An online workshop of practitioners in South Asia highlighted key challenges and learnings on community-led initiatives to hold service providers accountable for the delivery of health and nutrition services.
The two day online workshop run by IDS and COPASAH last week as part of Making All Voices Count brought together a group participants from a variety of difference contexts in Pakistan, India and Bangladesh in the delivery of health and nutrition entitlements. Participants were invited to share information about their work, and how social accountability initiatives play out in the context of wider efforts to expand access to health and nutrition services and build more equitable and inclusive systems. Their primary focus was to discuss the political context surrounding social accountability, beyond the technical analysis of what works at a community level.
Building a culture of questioning
The starting point of the discussion was that social accountability is to be conceived as building of a ‘culture of questioning’ among citizens, which begins with demands for better access to health and nutrition services to extend much beyond that, impacting wider power dynamics within communities and between communities and the state. And how the rights-based framework is essential to build the culture of questioning, and more importantly to provide a framework for social action.
Negotiating with service providers at different levels of the state
Participants concluded that the effectiveness of social accountability did not depend on the type of tool chosen but on the strategy built around it, and on how the process of data collection increases the ability of community members to ‘negotiate’ with service providers. When dealing with service providers, practitioners may mix collaborative and confrontational approaches. Overall, negotiating with state authorities is usually easier at community level, where frontline workers and patients live side by side and find ways to collaborate, but it becomes more difficult to translate local demands into wider changes. Participants discussed examples of how locally-collected data can be aggregated, for instance through the use of ICTs, to push demands for better service delivery at higher levels, such as District or State.
Demanding accountability from the private sector
There was a consensus that the private sector is a crucial piece in ensuring greater accountability in the delivery of healthcare and that regulation of the private health sector is seen as a critical and urgent task. Regulation should recognize the primary role of the state in ensuring service delivery.
Recognising the varied impacts beyond simple service uptake
An important element of the workshop focused on measuring impact and the need for evaluations to reflect the many aspects of social change, other than simple increase in access to services, such as the ability to negotiate and assert rights and entitlements. It also recognised the variety of approaches to impact assessment such as stories of change as a promising method to document not only ‘why’ change was created, but ‘how’.
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