Department of International Health, Johns Hopkins Bloomberg School of Public Health, 614 N Wolfe St, Baltimore, MD, USA.
Department of Health Policy, Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda.
Int J Equity Health. 2020 Dec 10;19(1):220. doi: 10.1186/s12939-020-01341-x.
This editorial provides an introduction to the special issue on "Lessons about intervening in accountability ecosystems: implementation of community scorecards in Bangladesh and Uganda". We start by describing the rationale for this work in the two study countries. While our project, the Future Health Systems (FHS) project, had been working over the course of more than a decade to strengthen health services, particularly for low income households in rural areas, our teams increasingly recognized how difficult it would be to sustain service improvements without fundamental changes to local accountabilities. Accordingly, in the final phase of the project 2016-2018, we designed, implemented and assessed community scorecard initiatives, in both Bangladesh and Uganda, with the aim of informing the design of a scalable social accountability initiative that could fundamentally shift the dynamics of health system accountability in favor of the poor and marginalized.We describe the particular characteristics of our approach to this task. Specifically we (i) conducted a mapping of accountabilities in each of the contexts so as to understand how our actions may interact with existing accountability mechanisms (ii) developed detailed theories of change that unpacked the mechanisms through which we anticipated the community scorecards would have effect, as well as how they would be institutionalized; and (iii) monitored closely the extent of inclusion and the equity effects of the scorecards. In summarizing this approach, we articulate the contributions made by different papers in this volume.
这篇社论介绍了一期特刊，主题是“关于干预问责制生态系统的经验教训：孟加拉国和乌干达社区记分卡的实施”。我们首先描述了在这两个研究国家开展这项工作的基本原理。虽然我们的未来卫生系统（FHS）项目在过去十余年中一直致力于加强卫生服务，特别是为农村地区的低收入家庭提供服务，但我们的团队越来越认识到，如果不对当地问责制进行根本性改革，维持服务改善将是多么困难。因此，在项目的最后阶段（2016-2018 年），我们在孟加拉国和乌干达设计、实施和评估了社区记分卡举措，旨在为设计一个可扩展的社会问责制举措提供信息，该举措可以从根本上改变卫生系统问责制的动态，有利于穷人和边缘化群体。我们描述了我们在完成这项任务时所采用的特定方法。具体而言，我们（i）对每个背景下的问责制进行了映射，以便了解我们的行动可能与现有的问责制机制如何相互作用；（ii）制定了详细的变革理论，阐述了我们预计社区记分卡将产生影响的机制，以及它们将如何制度化；（iii）密切监测记分卡的包容性程度和公平性影响。在总结这种方法时，我们阐述了本期特刊中不同文章的贡献。
