Social accountability in maternal health services in the far-western development region in Nepal: An exploratory study

Mukesh Hamal, Kalina Heiter, Lian Schoenmakers, Myonne Smid, Tjard De Cock Buning, Vincent De Brouwere, Azucena Bardají, Chiranjibi Nepal, Marjolein Dieleman

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background
Social accountability or citizen-led accountability has been promoted in many low- and middle-income countries to improve the quality, access to and use of maternal health services. Experiences with social accountability in maternal health services in Nepal have not yet been documented. This study identifies existing social accountability structures and activities in maternal health services in two districts of Far-Western Nepal and explores their functions, implementation and gaps/challenges.

Methods
An exploratory study was conducted that included in-depth interviews with purposively selected policy advisors (8), healthcare officials (11), healthcare providers (12) and non-governmental staff (3); and focus group discussions (FGDs) with 54 women. Data analysis was conducted using thematic content analysis based on George’s information, dialogue and negotiation framework.

Results
Social accountability in maternal health existed in terms of structures such as mothers’ groups (MGs), female community health volunteers (FCHVs) and Health Facility Operation and Management Committees (HFOMCs); and activities such as social audits and community health score board (CHSB). MGs and FCHVs were perceived as trusted intermediaries, but their functioning was limited to information. HFOMCs were not fully functional. Social audits and CHSBs were implemented in limited sites and with poor participation by women. Health-sector responses were mainly found at the local level. Factors contributing to these challenges were the absence of a mandate and limited capacity, including resources.

Conclusion
Formal structures and activities existed for social accountability in maternal health services in the Far-Western Development Region of Nepal, but there were limitations pertaining to their implementation. The main recommendations are: for clear policy mandates on the social accountability roles of MGs and FCHVs; wider implementation of social audits and CHSBs, with emphasis on the participation of women from disadvantaged groups; improved capacity of HFOMCs; and improved engagement of the health sector at all levels to listen and respond to women’s concerns.
Original languageEnglish
Pages (from-to)280-291
Number of pages12
JournalInternational Journal of Health Policy and Management
Volume8
Issue number5
Early online date17 Feb 2019
DOIs
Publication statusPublished - May 2019

Fingerprint

Maternal Health Services
Nepal
Social Responsibility
Health Facilities
Health
Volunteers
Mothers
Negotiating
Vulnerable Populations
Focus Groups
Health Personnel
Interviews
Delivery of Health Care

Keywords

  • Governance
  • Health Services
  • Maternal Health
  • Nepal
  • Social Accountability

Cite this

Hamal, Mukesh ; Heiter, Kalina ; Schoenmakers, Lian ; Smid, Myonne ; Buning, Tjard De Cock ; Brouwere, Vincent De ; Bardají, Azucena ; Nepal, Chiranjibi ; Dieleman, Marjolein. / Social accountability in maternal health services in the far-western development region in Nepal : An exploratory study. In: International Journal of Health Policy and Management. 2019 ; Vol. 8, No. 5. pp. 280-291.
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title = "Social accountability in maternal health services in the far-western development region in Nepal: An exploratory study",
abstract = "BackgroundSocial accountability or citizen-led accountability has been promoted in many low- and middle-income countries to improve the quality, access to and use of maternal health services. Experiences with social accountability in maternal health services in Nepal have not yet been documented. This study identifies existing social accountability structures and activities in maternal health services in two districts of Far-Western Nepal and explores their functions, implementation and gaps/challenges. MethodsAn exploratory study was conducted that included in-depth interviews with purposively selected policy advisors (8), healthcare officials (11), healthcare providers (12) and non-governmental staff (3); and focus group discussions (FGDs) with 54 women. Data analysis was conducted using thematic content analysis based on George’s information, dialogue and negotiation framework. ResultsSocial accountability in maternal health existed in terms of structures such as mothers’ groups (MGs), female community health volunteers (FCHVs) and Health Facility Operation and Management Committees (HFOMCs); and activities such as social audits and community health score board (CHSB). MGs and FCHVs were perceived as trusted intermediaries, but their functioning was limited to information. HFOMCs were not fully functional. Social audits and CHSBs were implemented in limited sites and with poor participation by women. Health-sector responses were mainly found at the local level. Factors contributing to these challenges were the absence of a mandate and limited capacity, including resources. ConclusionFormal structures and activities existed for social accountability in maternal health services in the Far-Western Development Region of Nepal, but there were limitations pertaining to their implementation. The main recommendations are: for clear policy mandates on the social accountability roles of MGs and FCHVs; wider implementation of social audits and CHSBs, with emphasis on the participation of women from disadvantaged groups; improved capacity of HFOMCs; and improved engagement of the health sector at all levels to listen and respond to women’s concerns.",
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author = "Mukesh Hamal and Kalina Heiter and Lian Schoenmakers and Myonne Smid and Buning, {Tjard De Cock} and Brouwere, {Vincent De} and Azucena Bardaj{\'i} and Chiranjibi Nepal and Marjolein Dieleman",
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Social accountability in maternal health services in the far-western development region in Nepal : An exploratory study. / Hamal, Mukesh; Heiter, Kalina; Schoenmakers, Lian; Smid, Myonne; Buning, Tjard De Cock; Brouwere, Vincent De; Bardají, Azucena; Nepal, Chiranjibi; Dieleman, Marjolein.

