Improving Efficiency in Health through Social Accountability
Introduction
Accountability refers to the obligation of individuals or agencies to provide information about, and/or justification for, their actions to other actors, along with the imposition of sanctions for failure to comply and/or to engage in appropriate action.
It involves measures to ensure that the person or organization with the authority to provide a service actually delivers that service i.e. that providers and policy-makers are answerable for their actions, and to demonstrate that they have delivered.
Accountability is an important component of the Right to Health. It has the potential not only to significantly contribute to, but also accelerate the achievement of Universal Health Coverage (UHC). There are broad range of accountability mechanisms that include legal and regulatory, administrative or bureaucratic, fiscal, political and social accountability. The purpose of each mechanism is to ensure that actors in accountability relationship are answerable for their actions or inactions regarding healthcare; and there are effective remedies and sanctions when there are violations or infractions.
Social Accountability Mechanism.
- Citizens Voice is Key to Better Health
Social Accountability refers tothe broad range of actions and mechanisms used by the citizens to hold accountability actors to account, as well as actions on the part of government, civil society, media and other societal actors that promote or facilitate these efforts.
Health service users are increasingly seen as citizens who should be allowed to voice their concerns actively, to shape health services and policies in the public interest and hold health providers and policymakers accountable. Social accountability initiatives mobilize citizens to demand for more responsive service providers, reduce corrupt tendencies and improve the quality and availability of health care.This includes systems supported by non-state actors such as the community, civil society organizations and the media.
Community Participation in Health (CPH)
Over the years, direct community participation in health care delivery through the committee system (health development committees) has been in use at the primary health care level. It is a collective action that empower the people to engage with the local authorities and service providers.
The citizens through their representatives in the Health Development Committees at various levels – ward and community/village groups can be engaged in local level planning and budgeting. Community participation in monitoring of service delivery is a good strategy to assure compliance with standards and to increase grassroots accountability
Community monitoring tools include:
- Community Scorecards, are used at the local-level by communities themselves to conduct qualitative evaluations of public services, projects or institutions and involve a meeting between service-providers and community members to share results;
- Citizen Report Cards,which are surveys administered by citizens that provide quantitative feedback on the quality and accessibility of public services from actual users;
- Social Audits, which are community assessments of the impact of government projects or services that involve comparing the proposed and real benefits along with any unexpected challenges or negative effects associated with implementation.
Health Consumer Forum (HCF)
It is a client – provider platforms.
Health Consumers refer to people who use health services, as well as their family and carers. It include people who have used a health service in the past or who could potentially use it in the future.
The notion that consumers are the silent partners in a health care system is changing with the integration of health consumer forums for quality and efficient health care service deliveries in the system.
Health Consumer Forum (HCF) is a platform where health consumer representatives who are also health consumers, take up specific role to provide advice on behalf of consumers with the overall aim of improving health care.
They areused to improve Responsiveness to the Public. Responsiveness is one of the key functions of the health system. It involves how well the health system meet the expectations of the public (WHO 2000).
Quite often the expectations are:
- Protection Of Consumer Interests ( against fraud and abuse, respect)
- Client Satisfaction with Health Service.
Improvements in responsiveness require Management Attention and Public Spotlight and working in collaboration with key stakeholders,Health Consumer Forums could be a good platform for promoting consumer rights, increase public awareness of health and consumer issues and enhancing the voices of the people particularly the poor.
Specific Roles of Health Consumer Forum.
The forum works together to:
- Achieve safe, quality, timely health care for its consumers by way of advocating for appropriate and equitable health care
- Raise the health literacy of consumers, health professionals and stakeholders.
- Provide platform for awareness creation and sensitization on Patients’ Bill of Rights
- Provide advice on behalf of consumers with the overall aim of improving health care.
- Identify issues in safety and quality of health services for consumers
- Provide a voice for health consumers and supports participation in health policy and program decision making.
Civil Society Organizations (CSOs)
The role of civil society as a watchdog is well recognized. The CSOs enjoy liberties that donors and state-controlled accountability mechanisms don’t, including the freedom to raise queries on particularly sensitive matters, and expose poor governance without fear of bureaucratic red-tape or diplomatic incidences.
Civil society organizations can promote accountability through:
- Advocacy to political leaders, policy makers and health managers and presenting evidence to the government and relevant stakeholders.
- Mobilizing of citizens and local organizations to agitate for accountability and necessary policy reforms through meetings (Consumer Forums, Town Hall Meeting), seminars and conferences.
- Civil Education Activities and Public Campaign using IEC and radio/TV programmes can be used to disseminate information and mobilize the public towards greater understanding of the clients rights and the benefits of accountability.
- Strengthening the capacity of government actors on key accountability or management issues,
- Strategic use of the media,
- Citizens Survey and Report Cards can provide evidence on citizens need.
- Litigation
The use of these approaches has varied across countries, for instance, the PLWHA, a civil society platform for People Living with HIV/AIDs have used the media in Nigeria to successfully strengthen the implementation of antiretroviral drug treatment in Nigeria. CSNAC, the AntiCorruption Coalition in Nigeria has often used the media to highlight policy inadequacies and poor use of public resources.
Through the Health Consumer Forum, IHAT is helping health consumers, so that their voice will reach providers and decision makers, and affect policy.
Mass Media
The media can promote and monitor accountability through:
- Investigative Journalism to expose inappropriate policy decisions or poor use of resources and serves the role of getting the public involved in agitating for reforms and improvements.
- Disseminate information on Patients’ Bill of Rights defining standards of care patients can expect to receive and demand
- Providing information to the public and in the process expose the failure of actors to carry out their respective responsibilities properly.
- ‘Naming’ and ‘shaming’ institutions that fail to comply with health care regulations.
- Providing citizens with a platform to report health providers’ ethical performance.
Are you passionate for, and interested in the promotion of Right to Good Health?
Why not partner with IHAT as we work to improve health care in Nigeria.
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Dr M. J. Abdullahi
Convener, Initiative for Health Accountability and Transparency
