Social Accountability Initiatives Research Articles

Exploring the Role of Technology in the Implementation of Social Accountability in Medical Education: A Brief Review

ABSTRACT Social accountability has been acknowledged as an important facet of medical education delivery as it envisages that healthcare professionals have the responsibility to be accountable for health-related community needs. The purpose of the current review is to identify the factors that determine the success of social accountability in medical education and explore different ways in which technology can aid in the implementation of social accountability initiatives in medical institutions. The successful implementation of socially accountable medical education depends on a broad gamut of factors, which can be associated with different stakeholders, including the role of technology in facilitating the implementation of the same. Owing to the fact that technology has reached every aspect of human life, it is our responsibility to explore its scope in promoting the attainment of competencies pertaining to social accountability among medical students. In conclusion, social accountability in medical education has multiple benefits and has emerged as the need of the hour. The integration of technology into socially accountable medical education plays a defining role in improving the effectiveness of educational activities, facilitating better community and student engagement, and eventually contributing to the production of socially responsible healthcare professionals.

Social Accountability in Health System Governance: A Scoping Review.

Social accountability is an important element in health system governance, which is necessary for health system reform and reaching Universal Health Coverage. Understanding the social accountability mechanism and tools will help policymakers to design policies according to the context. We aimed to explore the extent of the application of social accountability in health system governance, its results, challenges, and tools. We conducted a scoping review study, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping review. An inclusive search in bibliographic databases and search engines was done to identify peer review articles and grey literatures, published in English in the range of 2010 to 2021. Search terms were (social accountability), (public accountability), AND (health system). Thirty-one records met inclusion criteria from 286 potentially relevant sources, which included 25 peer-review articles and 6 grey literatures. Maternal and child health was the main health subject for social accountability interventions. We identified some social accountability tools to apply at the health facility and community levels. Social accountability has some benefits for the health system and for the community and some challenges to the implementation of social accountability were listed. Social accountability improves health system performance. It contains different tools and strategies applied at different levels of the health system. Successful social accountability initiatives that are strategic, multi-interventional, and context-specific can produce good results in health services and social domains.

EFFECTS OF TRANSPARENCY-FOCUSED SOCIAL ACCOUNTABILITY ACTIONS ON PUBLIC SERVICE DELIVERY IN KAKAMEGA COUNTY GOVERNMENT MINISTRIES, KENYA

The provision of public services in the Republic of Kenya has encountered difficulties over the years. The implementation of many policies, such as performance contracts and measurement and evaluation, has not produced the desired outcomes. Therefore, it was necessary to concentrate on alternative approaches to enhance public service delivery, such as the implementation of social accountability measures. By encouraging openness through social accountability initiatives, corruption and bureaucratic inefficiencies are reduced, which enhances the delivery of services. Few studies have examined the link between the acts of social of accountability and delivery of services in Kenya, despite the fact that they are, thought to increase service delivery in the public sector. This study therefore sought to interrogate the effect of transparency-focused social accountability actions on public service delivery in Kakamega County Government Ministries, Kenya. The study was centered on Vance, Lowry, and Eggett's Accountability theory (2015). The research used a descriptive survey research approach. The employees from different ministries, county assembly members, as well as chief officers, who take part in public decision-making processes, made up the target population. A population of 1,904 persons was targeted. Accordingly, using Krejcie and Morgan (1970) table, a sample size of 322 was obtained. To analyse the quantitative data, the researcher employed the Statistical Package for Social Sciences. Content analysis was, used to look at qualitative data. The research instruments’ validity was certified by the experts in the area of study, while reliability of the research instruments was determined by use of Cronbach's alpha coefficient. This was meant to check on the internal consistency of the research instruments. A standardized questionnaire and interviews was used to collect the data, which was then analyzed using descriptive and inferential statistics and presented using tables. For this investigation, a multivariate regression analysis was, used. The findings revealed that transparency focused (β=.652, p<.05) had a positive significant effect on service delivery and accounted for 41.7%. The employees of Kakamega County may gain from this research because it will allow them to engage in more discussions with the county by engaging in advisory boards, project implementation, and project feasibility analysis, all of which can enhance the county's provision of public services.

