engagement of a wide range of professionals in responding to clinical, social and economic issues. While the clinical expression of the pandemic has generated strong media portrayal of physicians and nurses as frontline workers, social workers – who play a key role in helping individuals and families in crisis – have not been similarly highlighted. The pandemic within a social accountability framework highlights important roles of both public officials and civic society in containment efforts. This article recognizes social workers as important actors in their representative and supportive role for civil society during COVID-19.

Social Accountability and Institutional Change: The Case of Citizen Oversight of Police

AbstractThis article examines the ability of social accountability to spur gradual institutional change at the municipal level, using the case of citizen oversight agencies (COAs) for police agencies. Using the gradual change framework and the social accountability framework to guide the empirical strategy and data collected through an original survey of COAs, the authors test the impact of COAs on institutional outcomes in policing. We find that, in accordance with the gradual change framework, the degree to which a COA reduces racial disparity in policing outcomes depends on its scope of authority and the degree of discretion afforded by existing institutions to police officers. In general, the wider the scope of authority, and the broader the discretion afforded by existing institutions, the greater the likelihood of change in institutional outcomes.

Socially Accountable Academic Health Centers: Pursuing a Quadripartite Mission.

Academic health centers (AHCs) in the United States have had a leading role in educating the medical workforce, generating new biomedical knowledge, and providing tertiary and quaternary clinical care. Yet the health status of the U.S. population lags behind almost every other developed world economy. One reason is that the health care system is not organized optimally to address the major driver of health status, the social determinants of health (SDOH). The United States' overall poor health status is a reflection of dramatic disparities in health that exist between communities and population groups, and these are associated with variations in the underlying SDOH. Improving health status in the United States thus requires a fundamental reengineering of the health delivery system to address SDOH more explicitly and systematically. AHCs' tripartite mission, which has served so well in the past, is no longer sufficient to position AHCs to lead and resolve the intractable drivers of poor health status, such as unfair and unjust health disparities, health inequities, or differences in a population's SDOH.AHCs enjoy broad public support and have an opportunity-and an obligation-to lead in improving the nation's health. This Perspective proposes a new framework for AHCs to expand on their traditional tripartite mission of education, research, and clinical care to include explicitly a fourth mission of social accountability. Through this fourth mission, comprehensive community engagement can be undertaken, addressing SDOH and measuring the health impact of interventions by using a deliberate structure and process, yielding defined outcomes.

Social Accountability and Institutional Change: The Case of Citizen Oversight of Police

We examine the ability of social accountability to spur gradual institutional change at the municipal level, using the case of citizen oversight agencies (COAs) for police agencies. Using the gradual change framework (GCF) and social accountability framework to guide our empirical strategy, and data collected through an original survey of COAs, we test the impact of COAs on institutional outcomes in policing. We find, in accordance with the GCF, that the degree to which a COA reduces racial disparity in policing outcomes depends on its scope of authority, as well as the degree of discretion afforded by existing institutions to police officers. In general, the wider the scope of authority, and the broader the discretion afforded by existing institutions, the greater the likelihood of change in institutional outcomes.

Qualities before Quantities: A Framework to Develop Dynamic Assessment of the Nonprofit Sector

AbstractMetrics are essential for assessing performance and guiding course corrections. However, selecting the wrong metrics can damage organizations and communities by promoting resource investment in activities that don’t lead to envisioned impacts. Therefore, it is essential to reflect on what qualities an effective set of metrics should possess before insisting on quantification. This concept paper articulates design principles for developing an index of the nonprofit sector. Drawing from complexity theory and axiology (philosophy of values), the paper explains fundamental questions and values considerations to assist index developers in creating effective measures. It argues for the use of a capabilities approach, operationalized as multiple capitals, as the design architecture. It suggests the social accounting framework of Integrated Reporting as a way to track these capitals over multiple levels and time horizons.

Exploring a communication curriculum through a focus on social accountability: A case study at a South African medical school.

