La perspectiva de la comunidad sobre la responsabilidad social en el sistema de salud: un estudio transversal de Tanzania
Barra lateral del artículo
Contenido principal del artículo
Resumen
Introducción: Las iniciativas de responsabilidad social son una estrategia para abordar las ineficiencias y mejorar el desempeño del sistema de salud. Tanzania ha implementado los Comités de Gobierno de los Centros Sanitarios (CGCS) para reforzar esta responsabilidad social. No obstante, falta información sobre la percepción comunitaria de estos Comités. Este estudio buscó evaluar la prevalencia y los factores sociales que influyen en la responsabilidad de los CGCS desde la perspectiva comunitaria en Tanzania.
Métodos: La investigación utilizó una encuesta transversal en dos distritos tanzanos (Handeni y Mbarali) seleccionados por sus diferencias de rendimiento. La recopilación de datos se llevó a cabo entre julio y octubre de 2022, abarcando 1,184 hogares de 31 aldeas/vecindarios. El estudio midió la responsabilidad social a través de seis preguntas que abordan el apoyo comunitario, la sensibilización, la retroalimentación, la confianza, el compromiso y la responsabilidad general de los CGCS. Además, se recogieron datos sociodemográficos (sexo, edad, educación, ocupación, tipo de centro de salud y distrito) que se analizaron mediante regresión lineal para identificar los factores que influyen en la percepción de responsabilidad.
Resultados: Los resultados mostraron una baja prevalencia de responsabilidad social, particularmente en las variables de concienciación y compromiso de la comunidad hacia los CGCS. Solo un pequeño porcentaje de los encuestados se sentía adecuadamente informado o involucrado en las actividades de estos Comités. Factores como un mayor nivel educativo, determinadas ocupaciones (tener un negocio o estar jubilado) y vivir en el distrito de Handeni se correlacionaron positivamente con una percepción más favorable de la responsabilidad social.
Conclusiones: El estudio resalta importantes desafíos en la eficacia operativa de los CGCS en Tanzania, mostrando una desconexión entre estos comités y las comunidades que atienden. A pesar del marco teórico de responsabilidad social, la participación comunitaria sigue siendo limitada, lo que afecta la eficacia de la gobernanza sanitaria a nivel local. Futuros estudios deberían enfocarse en fortalecer la sensibilización y participación comunitaria en estos comités, alineándose con los objetivos de salud nacionales y necesidades locales.
Detalles del artículo
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Authors of content published in JCSH retain the copyright to their works.
Citas
Naher N, Balabanova D, Hutchinson E, Marten R, Hoque R, Tune SNBK, et al. Do social accountability approaches work? A review of the literature from selected low- and middle-income countries in the WHO South-East Asia region. Health Policy Plan. 2020 Nov 9;35(Suppl 1):i76–96.
Danhoundo G, Nasiri K, Wiktorowicz ME. Improving social accountability processes in the health sector in sub-Saharan Africa: a systematic review. BMC Public Health. 2018 Apr 13;18:497.
Molyneux S, Atela M, Angwenyi V, Goodman C. Community accountability at peripheral health facilities: a review of the empirical literature and development of a conceptual framework. Health Policy Plan. 2012 Oct;27(7):541–54.
Dwicaksono A, Fox AM. Does decentralization improve health system performance and outcomes in low‐ and middle‐income countries? A systematic review of evidence from quantitative studies. Milbank Q. 2018 Jun;96(2):323–68.
World Health Organization, Organisation for Economic Co-operation and Development, International Bank for Reconstruction and Development. Delivering quality health services: a global imperative for universal health coverage [Internet]. Geneva: World Health Organization; 2018 [cited 2023 Nov 10]. 93 p. Available from: https://iris.who.int/handle/10665/272465
Kesale AM, Mahonge C, Muhanga M. The quest for accountability of Health Facility Governing Committees implementing Direct Health Facility Financing in Tanzania: A supply-side experience. Mordaunt DA, editor. PLoS One. 2022 Apr 28;17(4):e0267708.
Boydell V, McMullen H, Cordero J, Steyn P, Kiare J. Studying social accountability in the context of health system strengthening: innovations and considerations for future work. Health Res Policy Syst. 2019 Mar 29;17(1):34.
