Since the publication of the 2004 World Development Report a range of different attempts have been made to make the design, prioritisation and delivery of health services more accountable to different stakeholders. However, complex politics and power dynamics can limit or skew people’s abilities to access services or hold them to account, particularly for poor and marginalized people.
Those who develop and implement strategies, and those who generate evidence and learning about these approaches and the places they are used in, are often disconnected. How politics and power shape access and influence decisions is either not fully understood, or, where understanding does exist, this has not been effectively used to guide accountability strategies. The research and policy communities working on health systems strengthening, building institutions for accountability and translating evidence into policy have struggled to find a common set of reference-points within which to exchange emerging insights.
Working with partners in sub-Saharan Africa (including Mozambique and Uganda), South Asia (including India and Bangladesh) and Latin America (Brazil), the IDS accountability for health equity programme aims to bridge the gaps between these communities and provide a theoretical understanding of the factors that influence decision-making within the health system; the role of power and politics when shaping effective strategies for building countervailing power where inequitable power relations exclude and marginalise certain groups; and ensuring that the perspectives and interests of poor and marginalised people are taken into account.
As part of this programme IDS hosted the Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity meeting in July 2017. This meeting was supported through the ESRC-DFID Unequal Voices project and the DFID Future Health Systems research programme consortium, as well as grants from the Open Society Foundation and the ESRC-DFID Impact Initiative. It brought together 90 key researchers, practitioners, advocates, opinion formers and policy influencers from Africa, Asia, Latin America, the UK and the US.