BackgroundGood communication is integral to social accountability, and training is included in medical curricula internationally. In KwaZulu-Natal, training is conducted in English, in spite of most public sector patients being mother tongue isiZulu speakers. Communication challenges with patients are common, but good communication and African language teaching are not emphasised in teaching.AimThis study explored communication training and how it related to social accountability at a single institution in KwaZulu-Natal.SettingThis exploratory, qualitative case study design at the medical school explored participants’ perceptions about communication and social accountability and reviewed relevant educational documentation for evidence.MethodsPurposive sampling was used to select medical students, educators and stakeholders from the educational and service platforms. Focus group discussions and semi-structured interviews were conducted. The data were thematically analysed with reference to Boelen’s social obligation scale for medical schools.ResultsGood communication was valued, but often poorly role-modelled. Participants agreed that communication and isiZulu teaching were insufficiently supported to respond adequately to the needs of local communities. Social accountability was not well understood by students, while medical school educators and other stakeholders indicated that, despite aspirations, this goal had not yet been achieved.ConclusionsLearning isiZulu language and culture in an integrated manner in both pre-clinical and clinical phases would improve communication with patients, contribute to socially responsive health care, and better address health care needs. Incorporating a social accountability framework in curriculum review would highlight the importance of measuring health outcomes and community impacts, and so enhance the educational mission of the medical school.

Talking to others' selves: Why a valuational paradigm of agency fails to provide an adequate theoretical framework for moral responsibility, social accountability, and legal liability.

In this commentary, I highlight the importance of a proper discussion of the pragmatic implications of John Doris's paradigm for allocation of personal responsibility proposed in his new book Talking to Our Selves. By employing some classic concepts of the American common law tradition, I discuss why Doris's valuational understanding of agency fails to provide an adequate framework for moral responsibility, social accountability, and legal liability.

Suggested framework for social accountability to be adopted by the World Federation of Neurology (WFN)

Suggested framework for social accountability to be adopted by the World Federation of Neurology (WFN)

Inculcating health awareness in Karachi, Pakistan: How innovative, socially acceptable methods can help combat communicable diseases of poverty

In the megacity of Karachi, which has a population of more than 24 million, more than 9.2 million people (approximately 40 per cent) live in squatter settlements. Communities here are characterised by low socioeconomic settings, crowded living conditions, inadequate water and sanitation facilities, and poor health-related behaviours. Such conditions create an environment favourable to the spread of communicable diseases like tuberculosis (TB), hepatitis and dengue. 
 
 Since 1985, the Department of Community Health Sciences at the Aga Khan University, Karachi, Pakistan has run the Urban Health Program (UHP), a community-campus partnership operating in these disadvantaged squatter settlements. Recent explosive increases in the spread of dengue, hepatitis and TB, however, necessitated special attention and activities on a scale and pace that was greater than could be accommodated as part of UHP’s core work. Thus, having an already well-established collaborative model with social accountability measures in place, a dedicated mass awareness program was initiated over the course of one year, from mid 2015: the AGAHI project. 
 
 This article describes AGAHI’s innovative, low-cost, collaborative activities conducted in partnership with two squatter communities, Sultanabad and Rehri Goth, to build health awareness, improved care-seeking and compliance to treatment. Activities ranged from school sessions, role plays and awareness walks to laneway meetings, training of health care workers, door-to-door campaigns and collaboration with local religious leaders, public sector groups and NGOs. 
 
 Building on the collaborative work of the UHP, in just 12 months AGAHI was able to conduct 80 health awareness sessions with 4000 participants. Moreover, high-risk and vulnerable populations were identified and referred for further treatment. A comparative cross-sectional survey afterwards revealed a significant increase in knowledge among Sultanabad residents as compared to the neighbouring settlement of Hijrat Colony. As a result, this article suggests that the need for and efficacy of targeted health awareness campaigns against the major infectious diseases of poverty cannot be overemphasised. By adopting community-based participatory models, couched in a framework of social accountability, activities that are low cost, innovative and scientifically robust hold real potential for improving health awareness in vulnerable megacities like Karachi.

Improving Community Health Using an Outcome-Oriented CQI Approach to Community-Engaged Health Professions Education.

Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement.

Introducing a Collaborative E2 (Evaluation & Enhancement) Social Accountability Framework for Medical Schools

Abstract Medical schools recognize that they have an important social mandate beyond their primary role to educate future physicians. The instantiation of social accountability (SA) within faculties of medicine requires intentional, effective partnering with diverse internal and external stakeholders. Despite early, promising academic work in the field of SA in medical education, there remains a lack of conceptual clarity about what SA could and should entail, and a lack of practical direction regarding how it could be implemented. The paper describes the development of an innovative SA framework that incorporates both pragmatic-evaluation and collaborative-enhancement components. The framework consists of five distinct phases, uses a deliberative engagement methodology, and is meaningfully informed by a set of four SA Lenses: Diversity, Inclusion and Cultural Responsiveness; Equity; Community / Stakeholder Engagement and Partnering; and Justice-Fairness and Sustainability. In addition to using the framework to evaluate and enhance the social accountability statuses of a variety of the medical school’s operational components, Dalhousie Faculty of Medicine leaders are committed to applying the framework’s SA Lenses to important decision-making processes, such as the revision of the medical school’s strategic directions and the allocation of limited resources to address important, emerging medical education issues and challenges.

