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Accountability and participation in Africa
2006
Barbara Klugman
Women’s Health Project
Why the concern with accountability?
The brief for this chapter was to review current experience in Africa with health sector reforms (HSR) as they pertain to health service accountability to users. The chapter, in fact, focuses as much on participation as on accountability, on the argument that the way in which community members participate will determine whether or not health services are accountable to them.
The discourse around community participation in health that has shaped developing country policies and practice has had two sources:
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empowerment and the holistic and intersectoral conceptualisation of the primary health care (PHC) approach encapsulated in the Declaration of Alma Ata;
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the need articulated by the Washington Consensus for communities to provide resources in the context of increasing resource constraints in the 1980s and 1990s.
By 1991, 70% of the member states of the World Health Organisation (WHO) reported having mechanisms for community involvement (Shisana and Versfeld 1993).
Keywords: accountability
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