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Service accountability and community participation in the context of health sector reforms in Asia: implications for sexual and reproductive health services.

机译：亚洲卫生部门改革背景下的服务问责制和社区参与：对性健康和生殖健康服务的影响。

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This paper examines the concept and practice of community participation in World Bank-supported health sector reforms in Asia, and how far such participation has strengthened accountability with regard to provision of sexual and reproductive health (SRH) services. It argues that the envisaged scope of community participation within a majority of reforms in Asia has been limited to programme management and service delivery, and it is occurring within the boundaries of priorities that are defined through non-participatory processes. Setting up of community health structures, decentralization and community financing are three important strategies used for promoting participation and accountability within reforms. The scant evidence on the impact of these strategies suggests that marginalized groups and sexual and reproductive rights based groups are poorly represented in the forums for participation, and that hierarchies of power between and amongst health personnel and the public play out in these forums. Community financing has not lead to enhanced service accountability. As a result of the above limitations, community participation in health sector reforms has rarely strengthened accountability with respect to provision of comprehensive SRH services. In this context, rights (including sexual and reproductive) based groups and researchers need to engage with design, monitoring and evaluation of health sector reforms, both from inside as participants and outside as pressure groups. Participation contracts enhancing powers of civil society representatives, quotas for participation (for women, other marginalized groups and rights-based organizations), and investment in capacity building of these stakeholders on leadership and sexual reproductive rights and health are pre-requisites if participation is to lead to health and SRH service accountability. Community participation and service accountability hence requires more and not less investment of resources by the state.
机译：本文研究了社区参与世界银行支持的亚洲卫生部门改革的概念和实践，以及这种参与在多大程度上加强了在提供性健康和生殖健康（SRH）服务方面的责任感。它认为，在亚洲大多数改革中，社区参与的预期范围仅限于计划管理和服务提供，并且发生在通过非参与性流程定义的优先事项的范围内。建立社区卫生结构，权力下放和社区筹资是在改革中促进参与和问责制的三个重要战略。关于这些战略的影响的证据很少，表明边缘群体以及基于性权利和生殖权利的群体在参与论坛中的代表性很低，而且卫生人员与公众之间的权力等级在这些论坛中发挥着作用。社区筹资并没有增强服务责任感。由于上述局限性，社区参与卫生部门的改革很少加强关于提供全面性生殖健康和生殖健康服务的责任。在这种情况下，基于权利（包括性和生殖）的团体和研究人员需要参与设计，监测和评估卫生部门的改革，既要从内部作为参与者，也要从外部作为压力团体。参与合同必须提高公民社会代表的权力，（妇女，其他边缘化群体和基于权利的组织的）参与配额以及对这些利益相关者在领导能力，性生殖权利和健康方面的能力建设进行投资，这是参与的先决条件。导致健康和SRH服务问责制。因此，社区参与和服务责任制需要国家投入更多而不是更少的资源。

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