Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review

Twenty years after the rights of women to go through pregnancy and childbirth safely were recognized by governments, we assessed the effects of interventions that promote awareness of these rights to increase use of maternity care services. Using inclusion and exclusion criteria defined in a peer-reviewed protocol, we searched published and grey literature from one database of studies on maternal health, two search engines, an internet search and contact with experts. From the 707 unique documents found, 219 made reference to rights, with 22 detailing interventions promoting awareness of rights for maternal and newborn health. Only four of these evaluated effects on health outcomes. While all four interventions promoted awareness of rights, they did so in different ways. Interventions included highly-scripted dissemination meetings with educational materials and other visual aids, participatory approaches that combined raising awareness of rights with improving accountability of services, and broader multi-stakeholder efforts to improve maternal health. Study quality ranged from weak to strong. Measured health outcomes included increased antenatal care and facility birth. Improvements in human rights outcomes such as availability, acceptability, accessibility, quality of care, as well as the capacity of rights holders and duty bearers were also reported to varying extents. Very little information on costs and almost no information on harms or risks were described. Despite searching multiple sources of information, while some studies did report on activities to raise awareness of rights, few detailed how they did so and very few measured effects on health outcomes. Promoting awareness of rights is one element of increasing demand for and use of quality maternity care services for women during pregnancy, birth and after birth. To date efforts have not been well documented in the literature and the program theories, processes and costs, let alone health effects have not been well evaluated.

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Scorecards and social accountability for improved maternal and newborn health services: A pilot in the Ashanti and Volta regions of Ghana

Background

With the limited availability of quality emergency obstetric and newborn care (EmONC) in Ghana, and a lack of dialogue on the issue at district level, the Evidence for Action (E4A) program (2011–2015) initiated a pilot intervention using a social accountability approach in two regions of Ghana.

Objective

Using scorecards to assess and improve maternal and newborn health services, the intervention study evaluated the effectiveness of engaging multiple, health and non‐health sector stakeholders at district level to improve the enabling environment for quality EmONC.

Methods

The quantitative study component comprised two rounds of assessments in 37 health facilities. The qualitative component is based on an independent prospective policy study.

Results

Results show a marked growth in a culture of accountability, with heightened levels of community participation, transparency, and improved clarity of lines of accountability among decision‐makers. The breadth and type of quality of care improvements were dependent on the strength of community and government engagement in the process, especially in regard to more complex systemic changes.

Conclusion

Engaging a broad network of stakeholders to support MNH services has great potential if implemented in ways that are context‐appropriate and that build around full collaboration with government and civil society stakeholders.

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Improving social accountability processes in the health sector in sub-Saharan Africa: a systematic review

Social accountability is a participatory process in which citizens are engaged to hold politicians, policy makers and public officials accountable for the services that they provide. In the Fifteenth Ordinary Session of the Assembly of the African Union, African leaders recognized the need for strong, decentralized health programs with linkages to civil society and private sector entities, full community participation in program design and implementation, and adaptive approaches to local political, socio-cultural and administrative environments. Despite the increasing use of social accountability, there is limited evidence on how it has been used in the health sector. The objective of this systematic review was to identify the conditions that facilitate effective social accountability in sub-Saharan Africa.

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Turning old problems into new problems: the role of young citizens in improving accountability in education in Malawi and Kenya

Accountability is increasingly recognised as the key mediating variable that encourages service providers to deliver efficient and effective local services. In the context of education, accountability strategies do not always explicitly consider young citizens as the primary users of education services. In this paper, a client approach to accountability is compared to a citizenship approach. Drawing on community scorecard and social audit research in Malawi and Kenya, the author explores whether education services are more responsive and accountable when young people access information and exercise their voice. The paper outlines a refreshed ‘accountability framework’ for education, placing young citizens at the centre, and argues that a citizenship-led approach in education governance is likely to be more realistic and effective than a ‘client power’ approach. This article makes an important contribution to the development community’s understanding of what constitutes an effective approach for promoting more transparent and responsive education governance.

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Creating spaces for dialogue: a cluster-randomized evaluation of CARE’s Community Score Card on health governance outcomes

Social accountability interventions such as CARE’s Community Score Card© show promise for improving sexual, reproductive, and maternal health outcomes. A key component of the intervention is creation of spaces where community members, healthcare workers, and district officials can safely interact and collaborate to improve health-related outcomes. Here, we evaluate the intervention’s effect on governance constructs such as power sharing and equity that are central to our theory of change.

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Enhancing governance and health system accountability for people centered healthcare: an exploratory study of community scorecards in Afghanistan

The premise of patient-centered care is to empower patients to become active participants in their own care and receive health services focused on their individual needs and preferences. Afghanistan has evidenced enormous gains in coverage and utilization, but the quality of care remains suboptimal, as evidenced in the balanced scorecard (BSC) performance assessments. In the United States and throughout Africa and Asia, community scorecards (CSC) have proved effective in improving accountability and responsiveness of services. This study represents the first attempt to assess CSC feasibility in a fragile context (Afghanistan) through joint engagement of service providers and community members in the design of patient-centered services with the objective of assessing impact on service delivery and perceived quality of care.