In: International Journal of Health Policy and Management, Vol. 8, No. 5, 05.2019, p. 280-291.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - Social accountability in maternal health services in the far-western development region in Nepal

T2 - An exploratory study

AU - Hamal, Mukesh

AU - Heiter, Kalina

AU - Schoenmakers, Lian

AU - Smid, Myonne

AU - Buning, Tjard De Cock

AU - Brouwere, Vincent De

AU - Bardají, Azucena

AU - Nepal, Chiranjibi

AU - Dieleman, Marjolein

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N2 - BackgroundSocial accountability or citizen-led accountability has been promoted in many low- and middle-income countries to improve the quality, access to and use of maternal health services. Experiences with social accountability in maternal health services in Nepal have not yet been documented. This study identifies existing social accountability structures and activities in maternal health services in two districts of Far-Western Nepal and explores their functions, implementation and gaps/challenges. MethodsAn exploratory study was conducted that included in-depth interviews with purposively selected policy advisors (8), healthcare officials (11), healthcare providers (12) and non-governmental staff (3); and focus group discussions (FGDs) with 54 women. Data analysis was conducted using thematic content analysis based on George’s information, dialogue and negotiation framework. ResultsSocial accountability in maternal health existed in terms of structures such as mothers’ groups (MGs), female community health volunteers (FCHVs) and Health Facility Operation and Management Committees (HFOMCs); and activities such as social audits and community health score board (CHSB). MGs and FCHVs were perceived as trusted intermediaries, but their functioning was limited to information. HFOMCs were not fully functional. Social audits and CHSBs were implemented in limited sites and with poor participation by women. Health-sector responses were mainly found at the local level. Factors contributing to these challenges were the absence of a mandate and limited capacity, including resources. ConclusionFormal structures and activities existed for social accountability in maternal health services in the Far-Western Development Region of Nepal, but there were limitations pertaining to their implementation. The main recommendations are: for clear policy mandates on the social accountability roles of MGs and FCHVs; wider implementation of social audits and CHSBs, with emphasis on the participation of women from disadvantaged groups; improved capacity of HFOMCs; and improved engagement of the health sector at all levels to listen and respond to women’s concerns.

AB - BackgroundSocial accountability or citizen-led accountability has been promoted in many low- and middle-income countries to improve the quality, access to and use of maternal health services. Experiences with social accountability in maternal health services in Nepal have not yet been documented. This study identifies existing social accountability structures and activities in maternal health services in two districts of Far-Western Nepal and explores their functions, implementation and gaps/challenges. MethodsAn exploratory study was conducted that included in-depth interviews with purposively selected policy advisors (8), healthcare officials (11), healthcare providers (12) and non-governmental staff (3); and focus group discussions (FGDs) with 54 women. Data analysis was conducted using thematic content analysis based on George’s information, dialogue and negotiation framework. ResultsSocial accountability in maternal health existed in terms of structures such as mothers’ groups (MGs), female community health volunteers (FCHVs) and Health Facility Operation and Management Committees (HFOMCs); and activities such as social audits and community health score board (CHSB). MGs and FCHVs were perceived as trusted intermediaries, but their functioning was limited to information. HFOMCs were not fully functional. Social audits and CHSBs were implemented in limited sites and with poor participation by women. Health-sector responses were mainly found at the local level. Factors contributing to these challenges were the absence of a mandate and limited capacity, including resources. ConclusionFormal structures and activities existed for social accountability in maternal health services in the Far-Western Development Region of Nepal, but there were limitations pertaining to their implementation. The main recommendations are: for clear policy mandates on the social accountability roles of MGs and FCHVs; wider implementation of social audits and CHSBs, with emphasis on the participation of women from disadvantaged groups; improved capacity of HFOMCs; and improved engagement of the health sector at all levels to listen and respond to women’s concerns.

KW - Governance

KW - Health Services

KW - Maternal Health

KW - Nepal

KW - Social Accountability

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