Abstract
# Background Despite there being many state and non-governmental organisation (NGO) health programs, Nepal still has a high maternal mortality ratio of 258. Previous research has indicated that social accountability mechanisms can improve maternal health. However, the functioning of these mechanisms has not yet been explored in Nepal. Social accountability mechanisms can be identified and analysed through the information, dialogue & negotiation model. # Objective To identify the role of social accountability mechanisms in maternal health and the challenges regarding these mechanisms in Baglung district, Nepal. # Methods Ten semi-structured interviews were held with healthcare officials, healthcare providers, NGO staff and mothers at the community level, and four focus group discussions were held with pregnant women and recent mothers, healthcare providers and Health Facility Operation and Management Committee (HFOMC) members. Data was coded and analysed with ATLAS.ti using the information, dialogue & negotiation model. # Results Mothers' Groups, Female Community Health Volunteers (FCHVs) and the HFOMC function as a two-step social accountability mechanism. The FCHVs act as a bridge between Mothers' Groups at the community level and the HFOMC. The HFOMC holds dialogues and negotiations with the district and central government. There seem to be two main obstructions in the information flow from the central or district levels to the community. They are located between the central government level and/or district level and the HFOMC, and between the HFOMC and the FCHV and Mothers\' Groups. The information from the community to higher levels seems to have an obstruction in the voicing of service-related needs/complaints in the Mothers' Groups and another obstruction of HFOMCs rarely interacting with health sector actors other than the local health facility. # Conclusions The information, dialogue & negotiation model is a sensitive analytical model to understand the functioning and challenges of social accountability in the maternal health care system of Nepal. The community-based accountability chain of HFOMC, FCHVs and Mothers' Groups presents a structure that facilitates the optimisation of maternal health services. Recommendations are given to improve gaps in this accountability chain.
Highlights
Despite there being many state and non-governmental organisation (NGO) health programs, Nepal still has a high maternal mortality ratio of 258
The information from the community to higher levels seems to have an obstruction in the voicing of service-related needs/complaints in the Mothers’ Groups and another obstruction of Health Facility Operation and Management Committee (HFOMC) rarely interacting with health sector actors other than the local health facility
It is defined by the WHO as “the health of women during pregnancy, childbirth and the postpartum period (42 days postdelivery)”. 1 This study examines the situation in Nepal, a small country in the Himalayas with a population of around 27 million, where maternal mortality was shown to be still
Summary
Ten semi-structured interviews were held with healthcare officials, healthcare providers, NGO staff and mothers at the community level, and four focus group discussions were held with pregnant women and recent mothers, healthcare providers and Health Facility Operation and Management Committee (HFOMC) members. Ten semi-structured interviews were conducted and four focus group discussions (FGDs) were held with participants from the community, healthcare providers and healthcare officials at the district level. The communities in central Baglung are well connected to health services. This is not the case for communities living in the more rural areas of the district. This is not the case for communities living in the more rural areas of the district. 20 Research carried out in Baglung in 2012 showed that the delay in deciding to seek care by pregnant women in the district occurs mostly in families with low socio-economic status (SES), resulting in low decision-making power and leaving them unable to exercise their reproductive rights. 20
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