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Participatory approach to design social accountability interventions to improve maternal health services: a case study from the Democratic Republic of the Congo.

ABSTRACT: Background: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. Methods: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. Results: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. Conclusions: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.

SUBMITTER: Mafuta EM

PROVIDER: S-EPMC5683322 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Participatory approach to design social accountability interventions to improve maternal health services: a case study from the Democratic Republic of the Congo.

Mafuta Eric M EM Dieleman Marjolein A MA Essink Leon L Khomba Paul N PN Zioko François M FM Mambu Thérèse N M TNM Kayembe Patrick K PK de Cock Buning Tjard T

Global health research and policy 20170206

<h4>Background</h4>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 impr ...[more]

PMID: 29202072

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Project description:BackgroundThe persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process.MethodsA literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords.ResultsThe study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal.ConclusionsSocial accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

Project description:BackgroundThe YAM DAABO study ("your choice" in Mooré) takes place in Burkina Faso and the Democratic Republic of Congo. It has the objective to identify a package of postpartum family planning (PPFP) interventions to strengthen primary healthcare services and determine its effectiveness on contraceptive uptake during the first year postpartum. This article presents the process of identifying the PPFP interventions and its detailed contents.MethodsBased on participatory action research principles, we adopted an inclusive process with two complementary approaches: a bottom-up formative approach and a circular reflective approach, both of which involved a wide range of stakeholders. For the bottom-up component, we worked in each country in three formative sites and used qualitative methods to identify barriers and catalysts to PPFP uptake. The results informed the package design which occurred during the circular reflective approach - a research workshop gathering service providers, members of both country research teams, and the WHO coordination team.ResultsAs barriers and catalysts were found to be similar in both countries and with the view to scaling up our strategy to other comparable settings, we identified a common package of six low-cost, low-technology, and easily-scalable interventions that addressed the main service delivery obstacles related to PPFP: (1) refresher training of service providers, (2) regularly scheduled and strengthened supportive supervision of service providers, (3) enhanced availability of services 7 days a week, (4) a counseling tool, (5) appointment cards for women, and (6) invitation letters for partners.ConclusionsOur research strategy assumes that postpartum contraceptive uptake can be increased by supporting providers, enhancing the availability of services, and engaging women and their partners. The package does not promote any modern contraceptive method over another but prioritizes the importance of women's right to information and choice regarding postpartum fertility options. The effectiveness of the package will be studied in the experimental phase. If found to be effective, this intervention package may be relevant to and scalable in other parts of Burkina Faso and the DRC, and possibly other Sub-Saharan countries.Trial registrationRetrospectively registered in the Pan African Clinical Trials Registry ( PACTR201609001784334 , 27 September 2016).

Project description:In sub-Saharan African settings like the Democratic Republic of the Congo, high-quality care during childbirth and the immediate postpartum period is lacking in public facilities, necessitating multipronged interventions to improve care. We used a pre-post design to examine the effectiveness of a low-dose, high-frequency capacity-building and quality improvement (QI) intervention to improve care for women and newborns around the day of birth in 16 health facilities in Kinshasa, Democratic Republic of the Congo. Effectiveness was assessed based on changes in provider skills, key health indicators, and beneficiary satisfaction. To assess changes in the competency of the 188 providers participating in the intervention, we conducted objective structured clinical examinations on care for mothers and newborns on the day of birth, immediate postpartum family planning (PPFP) counseling and method provision, and postabortion care before and after implementation of training and at 6 and 12 months after training. Interrupted time series (ITS) analysis techniques were used to analyze routine health service data for changes in select maternal, newborn, and postpartum outcomes before and after the intervention. To assess changes in clients' perceptions of care, 2 rounds of telephone surveys were administered. Before the intervention, less than 2% of participating providers demonstrated competency in skills. Immediately after training, more than 80% demonstrated competency, and 70% retained competency after 12 months. ITS analyses show the risk of early neonatal death declined significantly by 9% (95% confidence interval [CI]=4%, 13%, P<.001), and likelihood of immediate PPFP uptake increased significantly by 72% (95% CI=53%, 92%, P<.001). Client satisfaction improved by 58% over the life of the project. These findings build on previous studies documenting the effectiveness of clinical capacity-building and QI approaches. If implemented at scale, this approach has the potential to substantively contribute to improving maternal and perinatal health in similar settings.

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Participatory approach to design social accountability interventions to improve maternal health services: a case study from the Democratic Republic of the Congo.

Publications

Participatory approach to design social accountability interventions to improve maternal health services: a case study from the Democratic Republic of the Congo.

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