Accountability in Health Services Transforming Relationships and Contexts

Asha George Working Paper Series Volume 13 Number 1 February 2003 Harvard Center for Population and Development Studies

 Accountability mechanisms ideally mediate relationships between two unequal partners with the aim of redressing the imbalances between them. In order to do this accountability measures must contest power relations, legitimise marginalised groups, and transform the actors involved. These elements endear accountability to people at the margins of society and to health issues marked by social inequalities and stigma, thus making it particularly useful to sexual and reproductive health, but also to other areas like mental health and disability

An emphasis on information, dialogue, and negotiation can ground this approach to accountability within efforts to improve health service delivery. I review case studies that highlight these elements and conclude that efforts to improve accountability cannot just rely on instituting asocial mechanisms. They must support iterative processes and constructive relationships that together transform their social contexts. Here in lie their limitations but also their dynamic power.

Pendahuluan
Kebijakan yang responsif Pelayanan efektif

Mekanisme akuntabilitas : a. Consumer charter b. Hospital board c. Village health commiteess d. Publicity and advocacy campaign

Information disseminatio n Monitoring Mediation And peer pressure

Why is accountability is needed

Corruption Overwhelming staff vacancies Poor infrastructure Government sometimes may not be able to improve services Community based organisation may fail to access government services Acc ideally aims to support collaborative solutions

Tantangan dalam melakukan kolaborasi

1. 2. 3. 4. 5. Confronting power Representation Trnasforming actors Information Dialog and negotiation

Confronting power
Critical function of acc : to control arbitrary use of power by those who wield it Schedler : Acc == answerability and enforceability

Representation
=Consultation Accountability measures are therefore not just an accounting process between two unequal parties, but must also create opportunities for representing and addressing previously unacknowledged and neglected concerns

Challenges to Participatory Accountability Processes

Mekanisme akuntabilitas sangat tergantung pada proses partisipasi untuk mendukung hubungan yang mentransformasi engagement dan aktor itu sendiri

Kesimpulan
Lebih banyak penelitian yang dilakukan untuk mendokumentasikan pengalaman akuntabilitas dibidang kesehatan Perlu perhatian terhadap pengertian answerability and enforceability dalam sistem kesehatan Tantangan kuncinya adalah bagaiamana usaha partisipasi untuk menjamin akuntabilitas untuk dapat membuka blok sistem yang paling tinggi dengan birokrasi yg rigid

 Bagaiamana proses akuntabilitas dapat mendukung kontinuitas pelaksanaan pelayanan kesehatan pada area yang kurang beruntung (daerah rural) accountability mechanisms may serve as important resources to mediate relationships between users, providers, and manager

 Accountability is best achieved through negotiated, iterative processes that represent the participants involved, their relationships, and the social contexts they operate in. Here in lie their limitations but also their dynamic power.11

Penjelasan
Kertas kerja ini menjelaskan bagaiamana proses akuntabilitas dengan cara partisipatory dan memberikan contoh pada pelayanan kesehatan masyarakat. Menjelaskan bagaimana hubungan masyarakat pinggir yang kurang beruntung dan memiliki stigma sebagai user pelayanan kesehatan untuk mengevaluasi program kesehatan masyarakat serta terlibat dalam proses tersebut Pertanyaammya apakah metode partisipasi ini juga berlaku untuk di RS