Worldwide, there has been a renewed dedication to improving the health of women and children through reducing maternal mortality and achieving universal access to reproductive health services. Over the years, there has been a broad agreement on the technical interventions needed to improve maternal health, including access to quality, affordable health systems and services. Barriers to improving maternal health include limited availability and quality of health information and services; and gender and social norms, cultural acceptability, cost and distance, which reduce utilization even when services exist. However, focus on technical interventions alone to mitigate these barriers is not enough.  

A critical strategy to address many of these barriers is meaningful engagement of citizens, particularly the most marginalized, in shaping health policies, programs, and practices. This involves the establishment of systems of mutual accountability that are participatory, equitable and accountable and that support interaction between the community, health facilities and the government — the foundation for good governance. Social accountability planning emphasizing community mobilization, potentially empowers women to assert their entitlements to health, and creates environments where policy-makers and service providers recognize the urgency of policy implementation, interventions, and services. It also opens possibilities for better service-user interfaces and opportunities for highlighting mismatches between top-down services and bottom-up health needs (Murthy 2008).

Our partners in DRC have involved community members and key informants in designing social accountability initiatives for improving maternal health service provision and responsiveness.The research team involved community members in an advisory process with a predefined focus of setting interventions for improving social accountability in maternal health services in two health zones of DRC.  Community members and community health workers were involved in consultation, prioritization, integration and programming. From the social accountability mechanisms in DRC we learn that establishing systems of mutual accountability that are participatory, equitable and accountable and that support interactions between communities, health facilities and the government are needed. Strengthening the governance system is required if women are to be benefit from the maternal health initiatives.

As we enter the sustainable development era, the global community needs to be accountable to achievement of the Sustainable Development Goals (SDGs). Meaningful accountability is everyone’s responsibility. As we aim high and look toward 2030, we need to build clear roles, responsibilities and expectations in 2016.

Ensuring good community governance practices are in place will reflect the global health community’s due diligence to improving maternal health services worldwide.

References

1. CARE Governance Programming Framework, 2010–2011
2. Murthy, R.K. 2008. Strengthening accountability to citizens on gender and health. Global Public Health, 3, (suppl 1)