April 15, 2021

Threats to Health Systems Accountability & Governance

Much has been written about the impact of COVID-19. One of the more prominent issues which has come to light within the framework of health systems governance, has been Government corruption associated with COVID-19 response funds.  There is less focus on the severe impact on civil society organisations (CSOs) and their critical role in bolstering health systems accountability.

Since the onset of the pandemic, common themes across numerous civil society discussions; was the inability to reach target populations, implement programmes in communities/ disrupted programming and dwindling funding. Civil society plays a key role across the globe in delivering healthcare services especially in marginalized communities, pushing accountability and advocating on a wide range of issues. There are larger and smaller scale civil society organizations (CSOs) operating in different spheres/ topic areas and at different levels. Some have withstood the test of time (aka COVID-19) and have shaped the pandemic response, while others have had to scale back on staff and programming. It is the smaller community-based organisations (CBOs) which have really struggled during these times, many are on the brink of shutting down.  

CSOs also play a role in monitoring healthcare facilities e.g. stock-outs of medications or the quality of healthcare services. However, CSOs are no longer authorised to enter health facilities and there is little time or interest in anything other than COVID-19. The majority of healthcare facilities have adopted stringent measures which we have read about; where only patients and frontline staff are able to access facilities during these times. Patients are not allowed any visitors during these times. We don’t focus much on this in our field, but family members and care-givers also play a role in reporting poor quality of care or to escalate patient issues. However, family/care-giver reporting is probably a thing of the past; it is unlikely that to see our loved ones once they enter a healthcare facility. Neither are we sure whether they are receiving the care needed unless they are able to foster contact with us.

The stringent measures are needed, there is no arguing that. Although, I cannot help but wonder, that behind the closed doors of health facilities, it is only healthcare personnel and patients who will now be the most crucial in reporting any instances of poor quality of care. We see depressing glimmers of this, for example a few patients in South Africa have tweeted that they are being neglected or mistreated and not receiving food. Unfortunately, these tweets or other forms of reporting are not taken seriously, and patients often lose their lives. There are limited and dare I say weak mechanisms of accountability which exist at present, we are unable to monitor healthcare the way we used to. 

As we look towards the recovery period (hopefully, after these never-ending waves of this virus), key mechanisms  for governance and accountability have been dented. We will need to look towards supporting CSOs, reviving smaller CBOs and finding ways to expose what may be happening behind shut doors. We know all too well the types of injustices which happen in our facilities, we cannot kid ourselves that these have disappeared with the onset of the pandemic, they are in all likelihood ensuing.

Dr Shakira Choonara is an award-winning independent public health practitioner, and pens #ThoughtSpace with a touch of inspiration, critical thinking, and creativity

Tweet: @ChoonaraShakira

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