Place Leadership in Social Accountability Initiatives

ABSTRACT This paper explores how social movement and civic actors enact and contribute to place leadership. It does so by examining how social movement organizations in South Africa use social audits to investigate and challenge government accountability and service delivery failures. The paper describes the meaning-making practices evident in social audit reports, and detail how social audit actors construct issues and positions through three framings – rights, regulations and lived realities. In this process, they leverage rights discourses and governance arrangements to legitimize their place leadership, and draw on multiple aspects and experiences of place to expose failures of governance and in the realization of rights. Through the dynamic interplay between legitimizing and exposing, they translate embodied realities and relations in and of place into a sense of purpose and direction for mobilizing a wider network of governance actors. On this basis, the paper contributes a social accountability perspective to place leadership studies. MAD statement This paper aims to Make a Difference (MAD) by exploring how social movement actors contribute to collective place leadership through constructing and contesting the meanings of local governance issues and relationships. The paper highlights how social movement actors illuminate place as the objective and measurable built environment, and as subjectively experienced and constituted as places of heritage and community but also dislocation and trauma. That they use social audits to interrogate governance failures and legitimize communities’ situated knowledge suggests such social accountability initiatives offer a space for place leadership outside of but also interacting with broader governance networks.

Social Accountability in Challenging Environments: Case Studies from Egypt

Abstract Through deploying the 2015 World Bank framework of contextual drivers for social accountability, this article seeks to examine three recent social accountability initiatives (sais) in the agriculture, health, and local development sectors in Egypt to identify the contextual drivers and success factors of sais operating in challenging environments. The article aims to answer the following questions: what roles do recent sais in Egypt play? What are the challenges that sais encounter? And how do such challenges (re)shape the processes and dynamics of sais? The article finds that in challenging environments–where invited spaces are controlled, citizens’ collective action is limited, and commitment by state-officials is not guaranteed–the role of interlocutors becomes key in boosting the effectiveness of sais. It plays the role of a mediator, mobilizer to citizen and state action, and information intermediary, which generates, simplifies, and disseminates information. In this sense, this article draws on the critical missing link in sais through an in-depth analysis of the role of interlocutors in overcoming challenging or constraining circumstances.

“I will sample until things get better – or until I die.” Potential and limits of citizen science to promote social accountability for environmental pollution

Mining can cause harm to both human health and ecosystems. Regulators in low-income countries often struggle to enforce decent environmental standards due to financial, technical, and personal capacity constraints and political capture. In such settings, social accountability strategies are often promoted through which citizens attempt to hold governmental and private actors directly to account and demand better governance. However, social accountability initiatives are rarely effective. We demonstrate how political ecology analysis can inform social accountability theory and practice by identifying the power structures that define the potentials and limits of a social accountability strategy. We study the coal mining area of Hwange in Western Zimbabwe, where mining not only supplies coal to power plants and factories of multinational companies but also pollutes the Deka River. Together with local community monitors, we implemented the first citizen science project conducted in Zimbabwe and identified the sources and extent of the pollution. The scientific data strengthened the community monitors’ advocacy for a cleaner environment and empowered them in their exchanges with the companies and the environmental regulator. However, only some of their demands have been met. The political ecology analysis, spanning from the local to transnational levels, reveals why local social accountability initiatives are insufficient to spring the low-accountability trap in a state captured by a politico-military elite, and why corporate governance regimes have not been successful either. We argue that pro-accountability networks are more effective when they include complementary players such as multinational enterprises, provided their responsible procurement approach moves from a corporate risk management to a developmental logic.

Social Brokerage: Accountability and the Social Life of Information

Social accountability initiatives seek to empower citizens to hold officials to account between and beyond elections, yet often meet with mixed results. This article highlights a neglected dimension in the study of accountability: intermediation by brokers who share and frame information. In contrast to literature that focuses on political brokers in clientelist networks, I introduce the concept of social brokerage: efforts to motivate and to link action by citizens and officials, without the expectation of an electoral return. I illustrate the practice of social brokerage in India, through study of a network of citizen journalists who attempt to mobilize citizen claim-making and to encourage official responsiveness to those claims. I argue that effective social brokerage requires both vernacularization (giving information meaning in local contexts) and interlocution (speaking to and between multiple audiences). This, in turn, rests upon a powerful—but often elusive—combination of community embeddedness and ties to bureaucracy.

