Understanding how accountability, specifically social accountability has been implemented and sustained to institutionalization has not been well documented. While there are many social accountability efforts, once government take them up and own their responsibility for accountability by putting in place systemic level mechanisms for accountability is less clear. To increase the evidence on what works in scaling up social accountability in reproductive health, HEARD has partnered with WI-HER and Systems for Health Working Group of CORE Group to investigate and document successful examples in LMIC.
Using a case study methodology, rapid desk reviews will be conducted in Malawi and Rwanda. In each country, there is a policy in place that establishes a social accountability program within their primary health care system, and each has launched their program and sustained it for at least 18 months.
A tool has been developed for the rapid desk review based on an accountability framework that lays out how accountability is being established in countries. The tool facilitate data collection through key informant interviews (KIIs) and Focus Group Discussions (FGDs) at country level with local stakeholders. Researchers from the Social Accountability Workstream of the Systems for Health Working Group of CORE Group will facilitate the national level data collection in the countries.
Findings from the analysis of two countries will inform recommendations and shared practices that contribute to the institutionalization of programs/systems for social accountability in health at national level, particularly a s they related to Maternal Newborn and Child Health (MNCH). Further evidence gained from this process will be shared through a CORE Group webinar, which reaches US implementers as well as global stakeholders; and an abstract will be submitted to the World Bank’s Global Practitioners Social Accountability Conference (GPSA) to share learning at this global forum as well. HEARD and WI-HER will also facilitate the submission of a manuscript, developed from the activity report, for publication.
The assessment of the national SA programs will be carried out in two parts for each country. First, the quantitative scoring element of the instrument will be applied to the information provided through the desk review and resources (policy papers, strategy documents, guides, etc.) provided by the country. This initial quantitative ‘scoring’ process will allow a common assessment across all countries of the legal policy framework, the functionality, the sustainability and the effectiveness of the social accountability program or mechanism.
Subsequently, qualitative data will be collected through interviews to provide insight into how the SA mechanism is perceived at three levels of the system (national, sub-national, and community) and according to actors from both the duty bearer and rights holder populations. The qualitative assessment element of the instrument will also capture additional information not available in the published documents regarding the factors that may have facilitated or impeded the institutionalization and scale of the national SA program.
Together the KIIs and FGDs will explore the national SA program both retrospectively and prospectively to gain some understanding as to whether or not the program is seen to fulfill its purpose to 1) include community members or rights holders in decision-making and monitoring of the services that they receive from their health systems; and 2) receive grievances and provide timely responses with service improvements.
Role and Activities of Partners
The countries currently proposed are Malawi and Rwanda, which will only be shifted if the COVID 19 creates challenges. If one country team cannot participate, we will propose a substitute country that is one of USAID’s priority countries for MNCH. In each of the three countries, a facilitator will be identified through WI-HER’s project work and through the authors of this paper who are members of the Systems for Health Working Group and part of the Social Accountability Work Stream, and data collectors will be recruited and trained to carry out key informant interviews (KIIs) and focus group discussions (FGDs).
Members of the research team will facilitate the data collection in each country. To apply the instrument, they or their teams will 1) carry out key informant interviews at national, sub-national, and community level with government representatives and managers who are part of the public health system (duty bearers); and 2) lead focus groups with community representatives (rights holders).
It is anticipated that KIIs will be carried out over the telephone or on teleconference video call due to limitations and restrictions on travel and face-to-face meetings related to COVID 19. Similarly, where community level FGDs would put participants at risk, WI-HER will facilitate FGD data collection through discussions among NGO and FBO representatives of the community, who are able to access teleconference lines for a zoom-platform for participation in the FGD.
WI-HER, LLC, will lead the desk research and field assessment in three countries – Malawi and Rwanda – and analysis to complete the research paper “Institutionalizing Social Accountability within National Health System’ (working title).
The data will be analyzed, and results will be documented in a final report, which will be the project deliverable. The report will include an analysis of the findings as well as an initial assessment of the instrument itself, with recommendations on how the instrument may be improved.
Beyond the project completion, authors will submit the paper for publication and for dissemination at various public venues proposed, e.g. the Health Systems Research Global Forum, the CORE Group Annual global meeting, or the World Bank sponsored Global Partnership for Social Accountability (GPSA).