How can social accountability improve family planning programs?

In June 2016, the Evidence Project collaborated with the Accountability Research Center at American University, International Planned Parenthood Federation, and the Reproductive Health Supplies Coalition to host a learning exchange on “Transparency and Accountability Strategies and Reproductive Health Delivery Systems.” Over 40 practitioners and researchers discussed what the fields of transparency, participation, and accountability (TPA) and reproductive health can learn from each other and, more specifically, how TPA methods can be applied to improve RH supply chains.

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Social accountability methods have great potential to improve family planning programs and services, including responsiveness of providers, patient-centered quality of care, availability of resources, and service access, coverage, and satisfaction. There are gaps, however, in understanding how social accountability interventions effect change and, importantly, how they can be applied in different contexts. A point of discussion, led by Laura Reichenbach of the Evidence Project, was applying implementation science to better understand the impact of social accountability methods on family planning programs and services, and how those changes occur.

Implementation science is concerned not just with outcomes but also with how those outcomes were reached. Implementation science studies are structured to account for and be responsive to real world contexts, and – in the words of learning exchange attendees – can help focus on “how people actually experience the operation of complex systems.”  These features make implementation science a well-suited approach for examining social accountability interventions – particularly those focused on reproductive health – and the complex issues of power and relationships those interventions raise.

The Learning Exchange was part of the Evidence Project’s larger portfolio on social accountability, which also includes a synthesis of existing evidence, a retrospective study of the Healthy Action Project in Uganda, a prospective study comparing two reproductive health projects in Uganda, and a collaboration with WHO to examine how social accountability in the context of FP programs influences contraceptive uptake and use.

The Evidence Project’s initial studies and collaborations with practitioners have informed the project’s recent activities, and are helping the Evidence Project team better map the pathways through which social accountability can improve family planning programs. As Vicky Boydell reflected in the report from the recent AU meeting, “By outlining the assumed pathway through which change takes hold (both technical and political), measures and outcomes can be linked to the theory of change, and data on the assumed change processes better captured.” By fleshing out the theories of change that underpin social accountability interventions and more concretely defining the processes and changes that occur, the Evidence Project is helping to explore how social accountability can be used to expand access to and choice of quality, voluntary family planning programs and services.