Examining the links between accountability, trust and performance in health service delivery in Orumba South Local Government Area, Nigeria
Accountability in Primary Health Care (PHC) delivery services is known to be important in delivering health care to the people. However, its impact on healthcare delivery is unknown in Nigeria. This study therefore examined the effects/impacts of health facility committees (HFCs), a specific type of accountability structure, on health service delivery and resource mobilisation. It also investigated the influence of trust over the functioning of HFCs.
The study took place in the Orumba South Local Government Area (LGA) in Nigeria. The first phase of data collection involved a rapid appraisal of 25 HFCs in the LGA to assess their levels of basic functionality and to provide information for the selection of the sites for the detailed case study work. Functionality was judged according to certain criteria: gender composition of the committees; the frequency of the committees’ meetings; consistency of member attendance over time; and whether the committees kept minutes of their meetings. This information was obtained by interviewing the health officer in-charge (OIC) of the facility and the HFC chairman. After the rapid appraisal, one more functional and another less functional committee were chosen for detailed investigation of the impact of the committees and the role of trust in the functioning of the committees. The key data collection strategies included in-depth interviews with different stakeholders, focus group discussions with community members and observations of HFC meetings. Data analysis was done using Nvivo 8 software.
The results showed that the more functional HFC improved the availability of health workers in the health facility to which it was attached. Linkage with other local accountability structures, provision of infrastructure and proper information dissemination strengthened the functionality of HFCs. The leadership style of the committee chairman, support by and linkage with other community accountability structures through financial contribution, and provision of manpower for work at the health facility made the committee more functional. On the other hand, the less functional HFC experienced lack of funds for health activities. In addition, lack of remuneration for committee members, power struggles/social conflicts within the community and lack of information about the HFC contributed to its low functionality.
Furthermore, there is evidence of both interpersonal and institutional trust as a factor that underpins the relationships between the health facility committee and other stakeholders, showing that trust relationships are important elements in local accountability structures such as HFC. Efforts should also be made to remunerate the committee members, strengthen health worker motivation and resolve tensions between local authorities.