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Health policy and planning v.32 no.1, 2017년, pp.125 - 140   SCIE SSCI
본 등재정보는 저널의 등재정보를 참고하여 보여주는 베타서비스로 정확한 논문의 등재여부는 등재기관에 확인하시기 바랍니다.

Health provider responsiveness to social accountability initiatives in low- and middle-income countries: a realist review

Lodenstein, Elsbet (Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University) ); Dieleman, Marjolein (KIT Health, PO Box 95001, 1090 HA Amsterdam, The Netherlands ); Gerretsen, Barend (KIT Health, PO Box 95001, 1090 HA Amsterdam, The Netherlands ); Broerse, Jacqueline E W (Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University) );
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    Social accountability in the health sector has been promoted as a strategy to improve the quality and performance of health providers in low- and middle-income countries. Whether improvements occur, however, depends on the willingness and ability of health providers to respond to societal pressure for better care. This article uses a realist approach to review cases of collective citizen action and advocacy with the aim to identify key mechanisms of provider responsiveness. Purposeful searches for cases were combined with a systematic search in four databases. To be included in the review, the initiatives needed to describe at least one outcome at the level of frontline service provision. Some 37 social accountability initiatives in 15 countries met these criteria. Using a realist approach, retroductive analysis and triangulation of methods and sources were performed to construct Context–Mechanism–Outcome configurations that explain potential pathways to provider responsiveness. The findings suggest that health provider receptivity to citizens’ demands for better health care is mediated by health providers’ perceptions of the legitimacy of citizen groups and by the extent to which citizen groups provide personal and professional support to health providers. Some citizen groups activated political or formal bureaucratic accountability channels but the effect on provider responsiveness of such strategies was more mixed. Favourable contexts for health provider responsiveness comprise socio-political contexts in which providers self-identify as activists, health system contexts in which health providers depend on citizens’ expertise and capacities, and health system contexts where providers have the self-perceived ability to change the system in which they operate. Rather than providing recipes for successful social accountability initiatives, the synthesis proposes a programme theory that can support reflections on the theories of change underpinning social accountability initiatives and interventions to improve the quality of primary health care in different settings.


  • 주제어

    Citizen participation .   health providers .   health rights .   health services .   low- and middle-income countries .   realist review .   responsiveness .   social accountability.  

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