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Table 1 Examples of accountability mechanisms and their functioning

From: Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings

Type of mechanism Example of functioning Link to citizen responsiveness
Internal accountability
Human resource management Regular performance appraisals between line managers and staff seek to evaluate the extent to which staff are meeting key performance areas. They also draw attention to the necessary competencies, behaviours and practices of staff needed to achieve agreed targets. Indirect
Budgeting, planning, priority setting, target setting Annual health care plans, based on an assessment of local needs, are used to guide resource allocation processes to districts and within districts; budget is allocated and targets are set; facilities report back to the district management on the extent to which targets have been met. Indirect
External accountability
Clinic committees A forum for hearing local needs is provided. Information is exchanged and citizen or patient questions or complaints can be answered. Information on local needs is fed into priority setting processes. Direct
Provider report cards Patients rate the quality of care at facilities; information is provided to citizens about facility quality of care; information is provided to district management teams about where improvements/ commendations are merited. Direct
Complaints boxes Patients give input into service aspects needing improvement. Staff are sensitised to patient perspectives. Direct