Reconciling the social sector with external accountability requirements: Lessons from stewardship theory

Not-for-profit organisations are increasingly being held to account for their social performance. Due to their resource dependency, they generally rely on external financial resources to ensure their missions. This alternative is usually coupled with social accountability requirements from private investors. Given their externally induced nature, social accountability initiatives might result in the implementation of management control systems imported from for-profit organisations without any real consideration – and, consequently, leading to an oversimplification – of the social sector’s characteristics and complexities. Relying on both agency and stewardship theories, we consider how to reconcile external reporting obligations with the characteristics of non-profit organisations. To this end, we use a single qualitative case study of a social organisation responsible for housing services, which recently introduced a reporting system to meet its private investors’ external requirements. We stress the potential risks of implementing an agency theory–based system in a social context and maintain that the expected accountability targets are unlikely to be reached. We also make recommendations to improve the current system by drafting new metrics.

An Integrative Dynamic Framework of Social Accountability: Determinants, Initiatives, and Outcomes

Existing conceptualizations of social accountability lack a comprehensive approach linking the determinants, initiatives, and performance outcomes of social accountability initiatives (SAIs). The present paper attempts to address this gap by developing an integrative dynamic framework of social accountability. The framework posits that the performance outcomes of SAIs influence not only the legitimacy of the SAIs but also shape the interaction effects of determinants on the existing as well as future SAIs. The proposed framework will potentially serve as a springboard to guide future research in better understanding the mechanisms of SAIs.

Social accountability in local government: Lessons from Vuwani (South Africa) and Gweru (Zimbabwe)

What do experiences in South Africa and Zimbabwe teach us about the relationship between social accountability and public participation? The relationship between social accountability and public participation is widely acknowledged as important, yet the nuances that inform such a relationship are not critically discussed. To understand such nuances, this paper critically engages two cases: Vuwani (South Africa) and Gweru (Zimbabwe). The study underscores the importance of social accountability and public participation in local governance. Robust and open citizen engagement is critical to hold the state accountable. Thus, the two cases show how lack of a constructive participatory framework, wherein all relevant stakeholders are given a voice and informed about all developments, is problematic and can cause destructive outcomes in one case and sustained political frustrations in another. Using interviews with various social actors, document analysis and observations to bring to the fore social accountability and public participation nuances, this paper argues that public participation applies in different contexts and forms part of social accountability initiatives which largely depend on the extent of public engagement with non‐state actors.

Social accountability for reproductive, maternal, newborn, child and adolescent health: A review of reviews.

Globally, increasing efforts have been made to hold duty-bearers to account for their commitments to improve reproductive, maternal, newborn, child and adolescent health (RMNCAH) over the past two decades, including via social accountability approaches: citizen-led, collective processes for holding duty-bearers to account. There have been many individual studies and several reviews of social accountability approaches but the implications of their findings to inform future accountability efforts are not clear. We addressed this gap by conducting a review of reviews in order to summarise the current evidence on social accountability for RMNCAH, identify factors contributing to intermediary outcomes and health impacts, and identify future research and implementation priorities. The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42019134340). We searched eight databases and systematic review repositories and sought expert recommendations for published and unpublished reviews, with no date or language restrictions. Six reviews were analysed using narrative synthesis: four on accountability or social accountability approaches for RMNCAH, and two specifically examining perinatal mortality audits, from which we extracted information relating to community involvement in audits. Our findings confirmed that there is extensive and growing evidence for social accountability approaches, particularly community monitoring interventions. Few documented social accountability approaches to RMNCAH achieve transformational change by going beyond information-gathering and awareness-raising, and attention to marginalised and vulnerable groups, including adolescents, has not been well documented. Drawing generalisable conclusions about results was difficult, due to inconsistent nomenclature and gaps in reporting, particularly regarding objectives, contexts, and health impacts. Promising approaches for successful social accountability initiatives include careful tailoring to the social and political context, strategic planning, and multi-sectoral/multi-stakeholder approaches. Future primary research could advance the evidence by describing interventions and their results in detail and in their contexts, focusing on factors and processes affecting acceptability, adoption, and effectiveness.

