umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Accountability in the health system of Tamil Nadu, India: exploring its multiple meanings
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, India.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0001-7234-3510
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0001-7087-1467
2019 (English)In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 17, article id 44Article in journal (Refereed) Published
Abstract [en]

Background: Accountability is increasingly being demanded of public services and is a core aspect of most recent frameworks of health system strengthening. Community-based accountability is an increasingly used strategy, and wasa core aspect of India's flagship National Rural Health Mission (NRHM; 2005-2014). Research on policy implementation has called for policy analysts to go beyond the superficial articulation of a particular policy intervention to study the underlying meaning this has for policy-makers and other actors of the implementation process and to the way in which problems sought to be addressed by the policy have been identified and problematised'.

Methods: This research, focused on state level officials and health NGO leaders, explores the meanings attached to the concept of accountability among a number of key actors during the implementation of the NRHM in the south Indian state of Tamil Nadu. The overall research was guided by an interpretive approach to policy analysis and the problematisation lens. Through in-depth interviews we draw on the interviewees' perspectives on accountability.

Results: The research identifies three distinct perspectives on accountability among the key actors involved in the implementation of the NRHM. One perspective views accountability as the achievement of pre-set targets, the other as efficiency in achieving these targets, and the final one as a transformative process that equalises power differentials between communities and the public health system. We also present the ways in which these differences in perspectives are associated with different programme designs.

Conclusions: This research underlines the importance of going beyond the statements of policy to exploring the underlying beliefs and perspectives in order to more comprehensively understand the dynamics of policy implementation; it further points to the impacts of these perspectives on the design of initiatives in response to the policy.

Place, publisher, year, edition, pages
BMC , 2019. Vol. 17, article id 44
Keywords [en]
Accountability, Community-based accountability, National Rural Health Mission, Belief structures, problematisation, Policy implementation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-159067DOI: 10.1186/s12961-019-0448-8ISI: 000466190800001PubMedID: 31029173OAI: oai:DiVA.org:umu-159067DiVA, id: diva2:1316921
Available from: 2019-05-21 Created: 2019-05-21 Last updated: 2019-05-21Bibliographically approved

Open Access in DiVA

fulltext(1218 kB)34 downloads
File information
File name FULLTEXT01.pdfFile size 1218 kBChecksum SHA-512
518b855d7093b9a64480a47759a687dc054bbd2055a57108bd1c426ee740654c7651a2d0b2a02e7b2a16e21ddb0328f7d9c4e7f59b530b95256c57adb2cb7dd6
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Authority records BETA

Gaitonde, RakhalSan Sebastian, MiguelHurtig, Anna-Karin

Search in DiVA

By author/editor
Gaitonde, RakhalSan Sebastian, MiguelHurtig, Anna-Karin
By organisation
Department of Public Health and Clinical Medicine
In the same journal
Health Research Policy and Systems
Health Care Service and Management, Health Policy and Services and Health Economy

Search outside of DiVA

GoogleGoogle Scholar
Total: 34 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 101 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf