Expanding community engagement and social accountability to boost governance and health in EthiopiaAnn K. Bloome, Nigist Livi · March 24, 2023
In international development, social accountability works as an approach that promotes change by engaging communities and strengthening civil society to hold governments accountable. This approach positions accountability as a social relationship between a powerholder such as a government official, and communities served by that decision-maker—intending to increase responsiveness to local needs. Programs funded by the World Bank and the U.S. Government use social accountability approaches to stimulate ongoing dialogue and build trusted relationships between local government and community groups. This often aims to improve service delivery, although at times the emphasis is on a strengthened state-society relationship rather than services.
Engaging civil society in social accountability approaches enables ongoing gathering of feedback from community members on services—health services as well as education, transport, water and sanitation. Tools such as a scorecard and/or accountability committees are used to develop, implement and monitor action plans to address community-identified concerns. Creating space for dialogue on community needs enables community groups to hold local governments and leaders accountable for improving services.
Pact’s global health and governance programming show how this cross-sectoral approach can improve community-level health outcomes. In Nepal, the Social Accountability in the Health Sector (SAHS) project supported multisectoral dialogue and social accountability practices, including training civil society advisory groups on local planning and budget expenditure tracking. This strengthened the capacity of civil society organizations (CSOs) to understand and analyze local government budgets. SAHS also surfaced a need to formalize accountability in guidelines such as allocating budget to social accountability processes, and in policies for gender and social inclusion.
In Nigeria, the State Accountability for Quality Improvement Project enhanced accountability and community engagement in the primary health care system in Gombe State. With Ward Development Committees that oversee primary health centers, the project's social accountability approach involved the use of a community scorecard, with one success being the mobilization of resources for ambulances. Use of the scorecard raised community involvement and promoted government responsiveness, improving trust and transparency between service users, providers and decision-makers. Outcomes included increasing antenatal care visits and delivery of infants in health facilities, which helped reduce the neonatal mortality rate.
In Ethiopia, since 2006 the World Bank has involved many CSOs in its Ethiopian Social Accountability Program, which has formed Social Accountability Committees and Joint Action Plans to improve community welfare. Pact works with many of these same CSOs and, based on our experience developing action plans with them under peacebuilding programming, we see the potential for social accountability to also improve community-level health and social welfare outcomes.
Social accountability approaches cultivate a relationship between citizens and service providers. Pact enhances these relationships by strengthening CSO capabilities in advocacy and representation, with the aim of improving service delivery and community wellbeing. CSOs play a key role as liaisons between citizens and local government representatives, facilitating collaborative processes that help local governments to reach and respond to the needs of the most vulnerable in any community.
Our programming promotes relationships for accountability among authorities and communities. Under the Strengthening Institutions for Peace and Development project, we facilitated a dialogue process between community and government representatives, which included developing joint action plans and commitment monitoring workshops. Dialogue Initiative outcomes included entrepreneurship training of more than 2,000 unemployed youth, followed by loans to start businesses from a Woreda Saving and Credit Office.
Building on this experience, under the ongoing Selam Ekisil (SEEK II) project, we facilitate dialogue for conflict prevention and management and reconciliation in border areas. SEEK II reinforces stability through social cohesion, working with “boundary partners” in cross-border peace committees. Members include youth, women, traditional leaders and local government representatives. SEEK II has strengthened partner capacity to represent community rights and hold peace actors responsible.
These grassroots approaches from Pact’s peacebuilding work can be applied multi-sectorally, enabling positive action. We understand the importance of recurrent processes for developing and updating action plans and see feedback mechanisms as a pathway to social accountability. Our partner CSOs have stressed the importance of institutionalizing social accountability processes, supporting the implementation of action plans to improve relationships and services. Given the significant gaps in power relationships between government representatives and users of services, dialogue and agreement on action represent achievement. In the health sector, such structured feedback and planning would help build trust.
Leveraging social accountability in Ethiopia has great potential to address persistent service quality issues that continue to affect neonatal health outcomes despite improvements in maternal and child health. We stand ready to build on our peacebuilding programming, with a network of hundreds of CSOs that consistently engage their communities and can enhance social accountability programs by identifying and addressing community needs and concerns.