02920nas a2200265   4500000000100000008004100001653002600042653001900068653001900087653003700106653002000143653001800163653002100181653002600202100001700228700001500245700001600260700001500276245012700291856009000418300000900508490000700517520211600524022001402640       2016                            d10aSocial accountability10aResponsiveness10aRealist review10aLow- and middle-income countries10aHealth Services10aHealth rights10aHealth providers10aCitizen participation1 aLodenstein E1 aDieleman M1 aGerretsen B1 aBroerse JE00aHealth provider responsiveness to social accountability initiatives in low- and middle-income countries: a realist review.  uhttp://heapol.oxfordjournals.org/content/early/2016/07/03/heapol.czw089.full.pdf+html  a1-160 v313 a<p>Social accountability in the health sector has been promoted as a strategy to improve the quality and performance of health providers in low- and middle-income countries. Whether improvements occur, however, depends on the willingness and ability of health providers to respond to societal pressure for better care. This article uses a realist approach to review cases of collective citizen action and advocacy with the aim to identify key mechanisms of provider responsiveness. Purposeful searches for cases were combined with a systematic search in four databases. To be included in the review, the initiatives needed to describe at least one outcome at the level of frontline service provision. Some 37 social accountability initiatives in 15 countries met these criteria. Using a realist approach, retroductive analysis and triangulation of methods and sources were performed to construct Context-Mechanism-Outcome configurations that explain potential pathways to provider responsiveness. The findings suggest that health provider receptivity to citizens' demands for better health care is mediated by health providers' perceptions of the legitimacy of citizen groups and by the extent to which citizen groups provide personal and professional support to health providers. Some citizen groups activated political or formal bureaucratic accountability channels but the effect on provider responsiveness of such strategies was more mixed. Favourable contexts for health provider responsiveness comprise socio-political contexts in which providers self-identify as activists, health system contexts in which health providers depend on citizens' expertise and capacities, and health system contexts where providers have the self-perceived ability to change the system in which they operate. Rather than providing recipes for successful social accountability initiatives, the synthesis proposes a programme theory that can support reflections on the theories of change underpinning social accountability initiatives and interventions to improve the quality of primary health care in different settings.</p>
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