Reinforcing Accountability at the Interpersonal Level in Healthcare Delivery Settings: A Case of Mwananyamala Hospital, Tanzania

Abstract

Accountability in public healthcare involves more than whether practitioners comply with professional standards; it also depends on the organisational and interpersonal mechanisms through which concerns are raised, considered and acted upon. This study examined communication behaviour, interpersonal trust and accountability practices at Mwananyamala Hospital, Tanzania. A mixed-methods design combined a structured survey of 120 patients with semi-structured interviews with 10 healthcare providers and six focus group discussions, each involving eight participants in the HIV care and treatment context. The survey assessed 30 communication-related items using a seven-point scale, while the qualitative component explored practitioners’ experiences and institutional conditions affecting communication and accountability. The reported association between communication behaviour and interpersonal trust was positive but weak (r = .15, 95% CI [-.03, .32], p = .102), and therefore does not support a claim that communication predicts trust in this sample. Descriptively, the highest-rated communication domain was practitioners’ demonstration of care (87.6%), while use of visual aids had the lowest percentage score (65.7%). Qualitative findings highlighted patient feedback, complaint handling, teamwork, psychological safety and institutional support as relevant accountability mechanisms. The study therefore treats interpersonal trust as a relational outcome associated with communication rather than as a proxy measure of accountability. The findings suggest that strengthening accountability at the interpersonal level requires responsive communication and responsibility in provider-patient encounters, supported by institutional arrangements that enable feedback, learning and response to concerns.