Implementing social accountability for contraceptive services: lessons from Uganda
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RESEARCH ARTICLE
Open Access
Implementing social accountability for contraceptive services: lessons from Uganda Victoria Boydell1* , Nanono Nulu2, Karen Hardee3 and Jill Gay4
Abstract Background: Growing evidence shows that social accountability contributes to improving health care services, with much promise for addressing women’s barriers in contraceptive care. Yet little is known about how social accountability works in the often-complex context of sexual and reproductive health, particularly as sex and reproduction can be sensitive topics in the open and public formats typical of social accountability. This paper explores how social accountability operates in the highly gendered and complex context of contraceptive care. Methods: This exploratory research uses a case study approach to provide a more grounded understanding of how social accountability processes operate in the context of contraceptive information and services. We observed two social accountability projects that predominantly focused on contraceptive care in Uganda over a year. Five instruments were used to capture information from different source materials and multiple respondents. In total, one hundred and twenty-eight interviews were conducted and over 1000 pages of project documents were collected. Data were analyzed and compiled into four case studies that provide a thick description of how these two projects operated. Results: The case studies show the critical role of information, dialogue and negotiation in social accountability in the context of contraceptive care. Improved community and health system relationships, community empowerment, provider and health system responsiveness and enhanced availability and access to services were reported in both projects. There were also changes in how different actors related to themselves and to each other, and contraceptive care, a previously taboo topic, became a legitimate area for public dialogue. Conclusion: The study found that while social accountability in the context of contraceptive services is indeed sensitive, it can be a powerful tool to dissolving resistance to family planning and facilitating a more productive discourse on the topic. Keywords: Gender, Social accountability, Contraception, Case studies, Uganda
Background Greater accountability is increasingly considered as central to improving health service delivery, patient experience and health outcomes in low- and middle-income countries [28, 59, 63]. In particular, social accountability, here defined as ongoing collective efforts to engage * Correspondence: [email protected] 1 Global Health Centre, Geneva Graduate Institute, Chemin Rigot 2, 1202 Geneva, Switzerland Full list of author information is available at the end of the article
public institutions for accountability in the provision of public goods [26], has reportedly improved service provision and utilization, and health care provider behavior and responsiveness [5, 6, 22, 25, 40, 42]. Studies have also documented enhanced rights literacy, improved social cohes
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