A strategic approach to social accountability: Bwalo forums within the reproductive maternal and child health accountability ecosystem in Malawi

BackgroundThe majority of documented social accountability initiatives to date have been ‘tactical’ in nature, employing single-tool, mostly community-based approaches. This article provides lessons from a ‘strategic’, multi-tool, multi-level social accountability project: UNICEF’s ‘Social Accountability for Every Woman Every Child’ intervention in Malawi.MethodsThe project targeted the national, district and community levels. Three Civil Society Organisations (CSOs) were engaged to carry out interventions using various tools to generate evidence and political advocacy at one or more levels. This article focuses on one of the social accountability methods – the bwalo forum (a meeting based on a traditional Malawian method of dialogue). A detailed political economy analysis was conducted by one of the co-authors using qualitative methods including interviews and group discussions. The authors conducted in-country consultations and analysed secondary data provided by the CSOs.ResultsThe political economy analysis highlighted several ways in which CSO partners should modify their work plans to be more compatible with the project context. This included shifting the advocacy and support focus, as well as significantly expanding the bwalo forums. Bwalos were found to be an important platform for allowing citizens to engage with duty bearers at the community and district levels, and enabled a number of reproductive, maternal, newborn, child and adolescent health issues to be resolved at those levels. The project also enabled learning around participant responses as intermediate project outcomes.ConclusionsThe project utilised various tools to gather data, elevate community voices, and facilitate engagement between citizen and state actors at the community, district and national levels. This provided the scaffolding for numerous issues to be resolved at the community or district levels, or referred to the national level. Bwalo forums were found to be highly effective as a space for inter-level engagement between citizens and state; however, as they were not embedded in existing local structures, their potential for sustainability and scalability was tenuous. A key strength of the project was the political economy analysis, which provided direction for partners to shape their interventions according to local and national realities and be sensitive to the barriers and drivers to positive action.

Ensuring women follow the money: Gender barriers in extractive industry revenue accountability: The Dominican Republic and Zambia

Social accountability initiatives (SAIs) can be important to help push for oil, gas, and mining revenues to go to communities impacted by extractive industries (EI). Local investments in targeted services and programs can improve development outcomes and address negative impacts caused by EI. Ensuring that women and women’s rights organizations (WROs) are part of SAIs is likewise crucial, without which investments financed by EI revenues may not reflect the needs and interests of women, missing an opportunity to advance women’s rights and gender equality. This article shares preliminary results from a project that involves: (1) research exploring a women’s rights approach to SAIs on EI revenue transparency; and (2) program activities intended to foster joint agenda-setting between WROs and EI revenue transparency civil society organizations (EITCSOs) that distinctly focus on advancing women’s rights. Initial findings suggest that addressing structural barriers to women’s participation, such as socio-cultural norms, women’s lack of ownership of land and resources, gender-insensitive consultation processes, inaccessibility of information, and women’s lack of awareness of their rights, in SAIs related to EI revenue transparency could improve women’s agency. Through this project, WROs and EITCSOs are building advocacy agendas that respond to these barriers to promote women’s rights.

Holding governments accountable for service delivery: the local government councils scorecard initiative in Uganda

Uganda’s Local Government Councils Scorecard Initiative is a strategic social accountability initiative designed to enable citizens to demand excellence of their local governments and enable local governments to respond to citizen demands for effective and efficient service delivery. Begun in 2009, it is one of the signature programmes of Advocates Coalition for Development and Environment (ACODE), a public policy research and advocacy think tank in Uganda. The initiative is implemented in partnership with the Uganda Local Governments Association. The centrepiece of the initiative is the local government council scorecard, a capacity-building tool for assessing the performance of district-level elected officials in accordance with roles and responsibilities set out in the Uganda’s Local Government Act 1997 (as amended). Incorporating multiple links in the supply and demand chain of good governance and accountability – citizens, civil society organisations, local government and central government – the administration of the scorecard and dissemination of performance results is grounded in an action research methodology. Follow the positive reception of the initiative after eight years of implementation in Uganda, it is hoped that other countries will look to adapt this methodology to engage in similar types of social accountability initiatives.

