Accountability is Key to Delivering Person-centered Care

May 2nd, 2023 | Viewpoint


While the global community agrees that health is a human right, we are far from our goal of ensuring accessible health care for all. International organizations, thought leaders, and governments have identified person-centered care (PCC), an approach to care that considers individuals and communities as participants in their own care, as a pathway to universal health coverage. However, PCC is challenging to implement and measure.

How can we put PCC in practice? One important but less emphasized way is by ensuring accountability of and for all actors in the health ecosystem. Accountability in this context means that actors are mutually responsible for achieving an agreed upon common goal. This also requires agreement on how to assess progress. We can also understand accountability as a process that engages multiple actors who must answer questions and provide information about their decisions and actions.

What is the importance of accountability in PCC?

Accountability is inextricably linked to PCC for several reasons:

  • It shapes individuals’ ability to realize their right to health care and reinforces provider, health system leader, and government obligations as duty bearers.
  • It builds trust and relationships between health system actors.
  • Emerging evidence across health areas (e.g., HIV, reproductive health, child health) indicates that accountability improves service uptake.
  • It is an important social justice tool as we work to improve healthcare quality, accessibility, person-centeredness, and equitability.

Accountability is highly embedded in power dynamics. If we are unwilling to challenge these dynamics, the results will be cosmetic. We need to shift from a system in which power structures and roles are vague and actions rarely tied to consequences to one in which individual actors at all levels uphold their commitments and answer for their actions.

What does accountability look like within a PCC framework?

JSI considers accountability an essential domain through which PCC is operationalized. Accountability is multidirectional and needed at every level, from the individual seeking care to communities to policymakers.

Using examples from our work at JSI, we’ve mapped how accountability can look at each socio-ecological level between different actors. Click on the graphic below to learn more about these examples.

Here are three things we can do to ensure accountability and promote PCC as we work toward health care for all:

Be explicit. Commitments should be clear and quantifiable to ensure understanding and alignment with different actors’ abilities and desires. To do this, we must engage with multiple diverse actors at different levels in transparent processes and track progress toward common goals.

Collect and share routine information. Citizen empowerment and social accountability activities require information from the government that is easily accessed and understood by all actors, and corresponding duty bearers who answer to citizens’ voices. Data can also unveil health inequities and offer redress. Yet while information and transparency are essential they do not directly equate to accountability.

Establish standards and create effective and continuous monitoring and feedback mechanisms. Perhaps most challenging is that all actors need to know when duty bearers have not met standards. Rights holders at all levels of the system need to be able to hold duty bearers accountable but they cannot do that without clear understanding of what the standards are. We must continue to develop timely and public-facing platforms and procedures for partners to collaborate and share knowledge. This will result in positive reinforcement and promote action-oriented feedback.

Join us May 23 at 10AM EDT to continue this important conversation at our second Livecast on PCC.

By Kate Onyejekwe, JSI International Division

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