Browsing by Subject "Accountability"

Now showing 1 - 3 of 3
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    Open Access
    An activity theory analysis of how management of a private higher education institution interpret and engage with re-accreditation
    (2021) Reid, Rhiannon Sara; Cliff, Alan
    The aim of this study was to provide an in-depth understanding of how a single private provider conducted an application for re-accreditation in line with the recently revised accreditation framework set out by the Council on Higher Education. This framework aims to promote an integrated approach to accreditation and increased autonomy for higher education institutions with regard to the reaccreditation of programmes. The research unpacked how accreditation was understood and applied within the context of the institution, placing emphasis on understanding the elements that promoted or inhibited quality as well as the tensions and contradictions that arose within this process. The driving question addressed by this research was: How does management within a South African private higher education institution engage with the re-accreditation process? Literature revealed that there is limited research on understanding quality assurance in private higher education in South Africa, and specifically on accreditation. Cultural-historical activity theory (CHAT) was considered the most effective lens to interpret the findings of this study, as research indicates that it is for teasing out the historical and cultural contradictions within as well as between people, tools and the environment within complex educational systems. Multiple data-gathering techniques, including semi-structured in-depth interviews, participant observations and documentation reviews, were conducted. The findings of this study illuminate the critical role of management and their respective interpretations of quality in the shaping of the application for re-accreditation, that balanced quality development and accountability requirements. The study highlighted contradictions and issues that inhibited meaningful engagement with accreditation as well as the enhancement of programme and institutional quality.
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    Open Access
    Can community action improve equity for maternal health and how does it do so? Research findings from Gujarat, India
    (BioMed Central, 2018-08-20) George, Asha S; Mohan, Diwakar; Gupta, Jaya; LeFevre, Amnesty E; Balakrishnan, Subhasri; Ved, Rajani; Khanna, Renu
    Background Efforts to work with civil society to strengthen community participation and action for health are particularly important in Gujarat, India, given that the state has resources and capacity, but faces challenges in ensuring that services reach those most in need. To contribute to the knowledge base on accountability and maternal health, this study examines the equity effects of community action for maternal health led by Non-Government Organizations (NGOs) on facility deliveries. It then examines the underlying implementation processes with implications for strengthening accountability of maternity care across three districts of Gujarat, India. Community action for maternal health entailed NGOs a) working with community collectives to raise awareness about maternal health entitlements, b) supporting community monitoring of outreach government services, and c) facilitating dialogue with government providers and authorities with report cards based on community monitoring of maternal health. Methods The study combined qualitative data (project documents and 56 stakeholder interviews thematically analyzed) with quantitative data (2395 women's self-reported receipt of information on entitlements and use of services over 3 years of implementation monitored prospectively through household visits). Multivariable logistic regression examined delivery care seeking and equity. Results In the marginalised districts, women reported substantial increases in receipt of information of entitlements and utilization of antenatal and delivery care. In the marginalized and wealthier districts, a switch from private facilities to public ones was observed for the most vulnerable. Supportive implementation factors included a) alignment among NGO organizational missions, b) participatory development of project tools, c) repeated capacity building and d) government interest in improving utilization and recognition of NGO contributions. Initial challenges included a) confidence and turnover of volunteers, b) complexity of the monitoring tool and c) scepticism from both communities and providers. Conclusion With capacity and trust building, NGOs supporting community based collectives to monitor health services and engage with health providers and local authorities, over time overcame implementation challenges to strengthen public sector services. These accountability efforts resulted in improvements in utilisation of public sector services and a shift away from private care seeking, particularly for the marginalised.
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    Open Access
    Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings
    (BioMed Central Ltd, 2013) Cleary, Susan; Molyneux, Sassy; Gilson, Lucy
    BACKGROUND: District level health system governance is recognised as an important but challenging element of health system development in low and middle-income countries. Accountability is a more recent focus in health system debates. Accountability mechanisms are governance tools that seek to regulate answerability between the health system and the community (external accountability) and/or between different levels of the health system (bureaucratic accountability). External accountability has attracted significant attention in recent years, but bureaucratic accountability mechanisms, and the interactions between the two forms of accountability, have been relatively neglected. This is an important gap given that webs of accountability relationships exist within every health system. There is a need to strike a balance between achieving accountability upwards within the health system (for example through information reporting arrangements) while at the same time allowing for the local level innovation that could improve quality of care and patient responsiveness. METHODS: Using a descriptive literature review, this paper examines the factors that influence the functioning of accountability mechanisms and relationships within the district health system, and draws out the implications for responsiveness to patients and communities. We also seek to understand the practices that might strengthen accountability in ways that improve responsiveness - of the health system to citizens' needs and rights, and of providers to patients. RESULTS: The review highlights the ways in which bureaucratic accountability mechanisms often constrain the functioning of external accountability mechanisms. For example, meeting the expectations of relatively powerful managers further up the system may crowd out efforts to respond to citizens and patients. Organisational cultures characterized by supervision and management systems focused on compliance to centrally defined outputs and targets can constrain front line managers and providers from responding to patient and population priorities. CONCLUSION: Findings suggest that it is important to limit the potential negative impacts on responsiveness of new bureaucratic accountability mechanisms, and identify how these or other interventions might leverage the shifts in organizational culture necessary to encourage innovation and patient-centered care.