Social accountability: What are the lessons for improving family planning and reproductive health programs?

The concept of accountability is increasingly important in the family planning (FP) and reproductive health (RH) field. While much recent discussion has focused on developing global or national-level mechanisms for accountability, less emphasis has been placed on understanding the relevance of “social accountability” approaches for ensuring access to, and quality of, FP/RH services. Social accountability refers to the efforts of citizens and civil society to scrutinize and hold duty bearers (politicians, government officials, and service providers) to account for providing promised services, actions most often at the subnational or community level. In the FP/RH field, this concept builds on a rich history of community involvement and civil society participation. This working paper draws on the debates and emerging lessons of the social accountability field to better understand its potential for improving FP/RH programs. It synthesizes the literature across a variety of sectors including the health sector, and on broad review papers as well as individual studies related to FP/RH programs

Strengthening the evidence base on social accountability for improving family planning and reproductive health programs

The concept of accountability is important in the family planning (FP) and reproductive health (RH) sector, building on a rich history of community involvement and civil society participation. There are three categories of FP/RH accountability initiatives: tracking donor and government financial commitments, tracking national-level program implementation, and tracking service-delivery outcomes. The third category, often referred to as “social accountability,” includes the efforts of citizens and civil society to scrutinize and hold duty bearers to account for providing promised services, most often at the subnational or community levels. Social accountability is premised on the assumption that increased and targeted citizen and civil society engagement and action will force public officials to act on their commitments. The Evidence Project convened an expert consultation, “Strengthening the Evidence Base on Social Accountability for Improving Family Planning and Reproductive Health Programs” in July 2014 hosted by the International Planned Parenthood Federation, an Evidence Project partner, in London. This meeting report notes that the aim was to develop an understanding of social accountability for improving FP/RH programs and to identify gaps in the evidence base that can be addressed by the Evidence Project

The social life of the Pill: An ethnography of contraceptive pill users in a central London family planning clinic.

This is an ethnographic study of users of the oral contraceptive pill at a London specialist clinic. The pill was introduced in the United Kingdom in 1964 and is currently provided free of charge to twenty-five percent of British women. It has had a major impact on the sexual and reproductive lives of people in contemporary Britain. This ethnographic analysis of the pill contributes to our understanding of the cultural meanings and practices associated with the pill and shows some of the fundamental assumptions and expectations of pill users about their lives, including particularly ideas of femininity and nature. In this thesis, the central question of how the 'natural facts' of femininity are constantly negotiated in both private and public domains will be explored through the related examples of pregnancy, sex, and menstruation, as experienced and conceptualised by the women in this study. The ways in which these women use, think and talk about the pill demonstrate their efforts to balance the often contradictory demands made upon their bodies and persons in various social fields as they participate in social terrains once inhabited primarily by men. Therefore, a key argument will be that the social life of the pill is inseparable from the constitution of femininity and female bodies more broadly. This thesis contributes to the anthropological theory of "natural facts" by providing an example of how they are mobilised by women using the pill. It suggests that "natural facts" continue to provide a privileged ground for femininity. It adds to research on gender in the UK by illustrating the strategies employed by women at both symbolic and relational levels as they attempt to control their identities in the face of changing conventions and institutions. Finally, it is hoped that this ethnographic illustration of the experiences of pill users will provide insights relevant to the work of public health practitioners

Getting Intentional about Intention to Use: A Scoping Review of Person‐Centered Measures of Demand

In recent years, there has been much reflection on the measures used to assess and monitor contraceptive programming outcomes. The meaning and measurement of intention-to-use (ITU) contraception, however, has had less attention and research despite its widespread inclusion in many major surveys. This paper takes a deeper look at the meaning and measurement of ITU around contraception. We conducted a scoping review guided by the following questions: What is the existing evidence regarding the measurement of ITU contraception? What definitions and measures are used? What do we know about the validity of these measures? We searched databases and found 112 papers to include in our review and combined this with a review of the survey instruments and behavioral theory. Our review found growing evidence around the construct of ITU in family planning programming and research. However there are inconsistencies in how ITU is defined and measured, and this tends not to be informed by advances in behavioral theory and research. Further work is needed to develop and test measures that capture the complexity of intention, examine how intention differently relates to longer-range goals compared to more immediate implementation, and demonstrate a positive relationship between ITU and contraceptive use

