Accountability in Primary Health Care (PHC) delivery services is known to be important in delivering
health care to the people. However, its impact on healthcare delivery is unknown in Nigeria. This study
therefore examined the effects/impacts of health facility committees (HFCs), a specific type of
accountability structure, on health service delivery and resource mobilisation. It also investigated the
influence of trust over the functioning of HFCs.
The study took place in the Orumba South Local Government Area (LGA) in Nigeria. The first phase of
data collection involved a rapid appraisal of 25 HFCs in the LGA to assess their levels of basic
functionality and to provide information for the selection of the sites for the detailed case study work.
Functionality was judged according to certain criteria: gender composition of the committees; the
frequency of the committees’ meetings; consistency of member attendance over time; and whether the
committees kept minutes of their meetings. This information was obtained by interviewing the health
officer in-charge (OIC) of the facility and the HFC chairman. After the rapid appraisal, one more
functional and another less functional committee were chosen for detailed investigation of the impact
of the committees and the role of trust in the functioning of the committees. The key data collection
strategies included in-depth interviews with different stakeholders, focus group discussions with
community members and observations of HFC meetings. Data analysis was done using Nvivo 8 software.
The results showed that the more functional HFC improved the availability of health workers in the
health facility to which it was attached. Linkage with other local accountability structures, provision of
infrastructure and proper information dissemination strengthened the functionality of HFCs. The
leadership style of the committee chairman, support by and linkage with other community
accountability structures through financial contribution, and provision of manpower for work at the
health facility made the committee more functional. On the other hand, the less functional HFC
experienced lack of funds for health activities. In addition, lack of remuneration for committee
members, power struggles/social conflicts within the community and lack of information about the HFC
contributed to its low functionality.
Furthermore, there is evidence of both interpersonal and institutional trust as a factor that underpins
the relationships between the health facility committee and other stakeholders, showing that trust
relationships are important elements in local accountability structures such as HFC. Efforts should also
be made to remunerate the committee members, strengthen health worker motivation and resolve
tensions between local authorities.