Lodenstein Elsbet, Dieleman Marjolein, Gerretsen Barend, Broerse Jacqueline E W
Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University)
KIT Gender.
Health Policy Plan. 2017 Feb;32(1):125-140. doi: 10.1093/heapol/czw089. Epub 2016 Jul 3.
Social accountability in the health sector has been promoted as a strategy to improve the quality and performance of health providers in low- and middle-income countries. Whether improvements occur, however, depends on the willingness and ability of health providers to respond to societal pressure for better care. This article uses a realist approach to review cases of collective citizen action and advocacy with the aim to identify key mechanisms of provider responsiveness. Purposeful searches for cases were combined with a systematic search in four databases. To be included in the review, the initiatives needed to describe at least one outcome at the level of frontline service provision. Some 37 social accountability initiatives in 15 countries met these criteria. Using a realist approach, retroductive analysis and triangulation of methods and sources were performed to construct Context-Mechanism-Outcome configurations that explain potential pathways to provider responsiveness. The findings suggest that health provider receptivity to citizens' demands for better health care is mediated by health providers' perceptions of the legitimacy of citizen groups and by the extent to which citizen groups provide personal and professional support to health providers. Some citizen groups activated political or formal bureaucratic accountability channels but the effect on provider responsiveness of such strategies was more mixed. Favourable contexts for health provider responsiveness comprise socio-political contexts in which providers self-identify as activists, health system contexts in which health providers depend on citizens' expertise and capacities, and health system contexts where providers have the self-perceived ability to change the system in which they operate. Rather than providing recipes for successful social accountability initiatives, the synthesis proposes a programme theory that can support reflections on the theories of change underpinning social accountability initiatives and interventions to improve the quality of primary health care in different settings.
卫生部门的社会问责制已作为一项战略得到推广，旨在提高低收入和中等收入国家卫生服务提供者的质量和绩效。然而，是否会出现改善取决于卫生服务提供者是否愿意且有能力回应社会对改善医疗服务的压力。本文采用现实主义方法回顾集体公民行动和倡导的案例，旨在确定服务提供者做出回应的关键机制。对案例的有目的搜索与在四个数据库中的系统搜索相结合。要纳入该综述，这些举措需要描述至少一项一线服务提供层面的成果。15个国家的约37项社会问责举措符合这些标准。采用现实主义方法，进行溯因分析以及方法和来源的三角互证，以构建情境 - 机制 - 结果配置，解释服务提供者做出回应的潜在途径。研究结果表明，卫生服务提供者对公民改善医疗保健需求的接受程度，是由卫生服务提供者对公民团体合法性的认知以及公民团体为卫生服务提供者提供个人和专业支持的程度所介导的。一些公民团体启动了政治或正式官僚问责渠道，但此类策略对服务提供者回应的影响则更为复杂。有利于卫生服务提供者做出回应的情境包括：社会政治情境中，服务提供者将自己视为积极分子；卫生系统情境中，卫生服务提供者依赖公民的专业知识和能力；以及卫生系统情境中，服务提供者自认为有能力改变他们所处的系统。该综述并非提供成功的社会问责举措的秘诀，而是提出了一个项目理论，可支持对支撑社会问责举措和干预措施的变革理论进行反思，以改善不同环境下的初级卫生保健质量。
