Strengthening Social Accountability Process in Community Health Systems: Exploring the Role Of Community Actors in Africa and South Asia: Systematic Review

Abstract

Background: Despite a growing body of literature on social accountability in health systems, many questions remain unanswered about how community actors interact with health workers and demand accountability. Social accountability is viewed as an empowerment process and a social practice in which communities actively participate in changing the conditions that affect their health. Local factors, such as the role of community actors, influence the effectiveness of social accountability. The purpose of this research was to assess empirical evidence on the role of community actors in social accountability. Methods: Electronic searches were conducted for eligible studies within each of the Pubmed, Medline, Google Scholar and SciELO databases from 2012 to January 2022. Peer-reviewed English language publications describing a social accountability mechanism with a focus on the role of community actors in Africa and South Asia were eligible for inclusion. There were no restrictions on the research design. Results: The review included eleven relevant studies. According to the findings, community actors include Community Health Workers, Health Facility Committees, Community Elected Leaders, and the media, among others. Their responsibilities include monitoring services and health worker’s performance, gathering and sharing information, and resolving complaints. Some of the enablers to the role community health actors include diverse committee membership and the legitimacy of community leaders. On the other hand, knowledge and power asymmetry, the lack of a clear mandate, a lack of clarity on their roles and fear of reprisal are among the barriers to their role in Social Accountability. Conclusion: Community actors are part of the community health system, and understanding their role, strengths, and challenges has a practical impact on how they contribute to the overall health system's strength. The findings show that they can exert social pressure through their powerful coalitions, which is critical in Social Accountability activities. As a result, in order to maximize their potential, novel approaches to addressing the limitations identified in this review are required.