Mafuta Eric M, Dieleman Marjolein A, Essink Leon, Khomba Paul N, Zioko François M, Mambu Thérèse N M, Kayembe Patrick K, de Cock Buning Tjard
Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, P.O. Box: 11850, Kinshasa I, Kinshasa, Democratic Republic of the Congo.
Athena Institute, Faculty of Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
Glob Health Res Policy. 2017 Feb 6;2:4. doi: 10.1186/s41256-017-0024-0. eCollection 2017.
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.
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.
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.
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.
社会问责制（SA）包含一系列机制，一方面旨在让使用者能够表达他们对所接受的卫生服务的关切（发声），并要求卫生服务提供者（HP）对与卫生服务提供相关的行动和决策负责。另一方面，这些机制旨在促使卫生服务提供者在提供护理时考虑使用者的需求和期望。本文描述了一项社会问责制干预措施的制定，该措施旨在提高刚果民主共和国两个卫生区的卫生服务响应性。
有目的地挑选了包括男性、女性、社区卫生工作者（CHW）、卫生部门代表和地方当局在内的受益者，并在两个卫生区采用对话模式让他们参与一个咨询过程：（1）在协商期间分别组织了八次焦点小组讨论（FGD），旨在分享和讨论情况分析结果，并收集改进建议；（2）之前焦点小组讨论参与者的代表参与对话会议，对焦点小组讨论的建议进行优先排序和整合；（3）研究伙伴对整合后的建议进行讨论，并将其确定为干预措施的组成部分。所有过程都进行了录音、转录，并采用归纳性内容分析法进行分析。
该过程共有121名参与者，其中51名是女性。他们提出了48条建议。在对话会议期间，他们的建议被整合为六个干预措施组成部分：（1）利用社区卫生工作者和卫生委员会收集和传递社区对卫生服务的关切；（2）在知识和信息方面增强社区能力；（通过对话会议让社区领袖参与进来；（4）改善卫生服务提供者对发声的态度以及在卫生机构层面管理发声；（5）让卫生服务监督人员参与社区参与；（6）利用其他现有的干预措施。然后在规划过程中将这些组成部分明确为三个干预措施组成部分，即：创建一个正式的发声系统；引入对话会议以提高可执行性和可问责性；增强卫生服务提供者的响应性。
采用参与性过程的对话模式，使受益者能够在咨询过程中与具有不同观点和知识类型的其他社区利益相关者共同参与，并就针对两个卫生区具体情况的一系列社会问责制干预措施组成部分阐明他们的建议。
