Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Otago Business School and Division of Commerce, University of Otago, Dunedin, New Zealand.
Health Expect. 2018 Feb;21(1):149-158. doi: 10.1111/hex.12596. Epub 2017 Jul 21.
Despite some empirical findings on the usefulness of citizen's charters on awareness of rights and services, there is a dearth of literature about charter implementation and impact on health service delivery in low-income settings.
To gauge the level of awareness of the Charter within Nepal's primary health-care (PHC) system, perceived impact and factors affecting Charter implementation.
Using a case study design, a quantitative survey was administered to 400 participants from 22 of 39 PHC facilities in the Dang District to gauge awareness of the Charter. Additionally, qualitative interviews with 39 key informants were conducted to explore the perceived impact of the Charter and factors affecting its implementation.
Few service users (15%) were aware of the existence of the Charter. Among these, a greater proportion were literate, and there were also differences according to ethnicity and occupational group. The Charter was usually not properly displayed and had been implemented with no prior public consultation. It contained information that provided awareness of health facility services, particularly the more educated public, but had limited potential for increasing transparency and holding service providers accountable to citizens. Proper display, consultation with stakeholders, orientation or training and educational factors, follow-up and monitoring, and provision of sanctions were all lacking, negatively influencing the implementation of the Charter.
Poor implementation and low public awareness of the Charter limit its usefulness. Provision of sanctions and consultation with citizens in Charter development are needed to expand the scope of Charters from information brochures to tools for accountability.
尽管有一些关于公民宪章在提高权利和服务意识方面有用性的实证研究，但在低收入环境中，关于宪章实施及其对卫生服务提供影响的文献却很少。
评估尼泊尔初级卫生保健（PHC）系统对宪章的认知程度、感知影响以及影响宪章实施的因素。
采用案例研究设计，对 Dang 区 39 个 PHC 设施中的 22 个设施的 400 名参与者进行了定量调查，以评估对宪章的认知程度。此外，还对 39 名关键信息提供者进行了定性访谈，以探讨宪章的感知影响以及影响其实施的因素。
很少有服务使用者（15%）知道宪章的存在。在这些人中，文化程度较高的人比例较大，而且在族裔和职业群体方面也存在差异。宪章通常没有正确展示，并且在没有事先进行公众咨询的情况下实施。宪章包含有关卫生设施服务的信息，特别是对受过教育程度较高的公众，但增加透明度和使服务提供者对公民负责的潜力有限。适当的展示、与利益相关者的协商、定向或培训以及教育因素、后续和监测以及提供制裁都缺乏，这对宪章的实施产生了负面影响。
宪章的实施情况不佳且公众认知度低，限制了其有用性。需要提供制裁并在宪章制定过程中与公民协商，将宪章的范围从信息手册扩大到问责工具。
