Perceptions and experiences of frontline health managers and providers on accountability in a South African health district.
Identifieur interne : 000136 ( Main/Exploration ); précédent : 000135; suivant : 000137Perceptions and experiences of frontline health managers and providers on accountability in a South African health district.
Auteurs : Fidele Kanyimbu Mukinda [Afrique du Sud] ; Sara Van Belle [Belgique] ; Helen Schneider [Afrique du Sud]Source :
- International journal for equity in health [ 1475-9276 ] ; 2020.
Descripteurs français
- KwdFr :
- Accessibilité des services de santé (organisation et administration), Accessibilité des services de santé (statistiques et données numériques), Adulte (MeSH), Adulte d'âge moyen (MeSH), Femelle (MeSH), Humains (MeSH), Participation communautaire (psychologie), Participation communautaire (statistiques et données numériques), Personnel de santé (psychologie), Personnel de santé (statistiques et données numériques), Population d'origine africaine (psychologie), Population d'origine africaine (statistiques et données numériques), Recherche qualitative (MeSH), Responsabilité sociale (MeSH), Soins de santé primaires (organisation et administration), Soins de santé primaires (statistiques et données numériques).
- MESH :
- organisation et administration : Accessibilité des services de santé, Soins de santé primaires.
- psychologie : Participation communautaire, Personnel de santé, Population d'origine africaine.
- statistiques et données numériques : Accessibilité des services de santé, Participation communautaire, Personnel de santé, Population d'origine africaine, Soins de santé primaires.
- Adulte, Adulte d'âge moyen, Femelle, Humains, Recherche qualitative, Responsabilité sociale.
English descriptors
- KwdEn :
- Adult (MeSH), African Continental Ancestry Group (psychology), African Continental Ancestry Group (statistics & numerical data), Community Participation (psychology), Community Participation (statistics & numerical data), Female (MeSH), Health Personnel (psychology), Health Personnel (statistics & numerical data), Health Services Accessibility (organization & administration), Health Services Accessibility (statistics & numerical data), Humans (MeSH), Middle Aged (MeSH), Primary Health Care (organization & administration), Primary Health Care (statistics & numerical data), Qualitative Research (MeSH), Social Responsibility (MeSH).
- MESH :
- organization & administration : Health Services Accessibility, Primary Health Care.
- psychology : African Continental Ancestry Group, Community Participation, Health Personnel.
- statistics & numerical data : African Continental Ancestry Group, Community Participation, Health Personnel, Health Services Accessibility, Primary Health Care.
- Adult, Female, Humans, Middle Aged, Qualitative Research, Social Responsibility.
Abstract
OBJECTIVE
Public primary health care and district health systems play important roles in expanding healthcare access and promoting equity. This study explored and described accountability for this mandate as perceived and experienced by frontline health managers and providers involved in delivering maternal, newborn and child health (MNCH) services in a rural South African health district.
METHODS
This was a qualitative study involving in-depth interviews with a purposive sample of 58 frontline public sector health managers and providers in the district office and two sub-districts, examining the meanings of accountability and related lived experiences. A thematic analysis approach grounded in descriptive phenomenology was used to identify the main themes and organise the findings.
RESULTS
Accountability was described by respondents as both an organisational mechanism of answerability and responsibility and an intrinsic professional virtue. Accountability relationships were understood to be multidirectional - upwards and downwards in hierarchies, outwards to patients and communities, and inwards to the 'self'. The practice of accountability was seen as constrained by organisational environments where impunity and unfair punishment existed alongside each other, where political connections limited the ability to sanction and by climates of fear and blame. Accountability was seen as enabled by open management styles, teamwork, good relationships between primary health care, hospital services and communities, investment in knowledge and skills development and responsive support systems. The interplay of these constraints and enablers varied across the facilities and sub-districts studied.
CONCLUSIONS
Providers and managers have well-established ideas about, and a language of, accountability. The lived reality of accountability by frontline managers and providers varies and is shaped by micro-configurations of enablers and constraints in local accountability ecosystems. A 'just culture', teamwork and collaboration between primary health care and hospitals and community participation were seen as promoting accountability, enabling collective responsibility, a culture of learning rather than blame, and ultimately, access to and quality of care.
DOI: 10.1186/s12939-020-01229-w
PubMed: 32611355
PubMed Central: PMC7328263
Affiliations:
Links toward previous steps (curation, corpus...)
