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How do accountability problems lead to maternal health inequities? A review of qualitative literature from Indian public sector. / Hamal, Mukesh; Dieleman, Marjolein; De Brouwere, Vincent; de Cock Buning, Tjard.

In: Public Health Ethics, Vol. 39, 2018, blz. 9.

Onderzoeksoutput: Bijdrage aan tijdschriftA1: Web of Science-artikel

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@article{bf99706754ab41b180bd652d27652b04,
title = "How do accountability problems lead to maternal health inequities? A review of qualitative literature from Indian public sector",
abstract = "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 togetheraccountability process(in terms of standard setting, performance assessment, accountability (or answerability, and enforceability) -an ongoing cyclical feedback process at different levels of health system) anddeterminants of maternal healthto analyze the influence of the process on the determinant leading tomaternal 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.",
keywords = "Journal Article, Review",
author = "Mukesh Hamal and Marjolein Dieleman and {De Brouwere}, Vincent and {de Cock Buning}, Tjard",
year = "2018",
doi = "10.1186/s40985-018-0081-z",
language = "English",
volume = "39",
pages = "9",
journal = "Public Health Ethics",
issn = "1754-9973",
publisher = "OXFORD UNIV PRESS",

}

RIS

TY - JOUR

T1 - How do accountability problems lead to maternal health inequities? A review of qualitative literature from Indian public sector

AU - Hamal, Mukesh

AU - Dieleman, Marjolein

AU - De Brouwere, Vincent

AU - de Cock Buning, Tjard

PY - 2018

Y1 - 2018

N2 - 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 togetheraccountability process(in terms of standard setting, performance assessment, accountability (or answerability, and enforceability) -an ongoing cyclical feedback process at different levels of health system) anddeterminants of maternal healthto analyze the influence of the process on the determinant leading tomaternal 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.

AB - 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 togetheraccountability process(in terms of standard setting, performance assessment, accountability (or answerability, and enforceability) -an ongoing cyclical feedback process at different levels of health system) anddeterminants of maternal healthto analyze the influence of the process on the determinant leading tomaternal 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.

KW - Journal Article

KW - Review

U2 - 10.1186/s40985-018-0081-z

DO - 10.1186/s40985-018-0081-z

M3 - A1: Web of Science-article

C2 - 29568671

VL - 39

SP - 9

JO - Public Health Ethics

JF - Public Health Ethics

SN - 1754-9973

ER -

ID: 2303610