Abstract
Background: There are numerous barriers leading to a high unmet need for family planning and contraceptives (FP/C). These include limited knowledge and information, poor access to quality services, structural inefficiencies in service provision and inadequately trained and supervised health professionals. Recently, social accountability programs have shown promising results in addressing barriers to accessing sexual and reproductive health services. As a highly complex participatory process with multiple and interrelated components, steps and actors, studying social accountability poses methodological challenges. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project study protocol was developed to measure the impact of a social accountability intervention on contraceptive uptake and use and to understand the mechanisms and contextual factors that influence and generate these effects (with emphasis on health services actors and community members). Methods: CaPSAI Project is implementing a social accountability intervention where service users and providers assess the quality of local FP/C services and jointly identify ways to improve the delivery and quality of such services. In the project, a quasi-experimental study utilizing an interrupted time series design with a control group is conducted in eight intervention and eight control facilities in each study country, which are Ghana and Tanzania. A cross-sectional survey of service users and health care providers is used to measure social accountability outcomes, and a cohort of women who are new users of FP/C is followed up after the completion of the intervention to measure contraceptive use and continuation. The process evaluation utilizes a range of methods and data sources to enable a fuller description of how the findings were produced. Conclusion: This complex study design could provide researchers and implementers with the means to better measure and understand the mechanisms and contextual factors that influence social accountability processes in reproductive health, adding important findings to the evidence base.
Highlights
Many women who want to use family planning and contraceptives (FP/C) are unable to access it and are at risk of unintended pregnancy[1]
Interventions that change the attitude, norms, and behavior of both service users and providers, such as health communication, community group engagement, addressing provider bias and improving clientprovider interactions, have proven effective in addressing these barriers[3,4]. These are interventions encompassed within social accountability processes, where a combination of activities aims to empower and educate clients to demand quality services and to support health services actors to recognize and act on citizens’ demands[5]
The Medical Research Council (MRC) recommends that such evaluations: identify how the intervention works in everyday practice; explain the discrepancies between expected and observed outcomes; understand a wide range of effects; and determine how the intervention effects vary among recipients, in different sites, over time[25]
Summary
Many women who want to use family planning and contraceptives (FP/C) are unable to access it and are at risk of unintended pregnancy[1]. Interventions that change the attitude, norms, and behavior of both service users and providers, such as health communication, community group engagement, addressing provider bias and improving clientprovider interactions, have proven effective in addressing these barriers[3,4] These are interventions encompassed within social accountability processes, where a combination of activities aims to empower and educate clients to demand quality services and to support health services actors to recognize and act on citizens’ demands[5]. There are numerous barriers leading to a high unmet need for family planning and contraceptives (FP/C) These include limited knowledge and information, poor access to quality services, structural inefficiencies in service provision and inadequately trained and supervised health professionals.
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