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首页> 美国卫生研究院文献>Health Policy and Planning >From favours to entitlements: community voice and action and health service quality in Zambia
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From favours to entitlements: community voice and action and health service quality in Zambia

机译：从恩惠到应享权利：赞比亚的社区声音和行动以及卫生服务质量

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Social accountability is increasingly invoked as a way of improving health services. This article presents a theory-driven qualitative study of the context, mechanisms and outcomes of a social accountability program, Citizen Voice and Action (CVA), implemented by World Vision (WV) in Zambia. Primary data were collected between November 2013 and January 2014. It included in-depth interviews and focus group discussions with program stakeholders. Secondary data were used iteratively—to inform the process for primary data collection, to guide primary data analysis and to contextualize findings from the primary data. CVA positively impacted the state, society, state–society relations and development coordination at the local level. Specifically, sustained improvements in some aspects of health system responsiveness, empowered citizens, the improved provision of public goods (health services) and increased consensus on development issues appeared to flow from CVA. The central challenge described by interviewees and FGD participants was the inability of CVA to address problems that required central level input. The mechanisms that generated these outcomes included productive state–society communication, enhanced trust, and state–society co-production of priorities and the provision of services. These mechanisms were activated in the context of existing structures for state–society interaction, willing political leaders, buy-in by traditional leaders, and WV’s strong reputation and access to resources. Prospective observational research in multiple contexts would shed more light on the context, mechanisms and outcomes of CVA programs. In addition to findings that are intuitive and well supported in the literature we identified new areas that are promising areas for future research. These include (1) the context of organizational reputation by the organization(s) spearheading social accountability efforts; (2) the potential relationship between social accountability efforts and making ambitious national programs operational at the frontlines of the health system and (3) the feasibility of scale up for certain types of local level responsiveness.
机译：人们越来越多地要求社会责任作为改善卫生服务的一种方式。本文对由赞比亚世界宣明会（WV）实施的社会责任计划公民呼声与行动（CVA）的背景，机制和结果进行了理论驱动的定性研究。在2013年11月至2014年1月之间收集了主要数据，其中包括与计划利益相关者的深入访谈和焦点小组讨论。迭代地使用了辅助数据，以告知主要数据收集过程，指导主要数据分析并根据主要数据得出的结果。 CVA对地方的国家，社会，国家社会关系和发展协调产生了积极影响。具体而言，CVA似乎在持续改进卫生系统的响应能力，增强公民权能，改善公共产品（卫生服务）的提供以及对发展问题的共识。受访者和FGD参与者描述的主要挑战是CVA无法解决需要中央层面投入的问题。产生这些结果的机制包括生产性国家与社会之间的沟通，增强的信任以及国家与社会共同生产优先事项和提供服务。这些机制是在国家与社会互动的现有结构，愿意的政治领导人，传统领导人的支持以及WV强大的声誉和获取资源的背景下激活的。在多种情况下的前瞻性观察研究将为CVA计划的背景，机制和结果提供更多的启示。除了文献中直观且得到充分支持的发现，我们还确定了新的领域，这些领域是未来研究的有希望的领域。其中包括：（1）领导社会责任工作的组织在组织声誉方面的背景； （2）社会责任工作与使雄心勃勃的国家计划在卫生系统的一线运作之间的潜在关系，以及（3）扩大某些类型的地方级响应能力的可行性。

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