Multi-disciplinary support for families with complex needs and children on the edge of care in the UK: a mixed methods evaluation

Families on the ‘edge of care’ face complex intersecting issues that can work against positive changes and lead to the re-involvement of social care. A multi-disciplinary service working alongside social work and community services teams to respond to the multiple needs of vulnerable families was evaluated. A mixed methods evaluation drew upon service data and cost saving modelling, interviews and a survey of social care practitioners. The evaluation data relates to the period February 2021 -July 2022 and covers 81 families, of whom 41 families had their cases closed. There was a high level of engagement with families with complex issues who struggle to engage with community-based services, with improvements in parental and child risk factors. The programme was successful for many of the families that engaged and half of the children had their safeguarding level stepped down. Significant net cost savings were estimated for avoided care placements plus additional savings such as reduced social care staff hours. The service was clearly seen as an effective and valuable service by social care practitioners and was characterised as having good working relationships, good communication and distinct but complementary roles. The service offered a positive support service model to families based on trust, consistency and immediacy

Civil society involvement in family planning: A review of global programming and evidence

Civil society plays an important role in the provision of high quality family planning programs. Civil society organizations (CSOs) are often involved in expanding services, raising awareness, generating demand, and advocating for an improved enabling environment to ensure women and men have full, free and informed choice to determine whether and when they have children. Despite being a valued partner in many programs, there is little evidence on the contribution that CSOs have made to family planning and reproductive health (FP/RH) programs in terms of the types of activities undertaken and the impact that they can have. This review summarizes the evidence on civil society’s engagement in improving family planning programs and highlights the possible opportunities to further strengthen civil society engagement in family planning programs

Mapping the extent to which performance-based financing (PBF) programs reflect quality, informed choice, and voluntarism and implications for family planning services: A review of PBF operational manuals

Expanding access to and use of voluntary family planning (FP) services is a well-established global health goal- it is a specific target under the Sustainable Development Goal (SDG) of good health and well-being, an integral component of Every Woman Every Child (EWEC), and the overall objective of the Family Planning 2020 (FP2020) partnership, among other initiatives. | One promising approach for achieving global voluntary FP goals is performance-based financing (PBF), which deploys financial incentives to the health system to improve service availability, utilization, and quality as well as addressing some public financial management bottlenecks by directly targeting resources to facilities based on performance. | Setting global voluntary FP goals implies following a rights-based approach to family planning, which uses a set of standards and principles to guide program assessment, planning, implementation, monitoring, and evaluation that enables individuals and couples to decide freely and responsibly the number and spacing of their children, to have the information and services to do so, and to be treated equitably and free of discrimination. | While both PBF, which uses financial disbursements to incentivize health service delivery and quality, and rights-based programming have informed efforts to strengthen and scale FP services, there are gaps in understanding the linkages between PBF and a rights-based approach (RBA) to FP services. To address this gap, a review of performance-based financing (PBF) operations manuals was undertaken together with an analysis of PBF indicators relevant to FP services. This and another report (Mapping the extent to which performance-based financing (PBF) programs reflect quality, informed choice and voluntarism and implications for family planning services: A review of indicators) assess whether existing FP indicators are sensitive to the principles associated with an RBA

Methods to measure effects of social accountability interventions in reproductive, maternal, newborn, child, and adolescent health programs: systematic review and critique.