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Opening Government Data through Mediation: Exploring the Roles, Practices and Strategies of Data Intermediary Organisations in India

Opening Government Data through Mediation: Exploring the Roles, Practices and Strategies of Data Intermediary Organisations in India

In early 2012, Government of India approved the first policy in the country governing proactive disclosure of government data, and especially of born-digital and digitised data. This National Data Sharing and Accessibility Policy (NDSAP) extends the mandate of the Right to Information (RTI) Act to establish policy and administrative support to enable informed citizenship, better decision-making and heightened transparency and accountability.

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Briefing: Full disclosure policy is nice but not enough

Briefing: Full disclosure policy is nice but not enough

The Philippines is one of the 8 pioneering countries in the world that founded the Open Government Partnership in September 2011. The partnership calls for greater availability of government information to the public, implement standards of transparency and accountability in governments, as well as use technology for openness and accountability.

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Open data in legislative : The case of Sao Paulo City Council

Open data in legislative : The case of Sao Paulo City Council

Open Government Data policies in Brazil are still relatively recent. The beginning Open Government Data portal came in 2011. However, according to Matheus, Ribeiro and Vaz (2012), it is possible to find a number of open data policies in national and sub-national governments across Brazil: particularly at the states and municipality level.

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Measuring open data’s impact of Brazilian national and sub-national budget transparency websites and its impacts on people’s rights

Measuring open data’s impact of Brazilian national and sub-national budget transparency websites and its impacts on people’s rights

Having to access to budget information is critical for ensuring transparency in the public sector, thus enhancing its effectiveness and accountability, Recently, a movement was launched for data to be open, that is, freely available, in a timely fashion and to any citizen. This is a new process that is still under way and whose features vary according to the country where it is taking place. In Brazil, the availability of data on public management has increased since the Access to Information Act (LAI, in its Portuguese acronym) was passed in 2011, which governs the procedures to be followed by the federated entities to ensure access to information to society

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Case study: Open data in the governance of South African higher education

Case study: Open data in the governance of South African higher education

The availability and accessibility of open data has the potential to increase transparency and accountability and, in turn, the potential to improve the governance of universities as public institutions. In addition, it is suggested that open data is likely to increase the quality, efficacy and efficiency of research and analysis of the national higher education system by providing a shared empirical base for critical interrogation and reinterpretation. The Centre for Higher Education Transformation (CHET) has developed an online, open data platform providing institutional-level data on South African higher education. However, other than anecdotal feedback, little is known about how the data is being used. Using CHET as a case study, this project studied the use of the CHET open data initiative by university planners as well as by higher education studies researchers. It did so by considering the supply of and demand for open data as well as the roles of intermediaries in the South African higher education governance ecosystem

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Case Study Report on Investigation of the Use of the Online National Budget of Nigeria

Case Study Report on Investigation of the Use of the Online National Budget of Nigeria

Nigeria is a county facing severe challenges from corruption and weak governance. In the last year, Open Government Data initiatives have been launched in resource-rich Edo State, soon followed by an initiative at the Federal level with the objective of driving innovation, investment and economic growth by enabling access to government data. Through opening government data these initiatives also aim to encouraging feedback, information-sharing and increased accountability.

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The Politics of Accountability and Inclusive Development: Implications for Open Governance

The Politics of Accountability and Inclusive Development: Implications for Open Governance

There has been some important work done in recent years on the politics of inclusive development, and much of this has direct implications for those of us working on open governance.  In essence the question is whether open governance is contributing to inclusive development.  The answer may intuitively seem to be a yes, but I will argue that this isn’t necessarily the case.  I’ll then suggest some ways the links between openness and inclusion can be strengthened.

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The Role of Social Accountability in Improving Health Outcomes: Overview and Analysis of Selected International NGO Experiences to Advance the Field

The Role of Social Accountability in Improving Health Outcomes: Overview and Analysis of Selected International NGO Experiences to Advance the Field

The 1993 World Development Report (WDR), Investing in Health, deemed strengthening accountability as one of the core elements of health sector reform. Engaging communities and community-based workers in the process of measuring health status of children, in assessing causes of deaths, in defining high- risk groups, and in measuring changes in mortality over time will enable governments to achieve levels of under-5 mortality according to their commitments.

Models involving International NGOs that used a social accountability approach in various sectors and at different levels including community, district, and national level, were reviewed as part of this paper and are presented regarding the processes undertaken to increase accountability and improve health outcomes. This paper presents common themes, challenges, and recommendations to expand and bring this approach to scale in the context of health and development.

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How Useful are RCTs in Evaluating Transparency and Accountability Projects?

How Useful are RCTs in Evaluating Transparency and Accountability Projects?

This paper, produced under the research and evidence (R&E) component of the Making All Voices Count programme, reviews experience in the use of randomized control trials (RCTs) in evaluating transparency and accountability (T&A) initiatives, and where evidence exists, in evaluating Technology-for-Transparency-and-Accountability (henceforth T4T&A, also known as Tech-4-T&A) initiatives. The paper aims to contribute to understanding the potential usefulness of RCT approaches within Making All Voices Count and similar aid and research programmes and grant mechanisms.

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