Treatment Action Campaign (TAC), Johannesburg, South Africa.
L'Organisation de Développement et de Lutte contre la Pauvreté (ODELPA), Port-au-Prince, Haiti.
J Int AIDS Soc. 2024 Nov;27(11):e26374. doi: 10.1002/jia2.26374.
Despite international commitment to achieving the end of HIV as a public health threat, progress is off-track and existing gaps have been exacerbated by COVID-19's collision with existing pandemics. Born out of models of political accountability and historical healthcare advocacy led by people living with HIV, community-led monitoring (CLM) of health service delivery holds potential as a social accountability model to increase the accessibility and quality of health systems. However, the effectiveness of the CLM model in strengthening accountability and improving service delivery relies on its alignment with evidence-based principles for social accountability mechanisms. We propose a set of unifying principles for CLM to support the impact on the quality and availability of health services.
Building on the social accountability literature, core CLM implementation principles are defined. CLM programmes include a community-led and independent data collection effort, in which the data tools and methodology are designed by service users and communities most vulnerable to, and most impacted by, service quality. Data are collected routinely, with an emphasis on prioritizing and protecting respondents, and are then be used to conduct routine and community-led advocacy, with the aim of increasing duty-bearer accountability to service users. CLM efforts should represent a broad and collective community response, led independently by impacted communities, incorporating both data collection and advocacy, and should be understood as a long-term approach to building meaningful engagement in systems-wide improvements rather than discrete interventions.
The CLM model is an important social accountability mechanism for improving the responsiveness of critical health services and systems to communities. By establishing a collective understanding of CLM principles, this model paves the way for improved proliferation of CLM with fidelity of implementation approaches to core principles, rigorous examinations of CLM implementation approaches, impact assessments and evaluations of CLM's influence on service quality improvement.
尽管国际社会致力于实现终结艾滋病作为公共卫生威胁的目标，但进展偏离了轨道，而 COVID-19 的出现加剧了现有的差距，这些差距与现有的大流行病叠加在一起。社区主导的监测（CLM）是在艾滋病毒感染者领导的政治问责制和历史医疗保健倡导模式的基础上产生的，它有可能成为一个社会问责模式，以提高卫生系统的可及性和质量。然而，CLM 模式在加强问责制和改善服务提供方面的有效性取决于其与社会问责机制的循证原则保持一致。我们提出了一套统一的 CLM 原则，以支持对卫生服务质量和可及性的影响。
在社会问责制文献的基础上，确定了核心 CLM 实施原则。CLM 方案包括由社区主导和独立的数据收集工作，其中数据工具和方法由最容易受到服务质量影响、受服务质量影响最大的服务使用者和社区设计。数据是定期收集的，重点是保护受访者，并随后用于进行常规和社区主导的宣传，目的是增强责任方对服务使用者的问责制。CLM 工作应该代表广泛和集体的社区回应，由受影响的社区独立领导，将数据收集和宣传结合起来，并被理解为建立在系统范围内进行有意义的参与，以改善服务质量的长期方法，而不是离散的干预措施。
CLM 模型是改善关键卫生服务和系统对社区响应性的重要社会问责机制。通过确立对 CLM 原则的集体理解，该模型为更准确地实施核心原则、严格审查 CLM 实施方法、评估 CLM 对服务质量改善的影响铺平了道路，从而促进了 CLM 的更广泛传播。
