A study by World Bank (2005) defines social accountability as a demand-side effort of good governance and explains how communities can best interact with local governments, service providers and the actors of the state for demanding better service delivery in for example education and health.
We included social accountability in our patient centred medical centre whilst researching and implementing patient access to records and patient participation from 1996 to 2001. Patients were involved right from the start of the planning and discussion. Some were employed on a no pay contract to produce a system to extract patients' data for other patients, to run the information room, to design a software system etc, others to design artwork, another a theatre director to train patients to "Change their acts".
Patients are intelligent and motivated just as health professionals are and wish to see results from their work and as was apparent in the WHO EPIWin webinar on communicating risk and evidence, patients/citizens do not respond well to soft soaping or partial truths. Here are the findings from the WHO EpiWin webinar:
As engagement for social accountability takes place the implementer needs to adult learn about the social group it is engaging with and the social group needs to apply its own set of knowledge against the common business of social engagement. This helped us to see what we could achieve and what we could not achieve.
“Adult learning” is best understood not as a set of principles about what should happen, but as a set of descriptive generalisations about what does happen, whether we like it or not, together with some tentative suggestions about how such learning can be facilitated.
Self-Concept. When a person begins to see himself not as primarily as a learner, but as an actor or doer in the world,(s)he acquires a new status in others’ eyes but especially in his or her own eyes, and belief in self as a self-directing personality. The adult has a need to be treated as autonomous and worthy of respect. At the same time, most adults are not accustomed to directing their own learning in any systematic or disciplined way. They need to take responsibility for their learning; and having done so, frequently achieve great satisfaction from self-directed learning.
Possible implications. Need for spirit of mutual respect between student and student, and appreciation of each other as people and colleagues; need for student to diagnose her own needs; joint planning of objectives to be obtained and of learning experiences to attain these; learning process also a collaborative enterprise; evaluation of learning by student.
Reservoir of experience. The adult learner has had a great deal of experience with which any new experience can be compared and in relation to which any new experience will be understood. The adult tends to view and value himself or herself as a product of past experience, and therefore values that experience and is likely to feel unfairly humiliated by tasks which reject the relevance of that experience. Correspondingly, the adult tends to have established habits and patterns of thought which are not easily changed.
Possible implications. Effective teaching methods are likely to be those that encourage the use of, and reflection upon, the experiences that an adult perceives to be relevant; new ideas should be exemplified in terms of adult learners’ past experiences; adult learners need to recognise the way in which their thinking is bound by their new situations. Just as each individual is likely to have a different pattern of relevant experience, so their concerns and what they can bring to them are likely to be unique to each individual. [...]
HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data
Email address: richardpeterfitton7 AT gmail.com
