The impact of human immunodeficiency virus (HIV) service scale-up on mechanisms of accountability in zambian primary health centres: A case-based health systems analysis

Abstract

Background: Questions about the impact of large donor-funded HIV interventions on low- And middle-income countries' health systems have been the subject of a number of expert commentaries, but comparatively few empirical research studies. Aimed at addressing a particular evidence gap vis-à-vis the influence of HIV service scale-up on micro-level health systems, this article examines the impact of HIV scale-up on mechanisms of accountability in Zambian primary health facilities. Methods: Guided by the Mechanisms of Effect framework and Brinkerhoff's work on accountability, we conducted an in-depth multi-case study to examine how HIV services influenced mechanisms of administrative and social ..