Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings

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dc.contributor.authorCleary, Susanen_ZA
dc.contributor.authorMolyneux, Sassyen_ZA
dc.contributor.authorGilson, Lucyen_ZA
dc.date.accessioned2015-11-23T11:38:34Z
dc.date.available2015-11-23T11:38:34Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: 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.en_ZA
dc.identifier.apacitationCleary, S., Molyneux, S., & Gilson, L. (2013). Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/15222en_ZA
dc.identifier.chicagocitationCleary, Susan, Sassy Molyneux, and Lucy Gilson "Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings." <i>BMC Health Services Research</i> (2013) http://hdl.handle.net/11427/15222en_ZA
dc.identifier.citationCleary, S. M., Molyneux, S., & Gilson, L. (2013). Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings. BMC health services research, 13(1), 320.en_ZA
dc.identifier.ris TY - Journal Article AU - Cleary, Susan AU - Molyneux, Sassy AU - Gilson, Lucy AB - 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. DA - 2013 DB - OpenUCT DO - 10.1186/1472-6963-13-320 DP - University of Cape Town J1 - BMC Health Services Research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings TI - Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings UR - http://hdl.handle.net/11427/15222 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15222
dc.identifier.urihttp://dx.doi.org/10.1186/1472-6963-13-320
dc.identifier.vancouvercitationCleary S, Molyneux S, Gilson L. Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings. BMC Health Services Research. 2013; http://hdl.handle.net/11427/15222.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentHealth Policy and Systems Divisionen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2013 Cleary et al.; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Health Services Researchen_ZA
dc.source.urihttp://www.biomedcentral.com/bmchealthservres/en_ZA
dc.subject.otherAccountabilityen_ZA
dc.subject.otherGovernanceen_ZA
dc.subject.otherPrimary health careen_ZA
dc.subject.otherLow and middle income settingsen_ZA
dc.titleResources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settingsen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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