© Oxford University Press, 2004; all rights reserved
Service accountability and community participation in the context of health sector reforms in Asia: implications for sexual and reproductive health services
1 Independent Researcher, Adyar, Chennai, India
2 Ford Foundation, New York, USA
Correspondence: Ranjani K Murthy, 16 Srinivasamurthi Avenue, Adyar, Chennai – 600 020, India. Tel: + 91 44 2491 5429; fax: + 91 44 2490 0440; email: rk_km2000{at}yahoo.com or ranjani{at}hathway.com
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.
Key Words: community participation, accountability, health sector reforms, sexual and reproductive health, health services, World Bank, Asia
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  B. Jacobs, J.-M. Thome, R. Overtoom, S. O. Sam, L. Indermuhle, and N. Price From public to private and back again: sustaining a high service-delivery level during transition of management authority: a Cambodia case study Health Policy Plan., November 16, 2009; (2009) czp049v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Kamuzora and L. Gilson Factors influencing implementation of the Community Health Fund in Tanzania Health Policy Plan., March 1, 2007; 22(2): 95 - 102. [Abstract] [Full Text] [PDF]
|
|