The Quest for Government Accountability and Rule of Law: Conflicting Strategies of State and Civil Society in Cambodia and Serbia

This article deals with the social accountability activities of civil society organizations in Serbia and Cambodia. In both countries, they emerged with the conceptual and financial support of international development agencies; yet, the outputs were mediated by the social and political contexts. Still, these activities have some joint features: they (1) boost both understanding and awareness rather than solely mobilizing social interests; (2) target the interests of individual citizens rather than the interests of social-based groups or classes; (3) promote state cooperation instead of confrontation and (3) insist on the use of technical policy-related tools and mechanisms instead of political mobilization. The social accountability initiatives analyzed here have followed a policy-not-politics or depoliticized approach. As a consequence, they were ineffective in mobilizing citizens and social groups in a manner that would efficiently demand more accountability. On the other hand, governments contested civil society and appropriated its accountability discourses and strategies in an effort that can be read as an attempt to resist imposing government accountability and rule of law and pacifying present and future civic activism.

The community is just a small circle: citizen participation in the free maternal and child healthcare programme of Enugu State, Nigeria

ABSTRACTBackground: There is a gap in knowledge about how citizen participation impacts governance of free healthcare policies for universal health coverage in low- and middle-income countries.Objective: This study provides evidence about how social accountability initiatives influenced revenue generation, pooling and fund management, purchasing and capacity of health facilities implementing the free maternal and child healthcare programme (FMCHP) in Enugu State, Nigeria.Methods: The study adopted a descriptive, qualitative case-study design to explore how social accountability influenced implementation of the FMCHP at the state level and in two health districts (Isi-Uzo and Enugu Metropolis) in Enugu State. Data were collected from policymakers (n = 16), providers (n = 16) and health facility committee leaders (n = 12) through in-depth interviews. We also conducted focus-group discussions (n = 4) with 42 service users and document review. Data were analysed using thematic analysis.Results: It was found that health facility committees (HFCs) have not been involved in the generation of funds, fund management and tracking of spending in FMCHP. The HFCs did not also seem to have increased transparency of benefits and payment of providers. The HFCs emerged as the dominant social accountability initiative in FMCHP but lacked power in the governance of free health services. The HFCs were constrained by weak legal framework, ineffectual FMCHP committees at the state and district levels, restricted financial information disclosure, distrustful relationships with policymakers and providers, weak patient complaint system and low use of service charter.Conclusion: The HFCs have not played a significant role in health financing and service provision in FMCHP. The gaps in HFCs’ participation in health financing functions and service delivery need to be considered in the design and implementation of free maternal and child healthcare policies that aim to achieve universal health coverage.

Civil society, social accountability and service delivery in Zimbabwe

AbstractPost‐2000, the deterioration of Zimbabwe's socioeconomic and political conditions is widely acknowledged as phenomenal and unprecedented. Consequently, government and local authorities are struggling to provide basic services. At the same time, civil society initiatives are promoting transparency and accountability in service delivery. The article explains how civil society coalitions and citizens are promoting and demanding accountability in the delivery of public services by local authorities. In particular, it focuses on four critical issues; namely local authority–citizen engagement, social accountability focus areas, social accountability tools and emerging social accountability issues. The article concludes that civil society‐led social accountability initiatives are effective under conditions of civil society capacity, institutionalization of social accountability by local authorities, and negotiating local political dynamics.

