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Table 1 Examples of accountability mechanisms and their functioning

From: Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings

Type of mechanism

Example of functioning

Link to citizen responsiveness

Internal accountability

Human resource management

Regular performance appraisals between line managers and staff seek to evaluate the extent to which staff are meeting key performance areas. They also draw attention to the necessary competencies, behaviours and practices of staff needed to achieve agreed targets.

Indirect

Budgeting, planning, priority setting, target setting

Annual health care plans, based on an assessment of local needs, are used to guide resource allocation processes to districts and within districts; budget is allocated and targets are set; facilities report back to the district management on the extent to which targets have been met.

Indirect

External accountability

Clinic committees

A forum for hearing local needs is provided. Information is exchanged and citizen or patient questions or complaints can be answered. Information on local needs is fed into priority setting processes.

Direct

Provider report cards

Patients rate the quality of care at facilities; information is provided to citizens about facility quality of care; information is provided to district management teams about where improvements/ commendations are merited.

Direct

Complaints boxes

Patients give input into service aspects needing improvement. Staff are sensitised to patient perspectives.

Direct