Accountability represents an under-explored terms lies at the core of any effort to improve quality, build team, and get results Accountability acknowledges the reality of situation (perceives, sees and relate to it) and accepts the responsibility for the situation, finds and implements creative solutions to problems (solves it), and exhibit the commitment and the courage needed to follow through (does it).
Equitable health care is an integral part of the health system, and the accountability in health care is directly related to the level of the safety and the quality of care a patient receives and that same quality of care is directly related to the success of a health care. In health care, improving the quality of life for a patient is the ultimate goal: no patient to treat means, no health business to run.
Accountability and Health Systems
The accountability of health systems is complex with multiple accountability relationships. Health system users, health ministers, social health insurance agencies, public and health providers, legislature, finance ministers and regulatory agencies are all connected to each other in networks of control, oversight cooperation and reporting.
For example, for countries wishing to work to strengthen their system accountability, the starting point is understanding how existing health accountability mechanism work in practise before moving to identifying problem areas and appropriate reform strategies and accountability instruments. Key policy questions for consideration are likely to include how best to:
- Increase transparency and access information to address information asymmetries;
- Establish reliable ground rules for various accountable relationships;
- Effectively monitor and control accountability requirements;
- Improve access to resources where accountability obligations are not met;
- Better articulate the needs of those to whom duties are owned.
Elements of Accountability
Accountability involves following key elements:
- Delimitation of responsibility: defining over what, whom and how they duty holders are responsible for their action.
- Answerability: the obligation for duty holders to inform about and explain their actions. Accountability as answerability aims at creating transparency. It relies on information dissemination and the establishment of adequate monitoring and oversight mechanisms.
- Enforcement or the capacity to subject power to the threat of sanctions, or disciplinary actions. Legal and regulatory sanctions are at the core of enforcing accountability.
Accountability Types and Health Service Delivery
- Financial: 1) cost accounting /budgeting (personnel, operation, pharmaceuticals); definition of basic benefits packages; contract oversight.
- Performance: 1) allocation of resources needed for effective system performance; 2) quality of care; 3) service product behavior; 4) regulation by professional bodies; 5) contacting unit.
- Political/democratic: 1) service delivery; 2) transparency; 3) responsiveness to citizens; 4) service user trust; 5) dispute resolution.
Purpose of Accountability
Dominant purposes of accountability are:
- Control and assurance are dominant.
- Focus is on compliance with prescribed input and procedural standards; cost controls; resource efficiency measures; elimination of wastes; fraud and corruption.
- Assurance and improvement/learning are dominant.
- Assurance purpose emphasizes adherence to the legal, regulatory, and policy framework; professional service delivery procedures, norms and values; and quality of care standards and audits.
- Improvement/learning purpose focuses on benchmarking, standard setting quality management, operations research, monitoring and evaluation(M&E).
- Control and assurance purpose are emphasized.
- Control relates to citizen/voter satisfaction, use of taxpayer funds, addressing market failure and distribution of services (disadvantaged populations).
- Assurance focuses on principal agent dynamic for oversight; availability and dissemination of relevant information; adherence to quality standards, professional norms, and societal values.
To bring about accessible and better quality health care, it is important to recognize both the value and complexity of accountability interventions and operate accordingly. Accountability for the project and to the people is both desirable and essential. Ensuring this accountability is arguably one of the greatest challenges that face up to the health care sector. To reach every nook and the corner of the system, the accountability needs to take root and procedures need to be built into the system. However, the question arises that how accountability can be achieved in the days to come and who will be held responsible if desired and essential results are not achieved. To achieve the results greater transparency and resultant public scrutiny in every aspect of the project and its management are needed.