# name
How do accountability problems lead to maternal health
                inequities? A review of qualitative literature from Indian
                public sector

# metadata.dc.description.abstract[].value
Background: There are several studies from different
                geographical settings and levels on maternal health, but none
                analyzes how accountability problems may contribute to the
                maternal health outcomes. This study aimed to analyze how
                accountability problems in public health system lead to maternal
                deaths and inequities in India. Methods: A conceptual framework
                was developed bringing together accountability process (in terms
                of standard setting, performance assessment, accountability (or
                answerability, and enforceability) -an ongoing cyclical feedback
                process at different levels of health system) and determinants
                of maternal health to analyze the influence of the process on
                the determinant leading to maternal health outcomes. A scoping
                review of qualitative and mixed-methods studies from public
                health sector in India was conducted. A narrative and
                interpretive synthesis approach was applied to analyze data.
                Results: An overarching influence of health system-related
                factors over non-health system-related factors leading to
                maternal deaths and inequities was observed. A potential link
                among such factors was identified with gaps in accountability
                functions at all levels of health system pertaining to policy
                gaps or conflicting/discriminatory policies and political
                commitment. A large number of gaps were also observed concerning
                performance or implementation of existing standards. Inherent to
                these issues was potentially a lack of proper monitoring and
                accountability functions. A critical role of power was observed
                influencing the accountability functions. Conclusion: The
                narrative and interpretive synthesis approach allowed to
                integrate and reframe the relevant comparable information from
                the limited empirical studies to identify the hot spots of
                systemic flaws from an accountability perspective. The framework
                highlighted problems in health system beyond health service
                delivery to wider areas such as policy or politics justifying
                their relevance and importance in such analysis. A crucial
                message from the study pertains to a need to move away from the
                traditional concept of viewing accountability as a blame-game
                approach and a concern of limited frontline health workers
                towards a constructive and systemic approach.

# metadata.dc.relation.isformatof[].value
Reproducció del document publicat a:
                http://dx.doi.org/10.1186/s40985-018-0081-z

# metadata.dc.relation.ispartof[].value
Public Health Reviews, 2018, vol. 39, num. 9

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
How do accountability problems lead to maternal health
                inequities? A review of qualitative literature from Indian
                public sector