Effects of a community scorecard on improving the local health system in Eastern Democratic Republic of Congo: qualitative evidence using the most significant change technique
Effects of a community scorecard on improving the local health system in Eastern Democratic Republic of Congo: qualitative evidence using the most significant change technique
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DOI：
10.1186/s13031-015-0055-4
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发表时间：
2015-01-01
影响因子：
3.6
通讯作者：
Ratnayake, Ruwan
中科院分区：
文献类型：
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作者：
Ho, Lara S.;Labrecque, Guillaume;Ratnayake, Ruwan
工作背景：十多年的冲突削弱了刚果民主共和国的卫生系统，降低了其应对民众需求的能力。社区记分卡被认为是加强服务提供者的问责制和应对能力的一种方式，但其效果的证据有限，特别是在脆弱和受冲突影响的情况下。本文介绍了社区记分卡在刚果东部两个省的社区驱动重建项目中的实施情况。2012年6月至2013年11月，从村发展委员会、卫生委员会、社区成员（20名男性和18名女性）和医疗保健提供者（n = 7）在25个地点使用最显着变化技术。故事进行了定性分析的内容有关的类型和机制的变化observed.Results：最显着的变化是有关增加透明度和社区参与卫生设施的管理，并提高护理质量。护理质量包括增加获得服务的机会，改善病人与提供者的关系，提高服务提供者的业绩，改善有形基础设施的维护。变化是通过许多不同的机制发生的，包括提供者根据信息采取行动，来自社区代表或监督者的压力;以及卫生设施委员会和提供者的联合行动和改进的合作。虽然人们常常认为对抗是公民改变国家提供的服务的主要机制，这项研究表明，医疗保健提供者也可能有动力通过其他方式改变。社区记分卡的积极经验可以为社区成员和卫生系统之间的界面提供一个结构化的空间，允许用户表达他们的意见和偏好，并为用户和一线医疗保健提供者弥合信息差距。当通过记分卡确定的问题的解决方案在当地可获得时，用户和医疗保健提供者能够共同努力，实施相互可接受的解决方案，以提高医疗服务的质量，并使其更好地满足用户的需求。
Background: More than a decade of conflict has weakened the health system in the Democratic Republic of Congo and decreased its ability to respond to the needs of the population. Community scorecards have been conceived as a way to increase accountability and responsiveness of service providers, but there is limited evidence of their effects, particularly in fragile and conflict-affected contexts. This paper describes the implementation of community scorecards within a community-driven reconstruction project in two provinces of eastern Democratic Republic of Congo.Methods: Between June 2012 and November 2013, 45 stories of change in the health system were collected from village development committee, health committee, community members (20 men and 18 women) and healthcare providers (n = 7) in 25 sites using the Most Significant Change technique. Stories were analyzed qualitatively for content related to the types and mechanisms of change observed.Results: The most salient changes were related to increased transparency and community participation in health facility management, and improved quality of care. Quality of care included increased access to services, improved patient-provider relationships, improved performance of service providers, and improved maintenance of physical infrastructure. Changes occurred through many different mechanisms including provider actions in response to information, pressure from community representatives, or supervisors; and joint action and improved collaboration by health facility committees and providers.Conclusions: Although it is often assumed that confrontation is a primary mechanism for citizens to change state-provided services, this study demonstrates that healthcare providers may also be motivated to change through other means. Positive experiences of community scorecards can provide a structured space for interface between community members and the health system, allowing users to voice their opinions and preferences and bridge information gaps for both users and frontline healthcare providers. When solutions to problems identified through the scorecard are locally accessible, users and healthcare providers are able to work together to implement mutually acceptable solutions that improve quality of health services, and make them more responsive to users' needs.