Social Accountability - Taking Stock of All the Stock-Taking and Some Interesting Avenues for Future Practice and Research

Given the enormous popularity of social accountability initiatives and the proliferation of empirical syntheses on social accountability that have been produced over the last few years, it is a good time for taking stock of these stock-takes. This exercise therefore takes a meta approach. It distils some of the main insights from the evidence reviews already in existence, maps areas of agreement, identifies promising opportunities for further practical experiments and offers a commentary – phrased in somewhat provocative terms to enable a spirited discussion - on how the social accountability funding, design and research landscape is evolving and where it could productively venture next.The analysis proceeds as follows: Chapter 1 to 3 set the backdrop and provide a very brief introduction to the concept, its origins, usage over time as well as the common definitions and typologies that are usually associated with it. Chapter 4 moves into the synthesis of existing stock-take exercises on social accountability and distils some of the main insights into five key messages, which are subjected to a critical reflection.Chapter 5 draws out some implications and ideas for what could be worthwhile future trajectories, expansions and experimentations for social accountability with regard to three areas: substantive content, project design and related research strategies (5.1-5.3). Chapter 6 concludes.

Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo: a contextual factor analysis.

BackgroundSocial accountability has to be configured according to the context in which it operates. This paper aimed to identify local contextual factors in two health zones in the Democratic Republic of the Congo and discuss their possible influences on shaping, implementing and running social accountability initiatives.MethodsData on local socio-cultural characteristics, the governance context, and socio-economic conditions related to social accountability enabling factors were collected in the two health zones using semi-structured interviews and document reviews, and were analyzed using thematic analysis.ResultsThe contexts of the two health zones were similar and characterized by the existence of several community groups, similarly structured and using similar decision-making processes. They were not involved in the health sector’s activities and had no link with the health committee, even though they acknowledged its existence. They were not networked as they focused on their own activities and did not have enough capacity in terms of social mobilization or exerting pressure on public authorities or providers.Women were not perceived as marginalized as they often occupied other positions in the community besides carrying out domestic tasks and participated in community groups. However, they were still subject to the local male dominance culture, which restrains their involvement in decision-making, as they tend to be less educated, unemployed and suffer from a lack of resources or specific skills.The socio-economic context is characterized by subsistence activities and a low employment rate, which limits the community members’ incomes and increases their dependence on external support.The governance context was characterized by imperfect implementation of political decentralization. Community groups advocating community rights are identified as “political” and are not welcomed. The community groups seemed not to be interested in the health center’s information and had no access to media as it is non-existent.ConclusionsThe local contexts in the two health zones seemed not to be supportive of the operation of social accountability initiatives. However, they offer starting points for social accountability initiatives if better use is made of existing contextual factors, for instance by making community groups work together and improving their capacities in terms of knowledge and information.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1895-3) contains supplementary material, which is available to authorized users.

Health provider responsiveness to social accountability initiatives in low- and middle-income countries: a realist review.

Social accountability in the health sector has been promoted as a strategy to improve the quality and performance of health providers in low- and middle-income countries. Whether improvements occur, however, depends on the willingness and ability of health providers to respond to societal pressure for better care. This article uses a realist approach to review cases of collective citizen action and advocacy with the aim to identify key mechanisms of provider responsiveness. Purposeful searches for cases were combined with a systematic search in four databases. To be included in the review, the initiatives needed to describe at least one outcome at the level of frontline service provision. Some 37 social accountability initiatives in 15 countries met these criteria. Using a realist approach, retroductive analysis and triangulation of methods and sources were performed to construct Context-Mechanism-Outcome configurations that explain potential pathways to provider responsiveness. The findings suggest that health provider receptivity to citizens' demands for better health care is mediated by health providers' perceptions of the legitimacy of citizen groups and by the extent to which citizen groups provide personal and professional support to health providers. Some citizen groups activated political or formal bureaucratic accountability channels but the effect on provider responsiveness of such strategies was more mixed. Favourable contexts for health provider responsiveness comprise socio-political contexts in which providers self-identify as activists, health system contexts in which health providers depend on citizens' expertise and capacities, and health system contexts where providers have the self-perceived ability to change the system in which they operate. Rather than providing recipes for successful social accountability initiatives, the synthesis proposes a programme theory that can support reflections on the theories of change underpinning social accountability initiatives and interventions to improve the quality of primary health care in different settings.