This document proposes a framework for understanding social accountability in health service delivery based on stakeholder perceptions. The researcher conducted focus groups with community members, medical students, and partners in education in both rural and urban areas of South Africa. Interviews were also conducted with academics and health system managers. A grounded theory methodology was used to analyze the data and develop a ten-point framework. The framework is intended to be multifaceted, interactive and responsive, and mutually inclusive to advance the concept of social accountability.

1. Taking social accountability forward – a proposed framework Lionel Green-Thompson Wits Carnegie PhD Fellow Supervised by: Prof Trish McInerney Prof Bob Woollard

2. Disclosure Slide
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Faculty: Lionel Green-Thompson
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Relationships with non university interests:
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Wits Carnegie PhD Fellowship
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Discovery Foundation Academic Fellowship
(no influence on outcome except acknowledgement of financial contributions to this PhD)

3. Background
Boelen and Heck, 1995
….the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region and/or nation they have a mandate to serve.

4. Interdependence
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Isolation to systems
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Stand-alone to networks
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Inward – looking to harnessing global knowledge flows
Transformative learning
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Altered world view
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Competency based
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Interprofessional
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Technology enhanced

5. Aim of the study
Propose a framework for the understanding of social accountability based on the perceptions of the stakeholders in health service delivery

6. Methodology
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Grounded theory
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Three groups of stakeholders
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Community
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Final year medical students
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Partners in Education

7. Provincial Map of South Africa
Lehurutse
Bushbuckridge

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At least two weeks of training
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8 focus groups
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5 rural
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2 Lehurutse
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3 Bushbuckridge
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3 urban
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Boipatong
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Westbury
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Alexandra

9. 25 volunteers in 4 focus groups
70 purposively selected in 8 focus groups

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In depth interview
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Academics (12)
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Health system Manager (3)
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Health care insurer (1)
Chris Hani Baragwanath Hospital, Soweto

11. Community Concepts
You see they are supposed to touch with love, touch with... because..eish.. inside (the body) it’s very dangerous (Rural 2)
I was thinking about at medical school when you are teaching these doctors you need to teach them ubuntu as well so what they know what to do when they come to communities (Rural 2)

14. Relationship centred care
Advocacy and engagement
Asymmetrical relationships of power

15. A ten point framework to advance social accountability

16. 3
1
6
8
10
5
7
4
2
9

17. A ten point framework to advance social accountability
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Multifaceted
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Interactive and responsive
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Mutually inclusive

18. Acknowledgements
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Supervisors
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Professor Trish McInerney, CHSE
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Professor Bob Woollard, Canada
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Wits Carnegie Clinical PhD Fellowship
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Discovery Foundation Academic Scholarship
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Faculty Research Committee
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Centre for Health Science Education