Social Accountability: Introducing a new dimension in optometric education

Optometry globally has undergone major developments yet poor eye health statistics remain. The World Health Organization (WHO) cites social accountability as key to addressing health challenges, urging the education sector to be more socially accountable and train according to the needs of society. A qualitative, descriptive study was used to determine the integration of social accountability within optometric education in sub-Saharan Africa. Eleven academic leaders and two student groups participated in key stakeholder interviews and focus group discussions respectively. Data was thematically analysed using interpretive content analysis. The study found that social accountability policies or practices were not formally integrated across any academic area in the represented optometry education programmes. Optometric education needs to embrace and implement social accountability at country, regional and global levels. The World Council for Optometry is urged to provide leadership in this process by developing a Global Framework for Social Accountability in Optometric Education to guide regions and countries towards the adoption of social accountability. Key Words: optometric education; social accountability; World Council for Optometry; global framework; social determinants; eye care education.

Social accountability and nursing education in South Africa

BackgroundThere is global emphasis on transforming health workforce education in support of universal health coverage.ObjectiveThis paper uses a social accountability framework, specifically the World Health Organization's six building blocks for transformative education, to explore key informants’ perspectives on nursing education in South Africa.MethodsUsing a snowballing sampling technique, 44 key informants were selected purposively on the basis of their expertise or knowledge of the research area. Semi-structured interviews were conducted with the key informants after informed consent had been obtained. The interviews were analysed using template analysis.ResultsSouth Africa has strategic plans on human resources for health and nursing education, training, and practice and has a well-established system of regulation and accreditation of nursing education through the South African Nursing Council (SANC). Key informants criticised the following: the lack of national staffing norms; sub-optimal governance by both the SANC and the Department of Health; outdated curricula that are unresponsive to population and health system needs; lack of preparedness of nurse educators; and the unsuitability of the majority of nursing students. These problems are exacerbated by a perceived lack of prioritisation of nursing, resource constraints in both the nursing education institutions and the health training facilities, and general implementation inertia.ConclusionSocial accountability, which is an essential component of transformative education, necessitates that attention be paid to the issues of governance, responsive curricula, educator preparedness, and appropriate student recruitment and selection.

Pre-departure training and the social accountability of International Medical Electives.

Due to widespread awareness of global inequities in health and development, participation and interest in International Medical Electives has grown. However, it has been suggested that the benefits of these electives for students and communities may not outweigh the harms. Pre-departure training (PDT) has been proposed as a route through which participants can adequately prepare for their elective experience. Through a review of the current literature, this article explores the ethics of international medical electives using a social accountability framework and assesses the success of PDT in mitigating harms for students and communities. We find that the literature on PDT is limited. What is clear from completed studies is that the focus of PDT has often been centered on the clinical experience, while theories of development and health inequity remain minor topics. We argue that a greater benefit for students and communities could be gained from framing health inequity from a critical perspective, and integrating mandatory global health education into medical school curricula. We suggest that attention to only PDT is not enough. In a socially accountable program, community partnerships must be bilateral and respect communities as primary stakeholders in the training of students and in program evaluation. Unfortunately, research to-date has focused on the student experience; further studies of the community perspective would help to elicit how PDT and partnership models can be strengthened, improving the experiences of both students and communities. Finally, individual medical schools and organizations that offer global health elective experiences must ensure that they take responsibility for monitoring PDT.

An analysis of benefit flows in New Zealand using a social accounting framework

This paper presents a social accounting model to examine the entrants, exits and transitions of individuals among a wide range of benefit categories in New Zealand. Transition rates and flows are estimated separately for periods before the global financial crisis (GFC) and periods following the crisis. The data were obtained from the Benefit Dynamics Dataset maintained by the Ministry of Social Development. The model is used to examine, using simulations, the implications for the time profile of changes in the stock of benefit recipients under a range of counterfactual situations. It is suggested that the model can provide a useful tool for policy analysis.