What do we mean by ‘social accountability’ and why does it matter?
While you may not use the term ‘accountability’ very often, you are probably involved in the activity of accountability on a daily basis. Accountability refers to the requirement of a person providing services or having some authority, to provide information or justification for their actions or services to another actor who has the power to make these demands and apply sanctions for non-compliance. So when you complain about the poor quality of the food you receive from a restaurant, or the poor quality of the service from a government department, you are holding them accountable.
Social accountability refers to the ability of civil society and citizens to hold public officials and public service providers accountable for the provision of services, including health services. Social accountability has emerged as an important means of strengthening community participation and community level health systems in particular, and as a key link between community users and public service providers.
Why does it matter?
Social accountability has the potential to improve the effectiveness and quality of services provided, to improve the responsiveness of public agencies and government to citizen demands and expectations, and to increase the ability of disadvantaged or poorly served sections of the community to claim their rights.
This may sound fine in theory, but does it work in practice? Can you think of circumstances where you may have wanted to hold someone accountable, but were unable to do so? What are the potential constraints to social accountability? Brinkerhoff and Wetterberg (2015) identify three key areas that may constrain accountability, which they term demand related, supply related and contextual.
(1) Demand related. How to enable a community receiving poor services to mobilise, come together, and to demand improvements? It may well be that more educated and advantaged communities are better able to demand better services, and have a stronger sense of their ability to make those demands.
(2) Supply related. To what extent does the agent providing the services or in authority have the capacity and ability to provide the services, or exercise the authority as required? Do they have the resources?
(3) Contextual. What is the overall context of state-society relations, and to what extent does the community have trust in their government and regard the authority of state providers as legitimate?
What can we do to strengthen social accountability?
Three key strategies have been identified as steps to strengthen social accountability:
- information collection and analysis;
- presentation to officials or providers;
- action planning and negotiation, including follow up where the response is considered insufficient.
Some of the strategies in each step are set out in the following table, which is an edited excerpt taken from the paper by Lodenstein, et al. (2017).
You can see that strategies can be grouped into two main approaches: that of dialogue with local providers, and that of advocacy towards local authorities.
Identify examples of actions to strengthen social accountability, either from your own experience, or from the examples in the papers available to view in the ‘see also’ section below.
How effective were those actions?
What made them effective, or what prevented them from being effective?
Share your thoughts in the comments section below
Brinkerhoff, DW & Wetterberg, A, 2016, ‘Gauging the effects of social accountability on services, governance, and citizen empowerment’, Public Administration Review, vol. 76, no. 2, pp. 274-286.
Lodenstein, E, Dieleman, M, Gerretsen, B & Broerse, JE, 2016, ‘Health provider responsiveness to social accountability initiatives in low-and middle-income countries: a realist review’, Health Policy and Planning, vol. 32, no. 1, pp. 125-140.
© Nossal Institute for Global Health at the University of Melbourne