Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands.
KIT Gender, Royal Tropical Institute, Amsterdam, The Netherlands.
PLoS One. 2018 Apr 11;13(4):e0195671. doi: 10.1371/journal.pone.0195671. eCollection 2018.
Despite the expansion of literature on social accountability in low-and middle-income countries, little is known about how health providers experience daily social pressure and citizen feedback. This study used a narrative inquiry approach to explore the function of daily social accountability relations among maternal health care workers in rural Malawi. Through semi-structured interviews with 32 nurses and 19 clinicians, we collected 155 feedback cases allowing the identification of four main strategies social actors use to express their opinion and concerns about maternal health services. We found that women who used delivery care express their appreciation for successful deliveries directly to the health worker but complaints, such as on absenteeism and poor interpersonal behaviour, follow an indirect route via intermediaries such as the health workers' spouse, co-workers or the health committee who forward some cases of misbehaviour to district authorities. The findings suggest that citizen feedback is important for the socialization, motivation and retention of maternal healthcare workers in under resourced rural settings. Practitioners and external development programmes should understand and recognize the value of already existing accountability mechanisms and foster social accountability approaches that allow communities as well as health workers to challenge the systemic obstacles to quality and respectful service delivery.
尽管关于中低收入国家社会责任的文献不断增加，但对于卫生服务提供者如何每天应对社会压力和公民反馈，人们知之甚少。本研究采用叙事探究方法，探索马拉维农村地区产妇保健工作者日常社会责任关系的作用。通过对 32 名护士和 19 名临床医生进行半结构化访谈，我们收集了 155 个反馈案例，确定了社会行为者用来表达对产妇保健服务意见和关切的四种主要策略。我们发现，使用分娩护理的妇女会直接向卫生工作者表达对成功分娩的感谢，但也会有一些投诉，如旷工和不良的人际关系行为，则会通过中间人来表达，如卫生工作者的配偶、同事或卫生委员会，他们会将一些不当行为的案例上报给地区当局。研究结果表明，公民反馈对于资源匮乏的农村地区产妇保健工作者的社会化、激励和留用非常重要。从业者和外部发展计划应理解和认识到现有问责机制的价值，并促进社会问责方法，使社区和卫生工作者能够挑战质量和尊重服务提供方面的系统障碍。
