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To increase the evidence on what works in scaling up social accountability in reproductive health, the HEARD Project has partnered with Women Influencing Health, Education, and Rule of Law (WI-HER) and the Systems for Health Working Group of CORE Group to investigate and document successful examples in low- and middle-income countries.

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 to facilitate data collection through key informant interviews (KIIs) and Focus Group Discussions (FGDs) at country level with local stakeholders [1]

Findings from the analysis will inform recommendations and shared practices that contribute to the institutionalization of programs/systems for social accountability in health at a national level, particularly as they relate to Maternal Newborn and Child Health (MNCH).


The assessment of the national Social Accountability 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 Social Accountability 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 Social Accountability program.

Data collection and analysis will explore the national Social Accountability 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.

Activity Implementation

In Malawi and Rwanda, facilitators are preparing to carry out key informant interviews (KIIs) and focus group discussions (FGDs). Application of the data collection instruments will include 1) 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) focus groups with community representatives (rights holders).

Efforts to provide a safe environment for study participants will help to limit the spread of COVID-19.