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Using advocacy and data to strengthen political accountability in maternal and newborn health in Africa

Accountability mechanisms are important for helping Governments and development partners fulfil their commitments and promises to global initiatives. Internationally agreed commitmentsare the means used to build consensus on how to address social and political development challenges, and signature by members states commits then to take action in country. This paper discusses how three regional and global initiatives have influenced government accountability in five out of the six E4A-MamaYe countries (Nigeria, Sierra Leone, Tanzania, Malawi and Ghana). The initiatives considered are:

  • the Commission on Information and Accountability (CoIA) for Millennium Development Goals (MDGs) 4 and 5
  • the Abuja Declaration
  • the Campaign for the Accelerated Reduction in Maternal Mortality in Africa (CARMMA).

Key points:

Through an analysis of accountability mechanisms at country level in response these regional and global initiatives, the paper makes the following key points:

-          Global commitments have no value without real country level action to build accountability into national processes.

-          A combined evidence, advocacy, and accountability approach is required to increase government ownership in meeting commitments.

-          Strong data collection, analysis and presentation mechanisms are required to track progress. Data presented in user-friendly formats, such as scorecards adapted for the audience, can encourage buy-in and help stakeholders to track performance and identify gaps. This was effective in Nigeria, where a state accountability mechanism was developed in Bauchi state, comprising of strategically selected stakeholders, to review and package maternal and newborn health evidence in to scorecards. This fed in to planning cycles and helped track progress on key indicators, and supported advocacy efforts to hold decision makers to account on the Abuja Declaration, which successfully resulted in an increase in the health sector budget allocation to 15%.

-          A range of stakeholders including civil society should play a central role in advocacy and social accountability. In Malawi for example, sustained Civil Society Organisation advocacy contributed to improvements in health budget allocation.

-          Involvement of local or national champions may help increase public and stakeholder attention to government performance. For example, in Ghana the former First Lady along with UNFPA and Ghana Health Service organised 10 regional meetings at which sub-national political leaders were requested to present reports on the state of maternal mortality in their area. This resulted in a comprehensive plan of action and better accountability for progress on improving maternal mortality in their respective districts.

-          Strong implementation mechanisms, funding and tracking of progress is required from the start. For example, it took around 3-5 years before implementation of the MDGs really gained momentum, which was partly due to the time taken for donors’ priorities to shift in line with the MDGs, and delayed tracking of progress to highlight lack of progress in countries.


The paper concludes that although accountability is high on the international agenda, lessons learned from the MDGs and other global initiatives highlight that how countries implement targets and accountability mechanisms are as important as the commitments themselves.  To ensure continued momentum, accountability mechanisms need effective monitoring and coordination, and appropriate consequences for non-performance.

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ten Hoope-Bender, P., Martin Hilber, A., Nove, A., Bandali, S., Nam, S., Armstrong, C., Ahmed, A.M., Chatuluka, M.G., Magoma, M. & Hulton, L. (2016). Using advocacy and data to strengthen political accountability in maternal and newborn health in Africa. International Journal of Gynecology and Obstetrics, 135: 358-364.


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