Abstract
Background
Social accountability (SA) comprises a set of mechanisms aiming to, on the one hand, enable users to raise their concerns about the health services provided to them (voice), and to hold health providers (HPs) accountable for actions and decisions related to the health service provision. On the other hand, they aim to facilitate HPs to take into account users’ needs and expectations in providing care. This article describes the development of a SA intervention that aims to improve health services responsiveness in two health zones in the Democratic Republic of the Congo.
Methods
Beneficiaries including men, women, community health workers (CHWs), representatives of the health sector and local authorities were purposively selected and involved in an advisory process using the Dialogue Model in the two health zones: (1) Eight focus group discussions (FGDs) were organized separately during consultation aimed at sharing and discussing results from the situation analysis, and collecting suggestions for improvement, (2) Representatives of participants in previous FGDs were involved in dialogue meetings for prioritizing and integrating suggestions from FGDs, and (3) the integrated suggestions were discussed by research partners and set as intervention components. All the processes were audio-taped, transcribed and analysed using inductive content analysis.
Results
Overall there were 121 participants involved in the process, 51 were female. They provided 48 suggestions. Their suggestions were integrated into six intervention components during dialogue meetings: (1) use CHWs and a health committee for collecting and transmitting community concerns about health services, (2) build the capacity of the community in terms of knowledge and information, (3) involve community leaders through dialogue meetings, (4) improve the attitude of HPs towards voice and the management of voice at health facility level, (5) involve the health service supervisors in community participation and; (6) use other existing interventions. These components were then articulated into three intervention components during programming to: create a formal voice system, introduce dialogue meetings improving enforceability and answerability, and enhance the health providers’ responsiveness.
Conclusions
The use of the Dialogue Model, a participatory process, allowed beneficiaries to be involved with other community stakeholders having different perspectives and types of knowledge in an advisory process and to articulate their suggestions on a combination of SA intervention components, specific for the two health zones contexts.
| Original language | English |
|---|---|
| Article number | 4 |
| Journal | Global Health Research and Policy |
| Volume | 2 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 6 Feb 2017 |
Funding
The authors are grateful to the district health authorities and health facility managers in Muanda and in Bolenge HZs, DRC, and to the community groups who generously shared their time and insights in this research. This study was made possible by the support of the WOTRO program and its improving maternal health services responsiveness and performances through social accountability mechanisms in the DRC and Burundi (IMCH). WOTRO IMCH is managed by the VU University Amsterdam (VU) and Royal Tropical Institute, Amsterdam (KIT). The findings of this study are the sole responsibility of the authors, and do not necessarily reflect the views of the Government of the Netherlands. The study sponsors had no role in the collection, analysis, or interpretation of data; in the writing of the paper; or in the decision to submit it for publication. The datasets used and analysed during the current study are available from the corresponding author on reasonable request as they are in French. MEM and DM designed the project. MEM and EL conducted focus groups and community dialogues. MEM performed the analysis and drafted the manuscript. MEM, EL, DM, KP, ZF, MNT, KKP, and DCBT contributed to the interpretation of the analysis and edited the manuscript. All authors read and approved the final manuscript. The authors declare that they have no competing interests. Written informed consent was obtained from all participants to publish information containing some individual person’s data such as age, sex, occupation, location as they were important for understanding the research study. The research protocol was approved by the Kinshasa School of Public Health Internal Review Board. All participants were fully informed about the nature, the implications of the study and the freedom to opt out any time should they feel uncomfortable, and voluntarily provided written consented to participate. Participants in focus groups received reimbursement for transportation fees at the end of the meeting. All research procedures were in accordance with the Declaration of Helsinki.
| Funders | Funder number |
|---|---|
| DCBT | |
| Kinshasa School of Public Health Internal Review Board | |
| Royal Tropical Institute | |
| Diabetes Research Connection | |
| Vrije Universiteit Amsterdam |
Keywords
- Interactive learning and action Involving users Facility delivery Maternal mortality Quality of care Health service responsiveness Dialogue Model Social accountability Voice DR Congo
