Engendering Accountability: Upholding Commitments to Maternal and Newborn Health

This report was commissioned by the Bill & Melinda Gates Foundation and Children’s Investment Fund Foundation to improve understanding of the current landscape of maternal and newborn health accountability programmes.  The report provides an in-depth review of accountability processes at the regional, national, and sub-national levels, with a particular focus on civil-society led approaches. It describes the roles of citizens, civil society and government and provides recommendations for strengthening accountability for maternal and newborn health.  Case-studies of approaches currently being used in India, Nigeria, and Uganda are presented. Global MechanismsThe report highlights that global accountability mechanisms are fundamental to accountability efforts at the regional, national, and sub-national levels. Global initiatives underpin in-country processes, and can create an enabling environment for civil society to advocate for improved accountability. The report recognises various global initiatives that embrace the value of accountability, including the consultation process to develop the Sustainable Development Goals, the Every Newborn Action Plan, and A Promise Renewed.  It highlights Citizen’s Hearings as a way to promote civil society engagement, raise citizens’ voices, and mobilise participation. Despite these successes, the report notes the need for a more collaborative and coherent approach.  It calls for a shift from self-reports to the institutionalisation of transparency and accountability.  As described, reporting burden could be minimised by improving integration within existing systems. Regional MechanismsThe report outlines the ways in which regional accountability mechanisms can encourage linkages from the country level to the global level.  It highlights the role of the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA) in increasing the availability of accessible data and comparable indicators across African countries through the CARMMA Scorecards and online data platform African Health Stats. As explained, this promotes healthy competition, encourages advocacy, and can be used for celebrating progress. The Africa Health Budget Network (AHBN) is showcased as a promising model for developing capacity in the area of budget accountability.  The report outlines the role of AHBN in mobilising civil society in Africa to engage African leaders to increase budget transparency and accountability, both regionally and nationally. Country MechanismsThe report describes that in-country civil society action is fundamental to improving MNH outcomes and advocates that civil society must be adequately resourced and supported to play its central role. The Nigeria Independent Accountability Mechanism (NIAM) is highlighted in the Nigeria case study.  NIAM is part of the civil society organisation Accountability for Maternal, Newborn, and Child Health in Nigeria (AMHiN), which is supported by MamaYe-Evidence for Action.  NIAM assesses progress against commitments made under the 2010 Global Strategy for Women and Children’s Health and creates linkages among stakeholders across states to influence and accelerate progress in maternal, newborn, and child health. RecommendationsThe report outlines that evidence underpins all successful accountability campaigns.  The MamaYe-Evidence for Action scorecards are featured as key tools to provide immediate, useable information that can be fed back to service providers and leaders on the ground, as well as to local and national decision-makers.  Various scorecards are described, including the Malawi District Dashboards, the Sierra Leone Facility Improvement Team (FIT) Assessments and Quality of Institutional Care (QUIC) Tool, and Ghana Scorecards and MNH Councils. The report concludes by recommending 20 concrete actions to strengthen accountability mechanisms for maternal and newborn health. Click here to read the report for free.  You can also download several companion pieces, including the Nigeria Country Case Study. Global Health Visions. (2015). Engendering Accountability: Upholding Commitments to Maternal and Newborn Health. New York: Global Health Visions.