Person-centered care (PCC) is essential to advance universal health coverage. It is an approach through which health is co-produced with care recipients, care providers, and communities and reflects and respects peoples’ needs and preferences. Health systems are human systems, which is why it is critical to shift from health systems designed around diseases toward ones designed for people. To make this shift happen, accountability is essential.
Accountability, at its core and particularly in the context of PCC, can be thought of as mutual responsibility for achieving an agreed upon common goal. Rights holders (e.g., careseekers) and duty bearers (e.g., providers, policymakers) all have different needs, concerns, roles, responsibilities, and power in health systems. Connecting and facilitating dialogue across these actors through accountability approaches helps rights holders voice their needs and preferences and helps duty bearers be more responsive in meeting their needs. Emerging evidence across health areas (e.g., HIV, reproductive health, child health) indicates that accountability improves service uptake and builds trust – a foundational element of PCC.
JSI’s recent PCC Livecast posed these questions to experts in the field. This piece highlights three key elements panelists identified as necessary to ensure accountability in PCC.
1. A shared vision of success and how to measure it.
All actors need to know when duty bearers have or have not met standards, and this requires accurate, transparent information. There must be agreed-upon metrics to measure PCC that incorporate community input, can be used for decision making, and can motivate duty bearers to deliver PCC. When rights holders know and can articulate the quality of care they should be receiving and duty bearers know how their performance is being measured, then it becomes much clearer what actors are accountable for. This clarity leads to better understanding of roles and responsibilities, improved data for decision-making, and identifiable actions to meet quality standards.
For example, in India client satisfaction surveys are used as one performance measurement for government health facilities. As part of a national quality improvement initiative for maternity complexes, survey results form an important part of labor rooms’ assessment and quality certification. They are also used to guide allocation of government incentives. To receive an incentive, a quality-certified labor room must have at least 80 percent of users report they are satisfied or highly satisfied with their care. In addition to determining which labor rooms receive incentives, these data are used by the health facility for performance management and improving the quality of care.
2. Community- and user-led mechanisms should shape services and redress grievances.
Nothing is more powerful than having a robust mechanism to capture the experience of the community and to facilitate the sharing of that experience with actors in the health system. Accountability mechanisms like CARE’s community scorecards, community dialogues, and citizens charters help facilitate dialogue and feedback between providers and careseekers, communities and facility managers, and citizens and governments. Monitoring tools like JSI’s My Village My Home facilitate shared responsibility for community health by enabling community members and health facility staff to hold each other accountable for routinely vaccinating children. Treatment Action Campaign’s community-led monitoring model enables care users, providers, facility managers, and government officials to improve quality of care. Engaging rights holders and duty bearers at all levels elevates community voices, supports open communication, and establishes a common understanding of roles, responsibilities, and expectations. These mechanisms make information about services accessible to stakeholders and reinforce transparency at every level of the health system.
3. Health systems designed for people also need to respond to health workers’ needs and preferences.
Accountability mechanisms for PCC must consider the health system in its broadest sense–communities, government officials, religious leaders, care providers, and even actors working in other sectors are part of the ecosystem. Leaders need to be invested in the systems and policies they deliver. They should consider themselves fellow users of the system when making critical program and policy decisions. Health workers are vital to PCC, yet they face countless pressures and constraints when delivering care. Health workers must feel heard and supported as part of the accountability process.
Connecting communities and frontline providers can also facilitate collective action. When care seekers and providers work together to identify and voice their needs and concerns, and offer potential solutions, their demands are more likely to be met. This level of pressure and transparency advances action.
Accountability at every level of the health system is essential to PCC. High-quality PCC requires pursuing holistic programs that address the issues at the root of the challenges people face in achieving their right to health. Fundamentally, this is about human rights and social justice. As implementers, funders, government leaders, community members, care seekers, we are all accountable for person-centered care.
About the authors:
Kate Onyejekwe Director, International Division, Washington JSI: Kate Onyejekwe has more than 25 years of public health experience, applying her technical expertise to family planning and reproductive health, maternal and child health, immunization, HIV, and gender and youth programming. Kate oversees the division’s portfolio of global programs.
Kayode Afolabi, former head of Reproductive Health Division at the Nigerian Ministry of Health: Dr Kayode Afolabi holds a bachelor’s degree in medicine and surgery, master’s degree in health economics and a fellowship of the West African College of Surgeons in Obstetrics and Gynaecology. He has 32 years of experience in reproductive and maternal health.
Christine Galavotti, Senior Program Officer, Bill & Melinda Gates Foundation: Dr. Christine Galavotti has worked to advance reproductive health and rights throughout her career: as a behavioral scientist and Branch Chief at the US CDC, as Senior Director of Sexual Reproductive Health and Rights at CARE, and, since 2018, as a Senior Program Officer with the Gates Foundation.
Surbhi Seth, Program Specialist, John Snow India, Private Ltd.: Dr. Surbhi Seth holds degrees in medicine and public health and has over ten years of experience supporting ministries of health and partners to strengthen health systems. Her work focuses on respectful care and human-centered approaches for community engagement across health areas.
Anele Yawa, National General Secretary, Treatment Action Campaign: Anele Yawa has served as the National General Secretary of TAC since 2014. In 2022, he was re-elected as the General Secretary, and in 2023 he was appointed by the Minister of Health to serve as a board member for the Office of Health Standards Compliance (OHSC) for a 3 year term.
Jessica Posner, PCC Lead for JSI: Jessica Posner has 20 years of experience managing complex public health programs in partnership with local and international organizations, governments, donors, and private sector partners. She leads JSI’s person-centered care portfolio.
Nicole Castle, Senior Technical Officer, Social and Behavior Change, JSI: Nicole Castle holds a master’s degree in health and international development and a bachelor’s degree in anthropology. She supports teams at JSI apply social and behavioral sciences to program design and implementation and also supports JSI’s person-centered care portfolio.
Competing interests: None
Handling Editor: Neha Faruqui