Frontline health workers, working conditions and social accountability

Themes | Subthemes | Tags:  Health care system; accountability | Health Human resources
Duration: November 2018 onwards
Team:  A civil society network initiative. Sunita Sheel (2018 onwards) contributes to this work and represents FMES.
Funding support:  None
Product/s delivered and expected:

Overview:  There have been some efforts to ensure a level of continuity in the discourses around health care for the poor through a focus on approaches like Universal Health Coverage, Universal Access to Health Care, MDGs and SDGs. However, despite these advances alienation of communities has continued and governments with their eye on commercial interests have pursued policies that are undermining the gains of the Alma Ata.  Further, States have not enough to ensure citizens participation in planning, budgeting, implementation and oversight of the health services resulting in real needs and priorities of citizens especially poor and vulnerable communities being left out.  In health systems, social accountability implies that political and governmental actors, including public service providers, are held to account for their actions and decisions by citizens. The notions of transparency, participation and accountability are closely linked to the idea and processes of social accountability emphasised by different approaches to accountability.  In this initiative, we focus on health care workers (HCWs), their engagement with the state on one hand and with the communities they serve, on the other hand.  The objectives are two-fold. (a) To locate them in the system characterized by power hierarchies.; (b) To appreciate the ongoing efforts and strategies of HCWs [including  Auxiliary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs) and other community-level health workers (CHWs)] while demanding accountability from the state and to provide HCWs with all the support needed to help deliver on their commitments to communities by building and maintaining trust based relationships with communities. The underlying philosophy is to enable HCWs to be the change agents, rather than mere service providers.

Past contributions:

  • Iyer, Aditi; & Jesani, Amar. Barriers to the Quality of Care: The Experience of Auxiliary Nurse-Midwives in Rural Maharashtra. : In Improving Quality of Care in India’s Family Welfare Programme edited by Michael A. Koenig and M.E. Khan. Population Council. 1999. p.210-237. ISBN 0-87834-099-8.