Themes | Key Findings |
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Development of a shared understanding of system-wide accountability | • Degrees of understanding about the link between accountability and performance are varied • Focus is on accountability for individual performance as opposed to system-wide constructs of accountability • Preserve the connection between rights and accountability; consider constraints on the ability of the worker or the organization to perform well |
Streamlining of managerial accountability lines for healthcare managers | • Multiple, unsynchronized lines of accountability for healthcare managers exist • Politically-driven appointments for technical roles at all levels, from the woreda to the Federal Ministry of Health, are common • Poor merit-based appointment system creates lack of incentives for high performance |
Strengthening of medico-legal knowledge and systems | • Patients lack knowledge of their legal rights in the case of a medical error • Providers and institutions are unaware of what constitutes a medical mistake from a legal perspective • Medico-legal capacity at both the individual and institutional levels needs strengthening |
Development of mechanisms for bottom-up accountability | • Overall lack of responsiveness from higher levels in the health system • Current systems for routine oversight are limited and are not designed to be responsive to complaints or other early signals • Community and lower-level stakeholders should regularly evaluate higher-level health system entities |