Implementing a Social Accountability Approach for Maternal, Neonatal, and Child Health Service Performances in Ethiopia: A Pre-Post Study Design

Social accountability approaches, such as the community scorecard (CSC), can improve the performance of health systems in low-income countries by providing a mechanism for obtaining and incorporating community input. This longitudinal study assessed the effects of CSCs implemented by primary health care units (PHCUs) on health system performance in Ethiopia.

Key Findings

• The average community scorecard measurements on health workforce behavior toward patients, availability of services, patient waiting time, facility infrastructure, ambulance service, and cleanliness and safety of the health facility significantly improved over 1 year at primary health care units.
• Of the 10 key maternal neonatal and child health performance indicators measured, 9 were found to improve as a result of implementing the community scorecard approach.

Key Implications

• The implementation of a community scorecard approach enhances a culture of social accountability, transparency, and engagement of citizens in planning, implementing and evaluating maternal, neonatal, and child health services. In addition, it improves the negotiation capacities and involvement of both community members and health workers, resulting in increased availability and utilization of health services.
• Program managers and development partners should continue their support for the government-led social accountability interventions to ensure the sustainability of improvements in maternal, neonatal, and child health outcomes.

Authors: Mesele D. Argaw, Binyam D. Fekadu, Elias Mamo, Melkamu G. Abebe, Deirdre Rogers, Anteneh Demelash, Aklilu A. Ayele, Zinabu Reda, Amare S. Tareke, Alemu M. Erfo, Wegayehu W. Wonjalo, Temesgen A. Bele, Assefa Ayede, and Lidya G. Abebe