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first="Sara" last="Van Belle">Sara Van Belle</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp</wicri:regionArea><wicri:noRegion>Antwerp</wicri:noRegion></affiliation></author><author><name sortKey="Schneider, Helen" sort="Schneider, Helen" uniqKey="Schneider H" first="Helen" last="Schneider">Helen Schneider</name><affiliation wicri:level="1"><nlm:affiliation>School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Private Bag X17, Cape Town, 7535, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Private Bag X17, Cape Town, 7535</wicri:regionArea><wicri:noRegion>7535</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>South African Medical Research Council (MRC)/Health Services and Systems Unit, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>South African Medical Research Council (MRC)/Health Services and Systems Unit, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author></analytic><series><title level="j">International journal for equity in health</title><idno type="eISSN">1475-9276</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>African Continental Ancestry Group (psychology)</term><term>African Continental Ancestry Group (statistics & numerical data)</term><term>Community Participation (psychology)</term><term>Community Participation (statistics & numerical data)</term><term>Female (MeSH)</term><term>Health Personnel (psychology)</term><term>Health Personnel (statistics & numerical data)</term><term>Health Services Accessibility (organization & administration)</term><term>Health Services Accessibility (statistics & numerical data)</term><term>Humans (MeSH)</term><term>Middle Aged (MeSH)</term><term>Primary Health Care (organization & administration)</term><term>Primary Health Care (statistics & numerical data)</term><term>Qualitative Research (MeSH)</term><term>Social Responsibility (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Accessibilité des services de santé (organisation et administration)</term><term>Accessibilité des services de santé (statistiques et données numériques)</term><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Participation communautaire (psychologie)</term><term>Participation communautaire (statistiques et données numériques)</term><term>Personnel de santé (psychologie)</term><term>Personnel de santé (statistiques et données numériques)</term><term>Population d'origine africaine (psychologie)</term><term>Population d'origine africaine (statistiques et données numériques)</term><term>Recherche qualitative (MeSH)</term><term>Responsabilité sociale (MeSH)</term><term>Soins de santé primaires (organisation et administration)</term><term>Soins de santé primaires (statistiques et données numériques)</term></keywords><keywords scheme="MESH" qualifier="organisation et administration" xml:lang="fr"><term>Accessibilité des services de santé</term><term>Soins de santé primaires</term></keywords><keywords scheme="MESH" qualifier="organization & administration" xml:lang="en"><term>Health Services Accessibility</term><term>Primary Health Care</term></keywords><keywords scheme="MESH" qualifier="psychologie" xml:lang="fr"><term>Participation communautaire</term><term>Personnel de santé</term><term>Population d'origine africaine</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>African Continental Ancestry Group</term><term>Community Participation</term><term>Health Personnel</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>African Continental Ancestry Group</term><term>Community Participation</term><term>Health Personnel</term><term>Health Services Accessibility</term><term>Primary Health Care</term></keywords><keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Accessibilité des services de santé</term><term>Participation communautaire</term><term>Personnel de santé</term><term>Population d'origine africaine</term><term>Soins de santé primaires</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Female</term><term>Humans</term><term>Middle Aged</term><term>Qualitative Research</term><term>Social Responsibility</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Femelle</term><term>Humains</term><term>Recherche qualitative</term><term>Responsabilité sociale</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>Public primary health care and district health systems play important roles in expanding healthcare access and promoting equity. This study explored and described accountability for this mandate as perceived and experienced by frontline health managers and providers involved in delivering maternal, newborn and child health (MNCH) services in a rural South African health district.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>This was a qualitative study involving in-depth interviews with a purposive sample of 58 frontline public sector health managers and providers in the district office and two sub-districts, examining the meanings of accountability and related lived experiences. A thematic analysis approach grounded in descriptive phenomenology was used to identify the main themes and organise the findings.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Accountability was described by respondents as both an organisational mechanism of answerability and responsibility and an intrinsic professional virtue. Accountability relationships were understood to be multidirectional - upwards and downwards in hierarchies, outwards to patients and communities, and inwards to the 'self'. The practice of accountability was seen as constrained by organisational environments where impunity and unfair punishment existed alongside each other, where political connections limited the ability to sanction and by climates of fear and blame. Accountability was seen as enabled by open management styles, teamwork, good relationships between primary health care, hospital services and communities, investment in knowledge and skills development and responsive support systems. The interplay of these constraints and enablers varied across the facilities and sub-districts studied.