Títol:
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How do accountability problems lead to maternal health
inequities? A review of qualitative literature from Indian
public sector
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Autor/a:
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Hamal, Mukesh; Dieleman, Marjolein; Brouwere, Vincent De; Cock Buning, Tjard de
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Abstract:
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Background: There are several studies from different
geographical settings and levels on maternal health, but none
analyzes how accountability problems may contribute to the
maternal health outcomes. This study aimed to analyze how
accountability problems in public health system lead to maternal
deaths and inequities in India. Methods: A conceptual framework
was developed bringing together accountability process (in terms
of standard setting, performance assessment, accountability (or
answerability, and enforceability) -an ongoing cyclical feedback
process at different levels of health system) and determinants
of maternal health to analyze the influence of the process on
the determinant leading to maternal health outcomes. A scoping
review of qualitative and mixed-methods studies from public
health sector in India was conducted. A narrative and
interpretive synthesis approach was applied to analyze data.
Results: An overarching influence of health system-related
factors over non-health system-related factors leading to
maternal deaths and inequities was observed. A potential link
among such factors was identified with gaps in accountability
functions at all levels of health system pertaining to policy
gaps or conflicting/discriminatory policies and political
commitment. A large number of gaps were also observed concerning
performance or implementation of existing standards. Inherent to
these issues was potentially a lack of proper monitoring and
accountability functions. A critical role of power was observed
influencing the accountability functions. Conclusion: The
narrative and interpretive synthesis approach allowed to
integrate and reframe the relevant comparable information from
the limited empirical studies to identify the hot spots of
systemic flaws from an accountability perspective. The framework
highlighted problems in health system beyond health service
delivery to wider areas such as policy or politics justifying
their relevance and importance in such analysis. A crucial
message from the study pertains to a need to move away from the
traditional concept of viewing accountability as a blame-game
approach and a concern of limited frontline health workers
towards a constructive and systemic approach. |
Matèries:
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-Serveis de salut maternal -Índia -Maternal health services -India |
Drets:
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cc by (c) Hamal et al., 2018
http://creativecommons.org/licenses/by/3.0/es/ |
Tipus de document:
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Article Article - Versió publicada |
Publicat per:
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BioMed Central
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Compartir:
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