Strengthening social accountability in ways that build inclusion, institutionalization and scale: reflections on FHS exp
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(2020) 19:220
EDITORIAL
Open Access
Strengthening social accountability in ways that build inclusion, institutionalization and scale: reflections on FHS experience Sara Bennett1* , Eizabeth Ekirapa-Kiracho2, Shehrin Shaila Mahmood3, Ligia Paina1 and David H. Peters1
Abstract This editorial provides an introduction to the special issue on “Lessons about intervening in accountability ecosystems: implementation of community scorecards in Bangladesh and Uganda”. We start by describing the rationale for this work in the two study countries. While our project, the Future Health Systems (FHS) project, had been working over the course of more than a decade to strengthen health services, particularly for low income households in rural areas, our teams increasingly recognized how difficult it would be to sustain service improvements without fundamental changes to local accountabilities. Accordingly, in the final phase of the project 2016–2018, we designed, implemented and assessed community scorecard initiatives, in both Bangladesh and Uganda, with the aim of informing the design of a scalable social accountability initiative that could fundamentally shift the dynamics of health system accountability in favor of the poor and marginalized. We describe the particular characteristics of our approach to this task. Specifically we (i) conducted a mapping of accountabilities in each of the contexts so as to understand how our actions may interact with existing accountability mechanisms (ii) developed detailed theories of change that unpacked the mechanisms through which we anticipated the community scorecards would have effect, as well as how they would be institutionalized; and (iii) monitored closely the extent of inclusion and the equity effects of the scorecards. In summarizing this approach, we articulate the contributions made by different papers in this volume. Keywords: Social accountability, Community score cards, Scale-up, Sustainability, Inclusion
Introduction Over the past decade there has been a growing consensus that stronger accountability mechanisms are critical for improving health services and health [1–4]. While, on the one hand, there is evidence of the significant impact that strengthened accountability for health can have, there is also a substantive and growing body of evidence that documents the challenges involved in strengthening accountability, especially in terms of scaling up interventions [5, 6]
* Correspondence: [email protected] 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, 614 N Wolfe St, Baltimore, MD, USA Full list of author information is available at the end of the article
integrating approaches into existing health systems [7–9] and ensuring inclusiveness [8]. In 2016, a UK Department for International Development-funded research consortium, Future Health Systems (FHS) had the opportunity to address this question of social accountability through our work program in Uganda and Bangladesh. The FHS consortium was launched in 2005, and had previously
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