BACKGROUND: There is no agreed way to measure the effects of social accountability interventions. Studies to examine whether and how social accountability and collective action processes contribute to better health and healthcare services are underway in different areas of health, and health effects are captured using a range of different research designs. OBJECTIVES: The objective of our review is to help inform evaluation efforts by identifying, summarizing, and critically appraising study designs used to assess and measure social accountability interventions' effects on health, including data collection methods and outcome measures. Specifically, we consider the designs used to assess social accountability interventions for reproductive, maternal, newborn, child, and adolescent health (RMNCAH). DATA SOURCES: Data were obtained from the Cochrane Library, EMBASE, MEDLINE, SCOPUS, and Social Policy & Practice databases. ELIGIBILITY CRITERIA: We included papers published on or after 1 January 2009 that described an evaluation of the effects of a social accountability intervention on RMNCAH. RESULTS: Twenty-two papers met our inclusion criteria. Methods for assessing or reporting health effects of social accountability interventions varied widely and included longitudinal, ethnographic, and experimental designs. Surprisingly, given the topic area, there were no studies that took an explicit systems-orientated approach. Data collection methods ranged from quantitative scorecard data through to in-depth interviews and observations. Analysis of how interventions achieved their effects relied on qualitative data, whereas quantitative data often raised rather than answered questions, and/or seemed likely to be poor quality. Few studies reported on negative effects or harms; studies did not always draw on any particular theoretical framework. None of the studies where there appeared to be financial dependencies between the evaluators and the intervention implementation teams reflected on whether or how these dependencies might have affected the evaluation. The interventions evaluated in the included studies fell into the following categories: aid chain partnership, social audit, community-based monitoring, community-linked maternal death review, community mobilization for improved health, community reporting hotline, evidence for action, report cards, scorecards, and strengthening health communities. CONCLUSIONS: A wide range of methods are currently being used to attempt to evaluate effects of social accountability interventions. The wider context of interventions including the historical or social context is important, as shown in the few studies to consider these dimensions. While many studies collect useful qualitative data that help illuminate how and whether interventions work, the data and analysis are often limited in scope with little attention to the wider context. Future studies taking into account broader sociopolitical dimensions are likely to help illuminate processes of accountability and inform questions of transferability of interventions. The review protocol was registered with PROSPERO (registration # CRD42018108252)

A Rapid Review on the Success Factors for Mobilising Personalised Care with Frail Older Adults

This rapid review provides an overview of the evidence around the factors that influence successful cultural change that ensure the mobilisation of personalised care plans for frail older adults or older adults with multiple morbidities. This rapid review has been produced for the Aging Well stewardship team developed by the Mid and South Essex Health and Care Partnership. This review involved a systematic search for academic research that address the question: what factors influence a team’s success in implementing personalised care plans for frail older adults with frailty and other long-term conditions? Ten studies published since 2014 were analysed. The search strategy, inclusion and exclusion criteria are detailed in the methodology section. The rapid review reports on the factors discussed in the studies for successful change to implementing personalised care and using person-centred approaches. These factors are (1) planning and goal setting, (2) monitoring and evaluation, (3) inclusivity in care, (4) training and development, (5) adaptability and flexibility of services, (6) use of a biopsychosocial model, and (7) provision of resources. Most of these factors can be implemented to support staff members adopt personalised care in their everyday work. This review may also interest future research aimed to investigate the most effective factors and how to operationalise the success factors in different contexts, including a cultural change in personalised care for frail older adults

Mapping the extent to which performance-based financing (PBF) programs reflect quality, informed choice and voluntarism and implications for family planning services: A review of indicators

Expanding access to and use of voluntary family planning (FP) services is a well-established global health goal–it is a specific target under the Sustainable Development Goal (SDG) of good health and well-being, an integral component of Every Woman Every Child (EWEC), and the overall objective of the Family Planning 2020 (FP2020) partnership, among other initiatives. | One promising approach for achieving global voluntary FP goals is performance-based financing (PBF), which deploys financial incentives to the health system to improve service availability, utilization, and quality as well as addressing some public financial management bottlenecks by directly targeting resources to facilities based on performance. | Setting global voluntary FP goals implies following a rights-based approach to family planning, which uses a set of standards and principles to guide program assessment, planning, implementation, monitoring, and evaluation that enables individuals and couples to decide freely and responsibly the number and spacing of their children, to have the information and services to do so, and to be treated equitably and free of discrimination. | While both PBF, which uses financial disbursements to incentivize health service delivery and quality, and rights-based programming have informed efforts to strengthen and scale FP services, there are gaps in understanding the linkages between PBF and a rights-based approach (RBA) to FP services. To address this gap, a review of PBF operations manuals was undertaken together with an analysis of PBF indicators relevant to FP services. This and another report (Mapping the extent to which performance-based financing (PBF) programs reflect quality, informed choice, and voluntarism and implications for family planning services: A review of PBF operational manuals) assess whether existing FP indicators are sensitive to the principles associated with an RBA