Social accountability in health sector

For improved performance as well as realise the rights and entitlements of citizens to public goods such as health, improving the accountability of institutions and systems is essential. Social accountability approaches at the micro or meso level may mitigate the effects of poor service organisation and governance. It may also provide the means to address corruption. In the health sector a variety of public-representation or “social accountability” mechanisms have been developed including public hearings and community monitoring of health facilities. As a social accountability tool, public hearings aim at promoting transparency and accountability of public authorities in addressing the needs of the citizens. It can be thought of as a way of removing asymmetric information and thereby, empowering citizens with information, who can be expected to be in a better bargaining position than before. Also, presence of a large number of citizens in the public hearing creates a collective pressure on the public officials, who respond to the grievances expressed by the citizens and try to address these.

In the public hearings, usually a Corruption Prevention Committees (CPCs) invites public officials of a few government agencies and the citizens of the same locality and allows the citizens to express grievances regarding public service delivery to the concerned government officials, and service providers take necessary measures to resolve it. The committee consists of people from across the society including teachers, religious leaders and former government officials. However, there is almost no empirical research on the reach, process, and consequences of the hearings for evidence-informed evaluation.

The Public Hearings may be supplemented by comprehensive monitoring of health service activities by the community in upazila (sub-district) where public hearings on health issues have been/would be conducted. Community being vital in a people-centred health system, their engagement with it helps in raising accountability of the system as well as redressal of much of their grievances. The monitoring will involve several stages: i) rapport building and community discussion ii) formation of community monitoring teams and progress review committee iii) knowledge translation and developing monitoring plan iv) Data collection and analysis, and engaging the community in dialogue on the results found v) measurement of the impact.

The combination of these two analyses is expected to chart a clear pathway towards accountability and good governance in the delivery of UZ health services and reduce/alleviate corruption in its various forms.