Strengthening health system governance using health facility service charters: a mixed methods assessment of community experiences and perceptions in a district in Kenya
Strengthening health system governance using health facility service charters: a mixed methods assessment of community experiences and perceptions in a district in Kenya
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DOI：
10.1186/s12913-015-1204-6
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发表时间：
2015-12-04
影响因子：
2.8
通讯作者：
Cohn, Simon
中科院分区：
文献类型：
--
作者：
Atela, Martin;Bakibinga, Pauline;Cohn, Simon
背景资料：人们日益强调，加强卫生系统的问责制对于改善全世界特别是发展中国家卫生服务的性质和质量至关重要。问责机制包括卫生设施委员会、意见箱、设施和病人章程等。然而，关于问责机制的性质和影响问责机制绩效的因素的资料很少，特别是在发展中国家。我们研究社区成员的经验，这样的问责机制，在Kericho区，Kenya.Methods的卫生设施宪章：在2011年进行了一项家庭调查，1,024名受访者（36%男性，64%女性）年龄17岁及以上的医疗设施集水区分层，位于Kericho区的一个分区。此外，还与四个卫生设施服务区的卫生设施用户进行了16次重点小组讨论。通过频率分布和交叉制表对定量数据进行了分析。定性数据进行转录和分析，使用一个主题的approach.Results：大多数（65%）的家庭调查受访者看到了他们当地的设施服务宪章，其中84%的人读过的信息宪章。其中，83%的人认为宪章有用或非常有用。据受访者称，这些章程提供了有关所提供服务及其费用的有用信息，让用户有机会遏制潜在的过度收费，并帮助用户在接受服务之前规划医疗费用。然而，社区成员提到了使用特许证的几个挑战：卫生工作者不遵守特许证规定;难以辨认和语言问题;缺乏支出记录;往往由于排队压力而没有时间阅读和理解这些记录;以及社会文化限制。这项研究的结果表明，改善肯尼亚各地区卫生设施在设施服务实施方面的合规性，宪章对于问责制和社区对提供服务的满意度至关重要。为了改善卫生设施的遵守情况，需要重点关注有助于执行官方准则、解决能力差距和提高公众对宪章及其使用的认识的机制。
Background: Enhancing accountability in health systems is increasingly emphasised as crucial for improving the nature and quality of health service delivery worldwide and particularly in developing countries. Accountability mechanisms include, among others, health facilities committees, suggestion boxes, facility and patient charters. However, there is a dearth of information regarding the nature of and factors that influence the performance of accountability mechanisms, especially in developing countries. We examine community members' experiences of one such accountability mechanism, the health facility charter in Kericho District, Kenya.Methods: A household survey was conducted in 2011 among 1,024 respondents (36 % male, 64 % female) aged 17 years and above stratified by health facility catchment area, situated in a division in Kericho District. In addition, sixteen focus group discussions were conducted with health facility users in the four health facility catchment areas. Quantitative data were analysed through frequency distributions and cross-tabulations. Qualitative data were transcribed and analysed using a thematic approach.Results: The majority (65 %) of household survey respondents had seen their local facility service charter, 84 % of whom had read the information on the charter. Of these, 83 % found the charter to be useful or very useful. According to the respondents, the charters provided useful information about the services offered and their costs, gave users a voice to curb potential overcharging and helped users plan their medical expenses before receiving the service. However, community members cited several challenges with using the charters: non-adherence to charter provisions by health workers; illegibility and language issues; lack of expenditure records; lack of time to read and understand them, often due to pressures around queuing; and socio-cultural limitations.Conclusion: Findings from this study suggest that improving the compliance of health facilities in districts across Kenya with regard to the implementation of the facility service charter is critical for accountability and community satisfaction with service delivery. To improve the compliance of health facilities, attention needs to be focused on mechanisms that help enforce official guidelines, address capacity gaps, and enhance public awareness of the charters and their use.