Influence of community dialogues on social accountability in the health system in Nairobi County, Kenya
Keywords:Community dialogue, Social accountability, Community participation, Health systems
Background: Social accountability encompasses a variety of strategies that enable citizens to express their concerns about the performance of health-care services. Community dialogues provide a forum for community engagement and participation in the health care system. However, there is little documentation on how it is used to improve social accountability within government community health structures. The purpose of this study was to determine the influence of community dialogues on social accountability in Nairobi County, Kenya.
Methods: A qualitative study was conducted that included in-depth interviews with key stakeholders purposively selected. A total of three focus group discussions with 23 participants, eight key informant interviews and document review of minutes were conducted. Data analysis was done using thematic analysis.
Results: Findings showed that community dialogues were held quarterly. The forums were mostly used for education purposes with little evidence on community engagement. Minutes showed what the community health assistant and community health volunteer said to the community with minimal input from the community members. Feedback was a challenge because the health management team hardly attended community dialogues due to logistic and workload issues.
Conclusions: There is need of practical strengthening community dialogues through use of tools like chalk board and community scorecard as advocated in the community health policy. However, in practice, these tools were hardly used resulting to missed opportunity for the community to voice their opinions on health services.
Sudhinaraset M, Treleaven E, Melo J, Singh K, Diamond-Smith N. Women’s status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory. BMC Pregnancy and Childbirth. 2016;16(1):332.
Gurung G, Derrett S, Gauld R, Hill PC. Why service users do not complain or have ‘voice’: a mixed-methods study from Nepal’s rural primary health care system. BMC Health Services Res. 2017;17(1):81.
World Health Organization. Towards people-centred health systems - an innovative approach for better health outcomes. 2008. Available at: https://www.euro.who.int/__data/assets/pdf_file/0006/186756/Towards-people-centred-health-systems-an-innovative-approach-for-better-health-outcomes.pdf. Accessed on 24 February 2022.
Sachs J. The End of Poverty: Economic Possibilities for Our Time. Eur J Dent Educ. 2008;12:17-21.
Abuya T, Ndwiga C, Ritter J, Kanya L, Bellows B, Binkin N, et al. The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya. BMC Pregnancy and Childbirth. 2015;15(1):224.
State of the World’s Cities 2010/2011- Cities for All: Bridging the Urban Divide | UN-Habitat. Available at: https://unhabitat.org/state-of-the-worlds-cities-20102011-cities-for-all-bridging-the-urban-divide. Accessed on 03 June 2022.
Lodenstein E, Mafuta E, Kpatchavi AC. Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees. BMC Health Serv Res. 2017;17(1):403.
Hamal M, Heiter K, Schoenmakers L, Servais J, Dieleman M, Broerse JEW, et al. Social Accountability in Maternal Health Services in the Far-Western Development Region in Nepal: An Exploratory Study. Int J Health Policy Manag. 2019;8(5):280-91.
Camargo CB, Jacobs E. Social Accountability and its Conceptual Challenges: An analytical framework. Conference: Accountable Governance for Development - Setting an Agenda Beyond 2015. 2013.
Svensson J, Bjorkman M. Power To The People: Evidence From A Randomized Field Experiment Of A Community-Based Monitoring Project In Uganda. The World Bank. 2007.
Afulani PA, Phillips B, Aborigo RA, Moyer CA. Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India. The Lancet Global Health. 2019;7(1):96-109.
Panday S, Bissell P, van Teijlingen E, Simkhada P. Perceived barriers to accessing Female Community Health Volunteers’ (FCHV) services among ethnic minority women in Nepal: A qualitative study. PLoS One. 2019;14(6).
George M, Pant S, Devasenapathy N, Ghosh-Jerath S, Zodpey S. Motivating and demotivating factors for community health workers: A qualitative study in urban slums of Delhi, India. WHO South-East Asia J Public Health. 2017;6(1):82.
Kenya Community Health Policy 2020-2030 - Nurturing Care Framework for Early Childhood Development. 2020. Available at: https://nurturing-care.org/kenya-community-health-policy-2020-2030/. Accessed on 03 June 2022.
Wangũi Machira Y. Integrating Social Accountability in Healthcare Delivery: Lessons Drawn from Kenya. World Bank. 2015. Available at: https://openknowledge.worldbank.org/handle/10986/21666. Accessed on 03 June 2022.
Gal I, Doron I. Informal complaints on health services: hidden patterns, hidden potentials. Int J Qual Health Care. 2007;19(3):158-63.
Kiracho EE, Namuhani N, Apolot RR. Influence of community scorecards on maternal and newborn health service delivery and utilization. Int J Equity Health. 2020;19(1):145.
Hamal M, de Cock Buning T, De Brouwere V, Bardají A, Dieleman M. How does social accountability contribute to better maternal health outcomes? A qualitative study on perceived changes with government and civil society actors in Gujarat, India. BMC Health Serv Res. 2018;18(1):653.
Mahmood SS, Rasheed S, Chowdhury AH, Hossain A, Selim MA, Hoque S, et al. Feasibility, acceptability and initial outcome of implementing community scorecard to monitor community level public health facilities: experience from rural Bangladesh. Int J Equity Health. 2020;19:155.
Munakampe MN, Nkole T, Silumbwe A, Zulu JM, Cordero JP, Steyn PS. Feasibility testing of a community dialogue approach for promoting the uptake of family planning and contraceptive services in Zambia. BMC Health Serv Res. 2020;20:728.
Martin S, Rassi C, Antonio V, Graham K, Leitão J, King R, et al. Evaluating the feasibility and acceptability of a community dialogue intervention in the prevention and control of schistosomiasis in Nampula province, Mozambique. PLoS One. 2021;16(8):e0255647.
Muhwezi WW, Palchik EA, Kiwanuka DH, Mpanga F, Mukundane M, Nanungi A, et al. Community participation to improve health services for children: a methodology for a community dialogue intervention in Uganda. Afr Health Sci. 2019;19(1):1574-81.
Oluoch-Aridi J, Smith-Oka V, Milan E, Dowd R. Exploring mistreatment of women during childbirth in a peri-urban setting in Kenya: experiences and perceptions of women and healthcare providers. Reprod Health. 2018;15(1):209.
Wegs C, Creanga AA, Galavotti C, Wamalwa E. Community Dialogue to Shift Social Norms and Enable Family Planning: An Evaluation of the Family Planning Results Initiative in Kenya. PLoS One. 2016;11(4):e0153907.
Pieterse P. Citizen feedback in a fragile setting: social accountability interventions in the primary healthcare sector in Sierra Leone. Disasters. 2019;43.
Crankshaw TL, Kriel Y, Milford C, Cordero JP, Mosery N, Steyn PS, Smit J. “As we have gathered with a common problem, so we seek a solution”: exploring the dynamics of a community dialogue process to encourage community participation in family planning/contraceptive programmes. BMC Health Services Res. 2019;19(1):710.
Butler N, Johnson G, Chiweza A, Aung KM, Quinley J, Rogers K, et al. A strategic approach to social accountability: Bwalo forums within the reproductive maternal and child health accountability ecosystem in Malawi. BMC Health Serv Res. 2020;20:568.
Altheide D. Qualitative Media Analysis. SAGE Publications, Inc. 1996;2:24-44.