부산대학교 도서관

Globally, women's access to modern contraception can be attributed to poor service conditions and care. Growing evidence from across the health sector has found that social accountability approaches have the potential to improve the quality of care and therefore the utilization of health services, little of this evidence relates to family planning and reproductive health programs. This paper therefore assessed the results of retrospective implementation research into a five-year social accountability project in Uganda that focused on family planning and reproductive health. A mix of methods was used examine the project's implementation in three districts in Uganda between 2009 to 2013, including political economy analysis, document review, and in-depth interviews. Interviews were coded using ATLAS.ti software and analyzed with a thematic framework, organized by stakeholder groups and across districts. The research found that while the project broadly delivered as intended in local accounts, a wider range of activities and outcomes also occurred. Community participants in the three districts were much more likely to remember more personal changes, such as increased confidence when interacting with health care providers, in their health seeking behavior or in their ability to represent themselves. The research revealed a web of accountability relationships at play. These ranged from formal opportunities for community participation in institutional processes, to the more personal direct relationship between the service users and the health care provider compared to the less direct relationship between the community and local officials. In addition, ways in which elements of social accountability can be combined with features of FP program were seen, such as including outreach activities with civic and rights education. This appears to extend the reach and credibility of these services among community members while also counteracting barriers to women's and young people's participation. (Afr J Reprod Health 2018; 22[1]: 73-84). Keywords: social accountability, family planning, reproductive health, implementation science Resume Globalement, l'acces des femmes a la contraception moderne peut etre attribue a de mauvaises conditions de service et de soins. Des preuves croissantes provenant de l'ensemble du secteur de la sante ont montre que les activites de responsabilisation sociale peuvent ameliorer la qualite des soins et donc l'utilisation des services de sante, peu de ces preuves concernent les programmes de planification familiale et de sante de la reproduction. Cet article a donc evalue les resultats de la recherche retrospective sur la mise en oeuvre dans un projet quinquennal de responsabilite sociale en Ouganda axe sur le plan familial la sante de la reproduction. Une combinaison de methodes a ete utilisee pour examiner la mise en oeuvre du projet dans trois districts de l'Ouganda entre 2009 et 2013, y compris l'analyse de l'economie politique, l'examen des documents et des entretiens approfondis. Les entrevues ont ete codees a l'aide du logiciel ATLAS.ti et analysees a l'aide d'un cadre thematique, organise par des groupes d'intervenants et d'un district a l'autre. La recherche a revele que, meme si le projet s'est deroule comme prevu dans les comptes locaux, un plus grand eventail d'activites et de resultats s'est egalement produit. Les participants de la communaute dans les trois districts etaient beaucoup plus susceptibles de se souvenir de plus des changements personnels, comme une confiance accrue lorsqu'ils interagissent avec les fournisseurs de soins de sante, dans leur comportement de recherche de sante ou dans leur capacite a se representer. La recherche a revele un reseau de relations de responsabilisation en jeu. Celles-ci allaient des opportunites formelles de participation communautaire aux processus institutionnels a la relation directe plus personnelle entre les utilisateurs de services et le fournisseur de soins de sante par rapport a la relation moins directe entre la communaute et les autorites locales. En outre, des moyens de combiner des elements de responsabilite sociale avec les caracteristiques du programme de PF ont ete envisages, notamment des activites de sensibilisation a l'education civique et aux droits. Cela semble etendre la portee et la credibilite de ces services parmi les membres de la communaute tout en neutralisant les obstacles a la participation des femmes et des jeunes. (Afr J Reprod Health 2018; 22[1]: 73-84). Mots-cles: responsabilite sociale, planification familiale, sante de la reproduction, science de la mise en oeuvre
Introduction Unmet need for contraception remains high among women who are sexually active and want to avoid becoming pregnant (1).Unmet need affects an estimated 225 million women in the developing [...]