Department of International Development, University of Oxford, Oxford, UK.
Trop Med Int Health. 2012 May;17(5):674-82. doi: 10.1111/j.1365-3156.2012.02973.x. Epub 2012 Apr 9.
Community participation is often described as a key for primary health care in low-income countries. Recent performance-based financing (PBF) initiatives have renewed the interest in this strategy by questioning the accountability of those in charge at the health centre (HC) level. We analyse the place of two downward accountability mechanisms in a PBF scheme: health committees elected among the communities and community-based organizations (CBOs) contracted as verifiers of health facilities' performance.
We evaluated 100 health committees and 79 CBOs using original data collected in six Burundi provinces (2009-2010) and a framework based on the literature on community participation in health and New Institutional Economics.
Health committees appear to be rather ineffective, focusing on supporting the medical staff and not on representing the population. CBOs do convey information about the concerns of the population to the health authorities; yet, they represent only a few users and lack the ability to force changes. PBF does not automatically imply more 'voice' from the population, but introduces an interesting complement to health committees with CBOs. However, important efforts remain necessary to make both mechanisms work. More experiments and analysis are needed to develop truly efficient 'downward' mechanisms of accountability at the HC level.
社区参与通常被描述为低收入国家初级卫生保健的关键。最近基于绩效的融资（PBF）举措重新引起了人们对这一策略的兴趣，因为这一策略对卫生中心（HC）级别的负责人的问责制提出了质疑。我们分析了 PBF 计划中两种向下问责机制的地位：在社区中选举产生的卫生委员会和作为卫生设施绩效验证者签订合同的社区组织（CBO）。
我们使用在布隆迪六个省（2009-2010 年）收集的原始数据和基于社区参与卫生和新制度经济学文献的框架，对 100 个卫生委员会和 79 个 CBO 进行了评估。
卫生委员会似乎效果不佳，主要集中在支持医务人员，而不是代表民众。CBO 确实将民众的关切转达给卫生当局；然而，他们只代表少数用户，缺乏迫使变革的能力。PBF 并不自动意味着民众有更多的“发言权”，而是为卫生委员会与 CBO 之间引入了一种有趣的补充机制。然而，仍然需要做出重要的努力，使这两种机制都能发挥作用。需要进行更多的实验和分析，以在 HC 层面开发真正有效的向下问责机制。