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Providers and managers have well-established ideas about, and a language of, accountability. The lived reality of accountability by frontline managers and providers varies and is shaped by micro-configurations of enablers and constraints in local accountability ecosystems. A 'just culture', teamwork and collaboration between primary health care and hospitals and community participation were seen as promoting accountability, enabling collective responsibility, a culture of learning rather than blame, and ultimately, access to and quality of care.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">32611355</PMID><DateCompleted><Year>2020</Year><Month>10</Month><Day>26</Day></DateCompleted><DateRevised><Year>2020</Year><Month>10</Month><Day>26</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1475-9276</ISSN><JournalIssue CitedMedium="Internet"><Volume>19</Volume><Issue>1</Issue><PubDate><Year>2020</Year><Month>07</Month><Day>01</Day></PubDate></JournalIssue><Title>International journal for equity in health</Title><ISOAbbreviation>Int J Equity Health</ISOAbbreviation></Journal><ArticleTitle>Perceptions and experiences of frontline health managers and providers on accountability in a South African health district.</ArticleTitle><Pagination><MedlinePgn>110</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1186/s12939-020-01229-w</ELocationID><Abstract><AbstractText Label="OBJECTIVE">Public primary health care and district health systems play important roles in expanding healthcare access and promoting equity. This study explored and described accountability for this mandate as perceived and experienced by frontline health managers and providers involved in delivering maternal, newborn and child health (MNCH) services in a rural South African health district.</AbstractText><AbstractText Label="METHODS">This was a qualitative study involving in-depth interviews with a purposive sample of 58 frontline public sector health managers and providers in the district office and two sub-districts, examining the meanings of accountability and related lived experiences. A thematic analysis approach grounded in descriptive phenomenology was used to identify the main themes and organise the findings.</AbstractText><AbstractText Label="RESULTS">Accountability was described by respondents as both an organisational mechanism of answerability and responsibility and an intrinsic professional virtue. Accountability relationships were understood to be multidirectional - upwards and downwards in hierarchies, outwards to patients and communities, and inwards to the 'self'. The practice of accountability was seen as constrained by organisational environments where impunity and unfair punishment existed alongside each other, where political connections limited the ability to sanction and by climates of fear and blame. Accountability was seen as enabled by open management styles, teamwork, good relationships between primary health care, hospital services and communities, investment in knowledge and skills development and responsive support systems. The interplay of these constraints and enablers varied across the facilities and sub-districts studied.</AbstractText><AbstractText Label="CONCLUSIONS">Providers and managers have well-established ideas about, and a language of, accountability. The lived reality of accountability by frontline managers and providers varies and is shaped by micro-configurations of enablers and constraints in local accountability ecosystems. A 'just culture', teamwork and collaboration between primary health care and hospitals and community participation were seen as promoting accountability, enabling collective responsibility, a culture of learning rather than blame, and ultimately, access to and quality of care.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Mukinda</LastName><ForeName>Fidele Kanyimbu</ForeName><Initials>FK</Initials><Identifier Source="ORCID">0000-0002-0764-6213</Identifier><AffiliationInfo><Affiliation>School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Private Bag X17, Cape Town, 7535, South Africa. fmukinda@uwc.ac.za.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Van Belle</LastName><ForeName>Sara</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schneider</LastName><ForeName>Helen</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Private Bag X17, Cape Town, 7535, South Africa.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>South African Medical Research Council (MRC)/Health Services and Systems Unit, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>07</Month><Day>01</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Int J Equity Health</MedlineTA><NlmUniqueID>101147692</NlmUniqueID><ISSNLinking>1475-9276</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D044383" MajorTopicYN="N">African Continental Ancestry Group</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003256" MajorTopicYN="N">Community Participation</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006282" MajorTopicYN="N">Health Personnel</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006297" MajorTopicYN="N">Health Services Accessibility</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="Y">organization & administration</QualifierName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011320" MajorTopicYN="N">Primary Health Care</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="Y">organization & administration</QualifierName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D036301" MajorTopicYN="N">Qualitative Research</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012941" MajorTopicYN="Y">Social Responsibility</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">Accountability</Keyword><Keyword MajorTopicYN="Y">Equity</Keyword><Keyword MajorTopicYN="Y">Frontline health workers</Keyword><Keyword MajorTopicYN="Y">Maternal, newborn and child health</Keyword><Keyword MajorTopicYN="Y">Qualitative research</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>01</Month><Day>30</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>06</Month><Day>23</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>7</Month><Day>3</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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Schneider</name></country><country name="Belgique"><noRegion><name sortKey="Van Belle, Sara" sort="Van Belle, Sara" uniqKey="Van Belle S" first="Sara" last="Van Belle">Sara Van Belle</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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