“Disrespectful and abusive treatment (D&A)  is a signal of a health system in crisis—a crisis of quality and accountability. At the most fundamental level, a health system that tolerates D&A devalues women, which itself is an underlying cause of slow progress on reduction of maternal mortality. Moreover, D&A represents a breakdown in accountability of the health system not only to its users but also to the women and men it employs as service providers.”

Freedman & Kruk


While the global community has made great progress reaching SDG indicators, accountability mechanisms are critical to keep countries and the global community on track. In recent years there has been a global emphasis on respectful maternity care (RMC) to bring accountability for quality women’s care services back to the forefront of health service delivery at all levels. At the community level, there is an increasing emphasis on social accountability actions such as scorecards, dashboards, and other stock-taking mechanisms to promote improvements and uphold quality standards in primary health care services. Supporting civil society actors to use social accountability approaches and document their successes and challenges is key to creating accountability systems that work in the health sector.

To achieve progress, stakeholders must know how to measure social accountability systems, identify where gaps exist, and have access to evidence to draw from to improve their own national efforts. The HEARD Project is supporting researchers to develop monitoring approaches, assessments of accountability implementation, and strengthened reporting processes that support national-level duty bearers and global stakeholders to advance stronger social accountability systems and practices.

Learn more about Measuring Social Accountability and Health Outcomes on the following pages: