For all the work that has gone towards making it possible for all people to lead healthy lives, we are falling far short of that goal. The Sustainable Development Goals set out an ambitious agenda to achieve universal health coverage for all – and (under the new African director-general) WHO has made it a priority for Africa - but how will this goal be reached when we have seen already the ease with which reformed health services and refreshed health resources still fail to reach the people who need them most?
Accountability relationships oriented towards achieving health equity have the potential to shape a better future, but efforts to build these often face barriers that derive from misaligned incentives and skewed power dynamics. With the idea of finding ways forward to tackle these barriers in mind, we will be gathering together with colleagues across the spectrum of research, policy and practice – and from around the world – to discuss ‘Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity’ at an international workshop, supported by the Impact Initiative, and taking place at the Institute of Development Studies (IDS) from 19 to 21 July.
For those of us working on the Unequal Voices project – Vozes Desiguais in Portuguese - which examines the politics of accountability in health systems in Brazil and Mozambique and is enabled by the ESRC-DFID Joint Fund for Poverty Alleviation - this workshop will provide a great opportunity to discuss with other researchers, practitioners and opinion shapers working in a variety of contexts and countries around the world how accountability can be strengthened to ensure delivery of better health services. We will be able to critically examine the practices and politics that shape accountability in health systems from the local to the global levels, talking to people who are at the forefront of delivering these services in really challenging contexts. That is why we have taken the lead in organising the workshop.
All of us believe – and have seen first-hand – that we are stronger together. That is why we organised a workshop in Maputo in October 2016, which brought together researchers, citizen activists and officials of the Ministry of Health to explore practical ways for local initiatives to strengthen government efforts to improve access to health services. It is also why we decided to bring together a wide range of partners in the global south and north to encourage mutual learning on effective strategies for strengthening accountability for health equity.
Accountability matters. It matters that citizens should be able to exercise their rights to demand politicians and public services be accountable, and that there are mechanisms in place which allow this. And when there are accountability failures, such as the Grenfell Fire in the UK or the recent debt crisis in Mozambique or charges of corruption in Brazil, examining why these things happened and learning how to avoid them in future matters.
However, accountability means different things to different people, and efforts to strengthen it draw on many different - and sometimes contradictory - perspectives shaped by history, language and experience.
This leads us to ask: What can we – those working in different areas of accountability practice, policy and research – learn from each other?
The upcoming event brings close to 90 people together. The people sitting around the table will represent the many diverse voices across the health sector and beyond, bringing experience from around 20 different countries. We aim to catalyse innovative thinking and create space for new partnerships to emerge, strengthening national and international efforts to tackle health inequities and secure universal health coverage.
Local accountability politics
The workshop theme on local accountability politics is a key component of Unequal Voices. The recent boom in social accountability interventions has stimulated an impressive wave of innovation in local accountability practice, often centred on the use of tools such as community scorecards. A community scorecard is a citizen-driven accountability measure for the assessment, planning, monitoring and evaluation of service delivery. However, such interventions have also attracted criticism for being insufficiently attuned to the social, political and power relations shaping local accountability outcomes, for failing to achieve a sustainable fit with formal accountability structures within health systems, and for ignoring the higher-level constraints affecting the ability of local-level providers to respond to community feedback.
By discussing how power and politics shape accountability in health systems with other experts from different fields, we hope to find a common set of reference-points within which to exchange emerging insights. By doing so we are getting a step closer towards ensuring that better-quality health services reach the poorest and most marginalised people in countries such as Brazil, Mozambique, and elsewhere. This event, like the Unequal Voices project, supports efforts to translate national and international commitments to achieve universal health coverage into better access to high priority services by the poor and marginalised.
Ms Denise Namburete from Nweti Communication for Health, Dr Vera Coelho from the Brazilian Center of Analysis and Planning (Cebrap), Dr Alexander Shankland and Dr Gerald Bloom from IDS all work on the Unequal Voices project.
This blog was written with the kind assistance of: Karine Gatellier (Nutrition Coordinator) and Erica Nelson (Research Officer, Health and Nutrition) based at the Institute of Development Studies, IDS in the UK.
- The Unequal Voices project was designed to address the ESRC-DFID core research question "what political and institutional conditions are associated with effective poverty reduction and development, and what can domestic and external actors do to promote these conditions?"