Kisumu County Department of Health, Kisumu, Kenya.
Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands.
BMC Public Health. 2022 Oct 24;22(1):1960. doi: 10.1186/s12889-022-14388-y.
Women seeking family planning services from public-sector facilities in low- and middle-income countries sometimes face provider-imposed barriers to care. Social accountability is an approach that could address provider-imposed barriers by empowering communities to hold their service providers to account for service quality. Yet little is known about the feasibility and potential impact of such efforts in the context of contraceptive care. We piloted a social accountability intervention-the Community Score Card (CSC)-in three public healthcare facilities in western Kenya and use a mix of quantitative and qualitative methodologies to describe the feasibility and impact on family planning service provision.
We implemented and evaluated the CSC in a convenience sample of three public-sector facility-community dyads in Kisumu County, Kenya. Within each dyad, communities met to identify and prioritize needs, develop corresponding indicators, and used a score card to rate the quality of family planning service provision and monitor improvement. To ensure young, unmarried people had a voice in identifying the unique challenges they face, youth working groups (YWG) led all CSC activities. The feasibility and impact of CSC activities were evaluated using mystery client visits, unannounced visits, focus group discussions with YWG members and providers, repeated assessment of score card indicators, and service delivery statistics.
The involvement of community health volunteers and supportive community members - as well as the willingness of some providers to consider changes to their own behaviors-were key score card facilitators. Conversely, community bias against family planning was a barrier to wider participation in score card activities and the intractability of some provider behaviors led to only small shifts in quality improvement. Service statistics did not reveal an increase in the percent of women receiving family planning services.
Successful and impactful implementation of the CSC in the Kenyan context requires intensive community and provider sensitization, and pandemic conditions may have muted the impact on contraceptive uptake in this small pilot effort. Further investigation is needed to understand whether the CSC - or other social accountability efforts - can result in improved contraceptive access.
在中低收入国家，寻求公共部门计划生育服务的女性有时会面临提供者施加的护理障碍。社会问责制是一种方法，可以通过授权社区追究服务提供者的服务质量责任，来解决提供者施加的障碍。然而，在避孕护理方面，这种努力的可行性和潜在影响知之甚少。我们在肯尼亚西部的三家公共医疗保健机构试行社会问责制干预措施——社区评分卡（CSC），并使用定量和定性方法相结合来描述其可行性和对计划生育服务提供的影响。
我们在肯尼亚基苏木县的三个公共部门设施-社区对中实施并评估了 CSC，这些对都是随机选择的。在每个对中，社区开会确定并优先考虑需求，制定相应的指标，并使用评分卡来评估计划生育服务提供的质量并监测改进情况。为确保年轻未婚者能够在确定他们所面临的独特挑战方面有发言权，青年工作组（YWG）领导了所有 CSC 活动。通过神秘客户访问、突击访问、与 YWG 成员和提供者的焦点小组讨论、反复评估评分卡指标以及服务提供统计数据，评估 CSC 活动的可行性和影响。
社区卫生志愿者和支持性社区成员的参与-以及一些提供者愿意考虑改变自己的行为-是评分卡的关键促进因素。相反，社区对计划生育的偏见是广泛参与评分卡活动的障碍，一些提供者行为的顽固性导致质量改进的幅度很小。服务统计数据并未显示接受计划生育服务的女性比例有所增加。
在肯尼亚背景下成功和有影响力地实施 CSC 需要对社区和提供者进行深入的宣传，而大流行情况可能会削弱这一小型试点工作对避孕率的影响。需要进一步研究以了解 CSC-或其他社会问责制努力-是否能改善避孕方法的可及性。