Joshi A. Legal Empowerment and Social Accountability: Complementary Strategies Toward Rights-based Development in Health? World Dev. 2017 Nov;99:160–72.
Sirili N, Kiwara A, Gasto F, Goicolea I, Hurtig AK. Training and deployment of medical doctors in Tanzania post-1990s health sector reforms: assessing the achievements. Hum Resour Health. 2017 Dec;15(1):27.
Maluka SO, Bukagile G. Community participation in the decentralised district health systems in Tanzania: why do some health committees perform better than others? Int J Health Plann Manage. 2016 Apr;31(2):E86–104.
George AS, Mehra V, Scott K, Sriram V. Community participation in health systems research: A systematic review assessing the state of research, the nature of interventions involved and the features of engagement with communities. PLoS One. 2015 Oct 23;10(10):e0141091.
Kesale A, Mahonge C, Muhanga M. The Functionality of Health Facility Governing Committees and Their Associated Factors in Selected Primary Health Facilities Implementing Direct Health Facility Financing in Tanzania [Internet]. In Review; 2022 Jan [cited 2023 Oct 18]. Available from: https://www.researchsquare.com/article/rs-1092885/v1
Maluka SO. Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania. Glob Health Action. 2011;4.
Kinyenje ES, Yahya TA, Hokororo JC, Eliakimu ES, Mohamed MA, Degeh MM, et al. Social accountability in primary health care facilities in Tanzania: Results from Star Rating Assessment. Augusto O, editor. PLoS One. 2022 Jul 25;17(7):e0268405.
Kesale AM, Mahonge C, Muhanga M. Effects of decentralization on the functionality of health facility governing committees in lower and middle-income countries: a systematic literature review. Glob Health Action. 15(1):2074662.
Kraft JM, Paina L, Boydell V, Elnakib S, Sihotang A, Bailey A, et al. Social Accountability Reporting for Research (SAR4Research): checklist to strengthen reporting on studies on social accountability in the literature. Int J Equity Health. 2022 Aug 30;21(1):121.
Marston C, McGowan CR, Boydell V, Steyn P. Methods to measure effects of social accountability interventions in reproductive, maternal, newborn, child, and adolescent health programs: systematic review and critique. J Health Popul Nutr. 2020 Dec 7;39(1):13.
Maluka S, Kamuzora P, San Sebastiån M, Byskov J, Olsen ØE, Shayo E, et al. Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework. Soc Sci Med. 2010 Aug;71(4):751–9.
Mukasa O, Masanja H, DeSavigny D, Schellenberg J. A cohort study of survival following discharge from hospital in rural Tanzanian children using linked data of admissions with community-based demographic surveillance. Emerg Themes Epidemiol. 2021 Dec;18(1):4.
Tanzania National Bureau of Statistics and President’s Office - Finance and Planning, Presidents’ Office - Finance and Planning Office of the Chief Government Statistician Zanzibar. The 2022 Population and Housing Census: Administrative Units Population Distribution Report. 2022 [cited 2023 Oct 5]. Administrative_units_Population_Distribution_Report_Tanzania_volume1a.pdf. Available from: https://www.nbs.go.tz/nbs/takwimu/Census2022/Administrative_units_Population_Distribution_Report_Tanzania_volume1a.pdf
Department of Development Studies, College of Social Sciences and Humanities, Sokoine University of Agriculture, Ringo JJ, Bengesi KMK, Department of Policy Planning and Management, College of Social Sciences and Humanities, Sokoine University of Agriculture, Mbago MCY, Department of Statistics, University of Dar es Salaam. Access and Challenges of Health Facilities amongst Agro-pastoralist Communities in Handeni District, Tanzania. J Popul Soc Stud. 2017 Dec 27;26(1):53–67.
Kesale A, Mahonge C, Muhanga M. The determinants of the performance of health facility governing committees (HFGC) in selected primary health facilities in Tanzania. Tanzania J Community Develop. 2021 Nov 18;1:53–66.
Oyeyemi AI, Gberevbie DE, Ibietan J. Citizens participation and primary healthcare policy implementation in Ogun State, Nigeria: An empirical and systems enquiry. Humanit Soc Sci Lett. 2021;9(1):50–7.
Ageing and health [Internet]. [cited 2023 Dec 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health