A realist synthesis of the effect of social accountability interventions on health service providers’ and policymakers’ responsiveness

Abstract

BackgroundAccountability has center stage in the current post-Millennium Development Goals (MDG) debate. One of the effective strategies for building equitable health systems and providing quality health services is the strengthening of citizen-driven or social accountability processes. The monitoring of actions and decisions of policymakers and providers by citizens is regarded as a right in itself but also as an alternative to weak administrative accountability mechanisms, in particular in settings with poor governance. The effects of social accountability interventions are often based on assumptions and are difficult to evaluate because of their complex nature and context sensitivity. This study aims to review and assess the available evidence for the effect of social accountability interventions on policymakers’ and providers’ responsiveness in countries with medium to low levels of governance capacity and quality. For policymakers and practitioners engaged in health system strengthening, social accountability initiatives and rights-based approaches to health, the findings of this review may help when reflecting on the assumptions and theories of change behind their policies and interventions.Methods/DesignLittle is known about social accountability interventions, their outcomes and the circumstances under which they produce outcomes for particular groups or issues. In this study, social accountability interventions are conceptualized as complex social interventions for which a realist synthesis is considered the most appropriate method of systematic review. The synthesis is based on a preliminary program theory of social accountability that will be tested through an iterative process of primary study searches, data extraction, analysis and synthesis. Published and non-published (grey) quantitative and qualitative studies in English, French and Spanish will be included. Quality and validity will be enhanced by continuous peer review and team reflection among the reviewers.DiscussionThe authors believe the advantages of a realist synthesis for social accountability lie in the possibility of overcoming disciplinary or paradigmatic boundaries often found in public health and development. In addition, they argue that this approach fills the knowledge gap left by conventional synthesis or evaluation exercises of participatory programs. Finally, the authors describe the practical strategies adopted to address methodological challenges and validity.

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

“…Information from patient complaints – a widely accepted measure of patient–provider relationships and patients’ satisfaction with services they receive – can contribute towards improved patients’ engagement in health services [1], improved quality of health services [2–11], health staff review, management and development [10,12–18], improved accountability [19–23], reduced abuse, assured compliance with standards and improved overall health systems performance [2,24]. Therefore, effective patient complaint management systems constitute a crucial component of well-performing national health systems.…”

The community is just a small circle: citizen participation in the free maternal and child healthcare programme of Enugu State, Nigeria

“…An advanced form of citizen participation termed social accountability [3] comprises strategies, processes or interventions used by citizens to ensure that politicians, policymakers and service providers respond to citizens and account for their actions and decisions [4,5]. Social accountability strives to improve institutional performance by bolstering both citizen participation in policies and service delivery, and the public responsiveness of state and organisations [6].…”

“…In the current era of sustainable development goals, with a huge focus on UHC, citizen participation in implementing health financing policies may promote service use relative to the need for care, responsiveness of providers and financial protection [9]. Social accountability initiatives, such as patient complaints procedures, health facility committees (HFCs), provider report cards and patients’ rights charters [10–13], may inspire users to participate in management of health facilities, complement government-led supervision and regulation, and improve the quality of healthcare decisions by government [4,6,14]. These accountability initiatives may improve the capacity of policymakers and providers to make changes to services based on citizens’ expectations [12,15], promote transparency in service entitlement and enhance health system outcomes [2,16].…”

Social Accountability for Adolescent Sexual and Reproductive Health

“…Likewise, Lodenstein et al, (2013) in a critical realist synthesis of literature on social accountability have presented a hypothesized framework of social accountability with a configuration of context, mechanism and outcome. They summarized that social accountability is context sensitive and outcomes are triggers by mechanisms through citizen engagement and collective action.…”