Building a meaningful evidence base about what works

Accountability and transparency are increasingly evoked in global health. The Countdown to 2015 and Countdown to 2030 reports, reports of the UN Commission on Information and Accountability for Women’s and Children’s Health (here) and the UN High Commissioner for Human Rights (here and here), resolutions of the UN Human Rights Council, and Every Woman Every Child’s Global Strategy for Women’s, Children’s and Adolescent Health all call for greater accountability in maternal and newborn health programs.

AMDD promotes the translation of this high level commitment into participatory and impactful initiatives on the ground. Accountability should be meaningful to poor women seeking needed services in their local health facility.

Social Accountability

AMDD is particularly committed to advancing social accountability, or civic engagement for improved health care. Available research shows that social accountability efforts can lead to improvements in health care at the local level, including in respectful care.

AMDD partners with international and grassroots NGOs to understand how and in what contexts health systems become more accountable in response to citizen demands. This has included collaboration with World Vision International on Citizen Voice and Action; the Center for the Study of Equity and Governance and Health Systems (CEGSS) in Guatemala; Namati in Mozambique; and SAHAYOG and Nazdeek in India.  Through this collaborative research and documentation, we hope to learn how communities and organizations can better challenge, encourage, and collaborate with their governments to improve health services. 

In addition to social accountability, AMDD explores complex health systems challenges that social accountability practitioners identify as particular challenges. Topics explored have included posting and transfer (P&T), informal payments for healthcare services, and community health workers (CHWs).

  • Posting and Transfer: We examined accountability within the systems for assigning posts and granting transfers to healthcare workers and administrators. Additional information on P&T can be found on our Human Resources page.
  • Informal Payments: In some parts of the world, laboring women are asked to make informal payments in order to receive delivery care to which they are entitled. These demands hinder efforts to improve the utilization and quality of maternity care services. For that reason, AMDD works to better understand the factors behind these requests and how they are perceived by women and providers alike.
  • Community Health Workers: AMDD & partners examine the potential role of CHWs to act as accountability agents. After conducting a scoping of the field, AMDD and the Accountability Research Center (ARC) at American University hosted a ‘think-in’ on “Community Health Worker Voice, Power, and Citizens’ Right to Health.” Read more about the workshop, which explored factors that can promote or hinder CHWs’ ability to and interest in fostering health system accountability, in this blog authored by meeting participants. A report on the think-in is also available on ARC’s website.

For more on AMDD’s research and collaborations relating to accountability, please refer to the following open access publications.

Peer reviewed articles:

  • Freedman, L. P., & Schaaf, M. (2013). Act global, but think local: accountability at the frontlines. Reproductive health matters, 21(42), 103-112. Available here.
  • Schaaf, M., & Freedman, L. P. (2013). Unmasking the open secret of posting and transfer practices in the health sector. Health policy and planning, 30(1), 121-130. Available here.
  • Dasgupta, J., Sandhya, Y. K., Lobis, S., Verma, P., & Schaaf, M. (2015). Using technology to claim rights to free maternal health care: Lessons about impact from the My Health, My Voice Pilot project in India. Health & Human Rights: An International Journal, 17(2). Available here.
  • Sheikh, K., Freedman, L., Ghaffar, A., Marchal, B., el-Jardali, F., McCaffery, J., Olivier de Sardan, J., Dal Poz, M., Flores, W., Garimella, S., & Schaaf, M. (2015). Posting and transfer: key to fostering trust in government health services. Human resources for health, 13(1), 1. Available here.
  • Kwamie, A., Asiamah, M., Schaaf, M., & Agyepong, I. A. (2017). Postings and transfers in the Ghanaian health system: a study of health workforce governance. International journal for equity in health, 16(1), 85. Available here.
  • Abimbola, S., Olanipekun, T., Schaaf, M., Negin, J., Jan, S., & Martiniuk, A. L. (2017). Where there is no policy: governing the posting and transfer of primary health care workers in Nigeria. The International journal of health planning and management, 32(4), 492-508. Available here.
  • Schaaf, M., Topp, S. M., & Ngulube, M. (2017). From favours to entitlements: community voice and action and health service quality in Zambia. Health Policy and Planning. Available here.
  • Schaaf, M., Fox, J., Topp, S.M., Warthin, C., Freedman, L. P., Robinson, R.S., Thiagrarajan, S., Scott, K., Maboe, T., Zanchetta, M., Ruano, A. L., Kok, M., Closser, S. (2018). Community health workers and accountability: reflections from an international “think-in”. International Journal for Equity in Health. 17:66. Available here.
  • Sriram, V., Topp, S. M., Schaaf, M., Mishra, A., Flores, W., Rajasulochana, S. R., & Scott, K. (2018). 10 best resources on power in health policy and systems in low-and middle-income countries. Health policy and planning, 33(4), 611-621. Available here.





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