How does social accountability contribute to better maternal health outcomes? A qualitative study on perceived changes with government and civil society actors in Gujarat, India
How does social accountability contribute to better maternal health outcomes? A qualitative study on perceived changes with government and civil society actors in Gujarat, India
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DOI：
10.1186/s12913-018-3453-7
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发表时间：
2018-08-22
影响因子：
2.8
通讯作者：
Dieleman, Marjolein
中科院分区：
文献类型：
--
作者：
Hamal, Mukesh;Buning, Tjard de Cock;Dieleman, Marjolein
背景：社会问责机制被强调为有助于改善产妇保健结果和减少不平等现象。但缺乏证据表明它们如何对这种改善做出贡献。本研究旨在探讨印度古吉拉特邦选定地区与产妇健康相关的社会问责机制、所针对的因素以及如何看待这些机制的结果。方法：我们通过与公民社会和政府卫生系统参与者的深入访谈和焦点小组讨论，进行了定性研究。使用孕产妇健康的社会决定因素框架从结构决定因素和中介决定因素两个方面对数据进行分析。结果：在结构和活动方面，政府和公民社会都存在社会问责机制。但那些被认为影响产妇健康的人主要来自民间社会，特别是妇女团体、社区监测和产妇死亡审查。社会问责机制影响了结构性决定因素--治理、政策、健康信念、妇女地位，以及中介决定因素--社会资本、产妇保健行为以及保健服务提供系统的可获得性、可及性和质量。这些进一步积极地影响了产妇保健服务的使用。通过信息、对话和谈判进程，社会问责机制特别赋予妇女权力，使其能够对保健系统提出集体要求，并改变了该系统行为者对妇女的看法。它最终在信任和协作方面改善了妇女与卫生系统之间的关系，并促使卫生系统对满足妇女群体的需求作出适当反应。结论：古吉拉特邦的社会问责机制被认为改善了社区与卫生系统之间的互动，并有助于改善获得和使用孕产妇卫生服务的机会。社会问责的影响似乎仅限于地方/区一级，缺乏对政府结构的能力和自主权。
Background: Social accountability mechanisms have been highlighted as making a contribution to improving maternal health outcomes and reducing inequities. But there is a lack of evidence on how they contribute to such improvements. This study aims to explore social accountability mechanisms in selected districts of the Indian state of Gujarat in relation to maternal health, the factors they address and how the results of these mechanisms are perceived.Methods: We conducted qualitative research through in-depth interviews and focus group discussions with actors of civil society and government health system. Data were analyzed using a framework of social determinants of maternal health in terms of structural and intermediary determinants.Results: There are social accountability mechanisms in the government and civil society in terms of structure and activities. But those that were perceived to influence maternal health were mainly from civil society, particularly women's groups, community monitoring and a maternal death review. The social accountability mechanisms influenced structural determinants - governance, policy, health beliefs, women's status, and intermediary determinants - social capital, maternal healthcare behavior, and availability, accessibility and the quality of the health service delivery system. These further positively influenced the increased use of maternal health services. The social accountability mechanisms, through the process of information, dialogue and negotiation, particularly empowered women to make collective demands of the health system and brought about changed perceptions of women among actors in the system. It ultimately improved relations between women and the health system in terms of trust and collaboration, and generated appropriate responses from the health system to meeting women's groups' demands.Conclusion: Social accountability mechanisms in Gujarat were perceived to improve interaction between communities and the health system and contribute to improvements in access to and use of maternal health services. The influence of social accountability appeared to be limited to the local/district level and there was lack of capacity and ownership of the government structures.