Citizen Engagement in Health Service Delivery: Exploring Approaches and Outcomes

The Partnership for Transparency Fund (PTF) hosted a seminar November 3, 2016 to explore the experience of citizen engagement in health service delivery. Representatives from USAID and the World Bank participated as discussants.

The inclusion of citizen engagement in development programs, including those supporting the health sector, is based on the premise that giving citizens a voice will help ensure that programs are tailored to their needs, will build a greater sense of ownership by the community, and will make service delivery more accountable, all of which will contribute to more effective service delivery.

“Reviews of evidence of impact of citizen engagement instruments on health service delivery and health outcomes are consistently cautionary in drawing conclusions regarding the impact of any single citizen engagement instrument or even a group of instruments,“ explained Judith Edstrom, PTF Adviser and author of Engaging Citizens in Health Service Delivery: A Literature Review.  “And outcomes are generally not attributable to any single citizen engagement instrument because programs usually employ a variety of approaches at the same time, alongside improvements in service delivery.”

img_3348Nevertheless, evidence from Engaging Citizens in Health Service Delivery: A Literature Review confirms the potentially positive, although variable, impact of citizen engagement on health outcomes. Successful interventions usually focus on raising community awareness of targeted health issues and encouraging dialogue and community ownership. Key factors for successful citizen engagement include buy-in by service providers and good project design that takes into consideration differing contexts.

“When we engage citizens, we do a much better job of getting those who are the hardest to reach onto [HIV] treatment and keeping them on treatment,” said Kenneth Sklaw, Senior Capacity Building Advisor of the Systems and Program Sustainability Division in the Office of HIV-AIDS of USAID.  Sklaw acknowledged that many HIV-AIDS initiatives are still clinically led, but the sector is becoming more supportive to listening to citizens rather than focusing solely on one-way communications to stimulate behavioral change. He encouraged practitioners to engage with non-traditional, or even seemingly opposed, social forces to foster greater buy-in by communities.

Shomikho Raha, Senior Public Sector Governance Specialist in the Governance Global Practice at the World Bank urged the audience to focus on the goal of social accountability over the method or tools.  “It’s not about one instrument or another,” he said;  “what’s important is understanding what works in different contexts and sectors.” The key is to focus on improved service delivery performance.

Jeff Thindwa, Program Manager of the World Bank Global Partnership for Social Accountability and participant at the seminar, noted, “there has been a concerted effort to move beyond our traditional social accountability approaches and be much more sector literate, so when we apply these tools, we give the sectors what they really need.” He added, “social accountability works much better when it is flexible, adaptive and customized.”

Seminar participants, representing bilateral and multilateral agencies and a number of academic and not-for profit organizations, stressed the importance of both analysis and experimentation with different approaches on both the supply and demand fronts. Funding support needs to encourage organic approaches rather than externally induced solutions. Indeed, this is one of the major challenges for practitioners of good governance in development.

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