Participatory approach to design social accountability interventions to improve maternal health services: a case study from the Democratic Republic of the Congo.
Participatory approach to design social accountability interventions to improve maternal health services: a case study from the Democratic Republic of the Congo.
复制标题
DOI：
10.1186/s41256-017-0024-0
复制
发表时间：
2017
影响因子：
8.7
通讯作者：
de Cock Buning T
中科院分区：
文献类型：
--
作者：
Mafuta EM;Dieleman MA;Essink L;Khomba PN;Zioko FM;Mambu TNM;Kayembe PK;de Cock Buning T
社会问责包括一套机制，目的是一方面使用户能够提出他们对所提供的卫生服务的关切（声音），另一方面使卫生服务提供者对与提供卫生服务有关的行动和决定负责。另一方面，这些措施旨在协助医护人员在提供护理服务时顾及使用者的需要和期望。本文介绍了SA干预的发展，旨在提高卫生服务的反应在两个卫生区在刚果民主共和国。受益者包括男子、妇女、社区卫生工作者、卫生部门和地方当局的代表，他们是有目的地挑选出来的，并参与了在两个卫生区采用对话模式的咨询过程：（1）在咨询期间，分别组织了8次焦点小组讨论，旨在分享和讨论形势分析的结果，并收集改进建议，（2）以往FGD参与者的代表参加了对话会议，以优先考虑和整合FGD的建议，（3）研究伙伴讨论了整合后的建议，并将其设定为干预要素。所有过程都进行了录音、转录和归纳内容分析。共有121人参与了这一进程，其中51人为女性。他们提出了48条建议。在对话会议期间，他们的建议被纳入六个干预部分：（1）利用社区卫生工作者和卫生委员会收集和传递社区对卫生服务的关注，（2）建设社区在知识和信息方面的能力，（3）通过对话会议让社区领导人参与进来，（4）改善卫生保健人员对声音的态度和卫生机构对声音的管理;（5）让卫生服务监督员参与社区参与;（6）利用其他现有的干预措施。然后，在方案编制期间将这些组成部分分为三个干预组成部分：建立一个正式的声音系统，举行对话会议，提高可解释性和可回答性，并加强保健提供者的反应能力。对话模式是一个参与性进程，它的使用使受益者能够与具有不同观点和知识类型的其他社区利益攸关方一起参与咨询进程，并就两个卫生区具体情况下的SA干预组成部分的组合提出建议。本文的在线版本（doi：10.1186/s41256-017-0024-0）包含补充材料，可供授权用户使用。
Social accountability (SA) comprises a set of mechanisms aiming to, on the one hand, enable users to raise their concerns about the health services provided to them (voice), and to hold health providers (HPs) accountable for actions and decisions related to the health service provision. On the other hand, they aim to facilitate HPs to take into account users’ needs and expectations in providing care. This article describes the development of a SA intervention that aims to improve health services responsiveness in two health zones in the Democratic Republic of the Congo. Beneficiaries including men, women, community health workers (CHWs), representatives of the health sector and local authorities were purposively selected and involved in an advisory process using the Dialogue Model in the two health zones: (1) Eight focus group discussions (FGDs) were organized separately during consultation aimed at sharing and discussing results from the situation analysis, and collecting suggestions for improvement, (2) Representatives of participants in previous FGDs were involved in dialogue meetings for prioritizing and integrating suggestions from FGDs, and (3) the integrated suggestions were discussed by research partners and set as intervention components. All the processes were audio-taped, transcribed and analysed using inductive content analysis. Overall there were 121 participants involved in the process, 51 were female. They provided 48 suggestions. Their suggestions were integrated into six intervention components during dialogue meetings: (1) use CHWs and a health committee for collecting and transmitting community concerns about health services, (2) build the capacity of the community in terms of knowledge and information, (3) involve community leaders through dialogue meetings, (4) improve the attitude of HPs towards voice and the management of voice at health facility level, (5) involve the health service supervisors in community participation and; (6) use other existing interventions. These components were then articulated into three intervention components during programming to: create a formal voice system, introduce dialogue meetings improving enforceability and answerability, and enhance the health providers’ responsiveness. The use of the Dialogue Model, a participatory process, allowed beneficiaries to be involved with other community stakeholders having different perspectives and types of knowledge in an advisory process and to articulate their suggestions on a combination of SA intervention components, specific for the two health zones contexts. The online version of this article (doi:10.1186/s41256-017-0024-0) contains supplementary material, which is available to authorized users.