Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo: a contextual factor analysis
Abstract Background Social accountability has to be configured according to the context in which it operates. This paper aimed to identify local contextual factors in two health zones in the Democratic Republic of the Congo and discuss their possible influences on shaping, implementing and running s...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2016-11-01
|
Series: | BMC Health Services Research |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12913-016-1895-3 |
id |
doaj-d119b7eb2d9b4d5681fc7258920c23e7 |
---|---|
record_format |
Article |
spelling |
doaj-d119b7eb2d9b4d5681fc7258920c23e72020-11-24T23:43:17ZengBMCBMC Health Services Research1472-69632016-11-0116111310.1186/s12913-016-1895-3Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo: a contextual factor analysisEric M. Mafuta0Lisanne Hogema1Thérèse N. M. Mambu2Pontien B. Kiyimbi3Berthys P. Indebe4Patrick K. Kayembe5Tjard De Cock Buning6Marjolein A. Dieleman7Kinshasa School of Public Health, Faculty of Medicine, University of KinshasaAthena Institute, Faculty of Life Sciences, VU University AmsterdamKinshasa School of Public Health, Faculty of Medicine, University of KinshasaKongo Central Health Province DivisionAgence d’Achat de performancesKinshasa School of Public Health, Faculty of Medicine, University of KinshasaAthena Institute, Faculty of Life Sciences, VU University AmsterdamAthena Institute, Faculty of Life Sciences, VU University AmsterdamAbstract Background Social accountability has to be configured according to the context in which it operates. This paper aimed to identify local contextual factors in two health zones in the Democratic Republic of the Congo and discuss their possible influences on shaping, implementing and running social accountability initiatives. Methods Data on local socio-cultural characteristics, the governance context, and socio-economic conditions related to social accountability enabling factors were collected in the two health zones using semi-structured interviews and document reviews, and were analyzed using thematic analysis. Results The contexts of the two health zones were similar and characterized by the existence of several community groups, similarly structured and using similar decision-making processes. They were not involved in the health sector’s activities and had no link with the health committee, even though they acknowledged its existence. They were not networked as they focused on their own activities and did not have enough capacity in terms of social mobilization or exerting pressure on public authorities or providers. Women were not perceived as marginalized as they often occupied other positions in the community besides carrying out domestic tasks and participated in community groups. However, they were still subject to the local male dominance culture, which restrains their involvement in decision-making, as they tend to be less educated, unemployed and suffer from a lack of resources or specific skills. The socio-economic context is characterized by subsistence activities and a low employment rate, which limits the community members’ incomes and increases their dependence on external support. The governance context was characterized by imperfect implementation of political decentralization. Community groups advocating community rights are identified as “political” and are not welcomed. The community groups seemed not to be interested in the health center’s information and had no access to media as it is non-existent. Conclusions The local contexts in the two health zones seemed not to be supportive of the operation of social accountability initiatives. However, they offer starting points for social accountability initiatives if better use is made of existing contextual factors, for instance by making community groups work together and improving their capacities in terms of knowledge and information.http://link.springer.com/article/10.1186/s12913-016-1895-3Context analysisCommunity participationSocial accountabilityDRCHealth committeeCommunity groups |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Eric M. Mafuta Lisanne Hogema Thérèse N. M. Mambu Pontien B. Kiyimbi Berthys P. Indebe Patrick K. Kayembe Tjard De Cock Buning Marjolein A. Dieleman |
spellingShingle |
Eric M. Mafuta Lisanne Hogema Thérèse N. M. Mambu Pontien B. Kiyimbi Berthys P. Indebe Patrick K. Kayembe Tjard De Cock Buning Marjolein A. Dieleman Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo: a contextual factor analysis BMC Health Services Research Context analysis Community participation Social accountability DRC Health committee Community groups |
author_facet |
Eric M. Mafuta Lisanne Hogema Thérèse N. M. Mambu Pontien B. Kiyimbi Berthys P. Indebe Patrick K. Kayembe Tjard De Cock Buning Marjolein A. Dieleman |
author_sort |
Eric M. Mafuta |
title |
Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo: a contextual factor analysis |
title_short |
Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo: a contextual factor analysis |
title_full |
Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo: a contextual factor analysis |
title_fullStr |
Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo: a contextual factor analysis |
title_full_unstemmed |
Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo: a contextual factor analysis |
title_sort |
understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural democratic republic of the congo: a contextual factor analysis |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2016-11-01 |
description |
Abstract Background Social accountability has to be configured according to the context in which it operates. This paper aimed to identify local contextual factors in two health zones in the Democratic Republic of the Congo and discuss their possible influences on shaping, implementing and running social accountability initiatives. Methods Data on local socio-cultural characteristics, the governance context, and socio-economic conditions related to social accountability enabling factors were collected in the two health zones using semi-structured interviews and document reviews, and were analyzed using thematic analysis. Results The contexts of the two health zones were similar and characterized by the existence of several community groups, similarly structured and using similar decision-making processes. They were not involved in the health sector’s activities and had no link with the health committee, even though they acknowledged its existence. They were not networked as they focused on their own activities and did not have enough capacity in terms of social mobilization or exerting pressure on public authorities or providers. Women were not perceived as marginalized as they often occupied other positions in the community besides carrying out domestic tasks and participated in community groups. However, they were still subject to the local male dominance culture, which restrains their involvement in decision-making, as they tend to be less educated, unemployed and suffer from a lack of resources or specific skills. The socio-economic context is characterized by subsistence activities and a low employment rate, which limits the community members’ incomes and increases their dependence on external support. The governance context was characterized by imperfect implementation of political decentralization. Community groups advocating community rights are identified as “political” and are not welcomed. The community groups seemed not to be interested in the health center’s information and had no access to media as it is non-existent. Conclusions The local contexts in the two health zones seemed not to be supportive of the operation of social accountability initiatives. However, they offer starting points for social accountability initiatives if better use is made of existing contextual factors, for instance by making community groups work together and improving their capacities in terms of knowledge and information. |
topic |
Context analysis Community participation Social accountability DRC Health committee Community groups |
url |
http://link.springer.com/article/10.1186/s12913-016-1895-3 |
work_keys_str_mv |
AT ericmmafuta understandingthelocalcontextanditspossibleinfluencesonshapingimplementingandrunningsocialaccountabilityinitiativesformaternalhealthservicesinruraldemocraticrepublicofthecongoacontextualfactoranalysis AT lisannehogema understandingthelocalcontextanditspossibleinfluencesonshapingimplementingandrunningsocialaccountabilityinitiativesformaternalhealthservicesinruraldemocraticrepublicofthecongoacontextualfactoranalysis AT theresenmmambu understandingthelocalcontextanditspossibleinfluencesonshapingimplementingandrunningsocialaccountabilityinitiativesformaternalhealthservicesinruraldemocraticrepublicofthecongoacontextualfactoranalysis AT pontienbkiyimbi understandingthelocalcontextanditspossibleinfluencesonshapingimplementingandrunningsocialaccountabilityinitiativesformaternalhealthservicesinruraldemocraticrepublicofthecongoacontextualfactoranalysis AT berthyspindebe understandingthelocalcontextanditspossibleinfluencesonshapingimplementingandrunningsocialaccountabilityinitiativesformaternalhealthservicesinruraldemocraticrepublicofthecongoacontextualfactoranalysis AT patrickkkayembe understandingthelocalcontextanditspossibleinfluencesonshapingimplementingandrunningsocialaccountabilityinitiativesformaternalhealthservicesinruraldemocraticrepublicofthecongoacontextualfactoranalysis AT tjarddecockbuning understandingthelocalcontextanditspossibleinfluencesonshapingimplementingandrunningsocialaccountabilityinitiativesformaternalhealthservicesinruraldemocraticrepublicofthecongoacontextualfactoranalysis AT marjoleinadieleman understandingthelocalcontextanditspossibleinfluencesonshapingimplementingandrunningsocialaccountabilityinitiativesformaternalhealthservicesinruraldemocraticrepublicofthecongoacontextualfactoranalysis |
_version_ |
1725502184051703808 |