Citizen engagement in public services in low- and middle-income countries: A mixed-methods systematic review of participation, inclusion, transparency and accountability (PITA) initiatives.

Abstract

How do governance interventions that engage citizens in public service delivery planning, management and oversight impact the quality of and access to services and citizens' quality of life? This systematic review examined high quality evidence from 35 citizen engagement programmes in low- and middle-income countries that promote the engagement of citizens in service delivery through four routes: participation (participatory priority setting); inclusion of marginalised groups; transparency (information on rights and public service performance), and/or citizen efforts to ensure public service accountability (citizen feedback and monitoring); collectively, PITA mechanisms. We collected quantitative and qualitative data from the included studies and used statistical meta-analysis and realist-informed framework synthesis to analyse the findings. The findings suggest that interventions promoting citizen engagement by improving direct engagement between service users and service providers, are often effective in stimulating active citizen engagement in service delivery and realising improvements in access to services and quality of service provision, particularly for services that involve direct interaction between citizens and providers. However, in the absence of complementary interventions to address bottlenecks around service provider supply chains and service use, citizen engagement interventions alone may not improve key wellbeing outcomes for target communities or state-society relations. In addition, interventions promoting citizen engagement by increasing citizen pressures on politicians to hold providers to account, are not usually able to influence service delivery. The citizen engagement interventions studied were more likely to be successful: (1) where the programme targeted a service that citizens access directly from front-line staff, such as healthcare, as opposed to services accessed independently of service provider staff, such as roads; (2) where implementers were able to generate active support and buy-in for the intervention from both citizens and front-line public service staff and officials; and (3) where the implementation approach drew on and/or stimulated local capacity for collective action. From a research perspective, the review found few studies that investigated the impact of these interventions on women or other vulnerable groups within communities, and that rigorous impact evaluations often lack adequately transparent reporting, particularly of information on what interventions actually did and how conditions compared to those in comparison communities.