Global Health Centre, Geneva Graduate Institute, Chemin Rigot 2, 1202, Geneva, Switzerland.
Department of Population Studies, Makerere University, Kampala, Uganda.
BMC Womens Health. 2020 Oct 12;20(1):228. doi: 10.1186/s12905-020-01072-9.
Growing evidence shows that social accountability contributes to improving health care services, with much promise for addressing women's barriers in contraceptive care. Yet little is known about how social accountability works in the often-complex context of sexual and reproductive health, particularly as sex and reproduction can be sensitive topics in the open and public formats typical of social accountability. This paper explores how social accountability operates in the highly gendered and complex context of contraceptive care.
This exploratory research uses a case study approach to provide a more grounded understanding of how social accountability processes operate in the context of contraceptive information and services. We observed two social accountability projects that predominantly focused on contraceptive care in Uganda over a year. Five instruments were used to capture information from different source materials and multiple respondents. In total, one hundred and twenty-eight interviews were conducted and over 1000 pages of project documents were collected. Data were analyzed and compiled into four case studies that provide a thick description of how these two projects operated.
The case studies show the critical role of information, dialogue and negotiation in social accountability in the context of contraceptive care. Improved community and health system relationships, community empowerment, provider and health system responsiveness and enhanced availability and access to services were reported in both projects. There were also changes in how different actors related to themselves and to each other, and contraceptive care, a previously taboo topic, became a legitimate area for public dialogue.
The study found that while social accountability in the context of contraceptive services is indeed sensitive, it can be a powerful tool to dissolving resistance to family planning and facilitating a more productive discourse on the topic.
越来越多的证据表明，社会问责制有助于改善医疗服务，对于解决避孕护理方面的女性障碍具有很大的前景。然而，人们对社会问责制在性健康和生殖健康方面的复杂环境中如何运作知之甚少，特别是在社会问责制通常采用公开和公共形式的情况下，性和生殖可能是敏感话题。本文探讨了社会问责制在避孕护理这一高度性别化和复杂的背景下是如何运作的。
这项探索性研究采用案例研究方法，更深入地了解社会问责制在避孕信息和服务方面的运作方式。我们观察了乌干达的两个主要关注避孕护理的社会问责制项目，为期一年多。使用五种工具从不同的资料来源和多个受访者那里获取信息。总共进行了 128 次访谈，并收集了 1000 多页的项目文件。对数据进行了分析和汇编成四个案例研究，详细描述了这两个项目的运作方式。
案例研究表明，在避孕护理方面，信息、对话和协商在社会问责制中起着关键作用。两个项目都报告了社区和卫生系统关系的改善、社区赋权、提供者和卫生系统的回应能力以及服务的可用性和可及性的提高。不同的行为体之间的关系以及对自身和彼此的关系也发生了变化，避孕护理这个以前的禁忌话题，成为了公开对话的合法领域。
研究发现，尽管避孕服务方面的社会问责制确实很敏感，但它可以成为打破计划生育阻力和促进更具成效的相关话题讨论的有力工具。
