Accountability for health equity: galvanising a movement for Universal Health Coverage

IDS Bulletin: 49.2

Editors: Nelson, E., Bloom, G., and Shankland, A.
Publisher: IDS
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Since the publication of the 2004 World Development Report, a range of different attempts have been made to make the design, prioritisation and delivery of health services more accountable to different stakeholders. However, complex politics and power dynamics can limit or skew people’s abilities to access services or hold them to account, particularly for poor and marginalized people.

In July 2017, the Institute of Development Studies (IDS) hosted a workshop in collaboration with Future Health Systems, the Impact Initiative, the Open Society Foundation, Unequal Voices, and Health Systems Global, to develop new thinking and practical approaches to improving accountability relationships and processes in favour of greater health equity.

This new issue of the IDS Bulletin, which draws on research enabled by the ESRC-DFID strategic partnership and beyond, focuses on three principal themes that emerged from this workshop as needing particular attention. First, the nature of accountability politics ‘in time’ and the importance of longitudinal approaches to change. Second, the contested politics of ‘naming’ and measuring accountability, and the intersecting dimensions of marginalisation and exclusion that are missing from current debates. Third, the shifting nature of power in global health and new configurations of health actors, social contracts, and the role of technology.

Read the articles by ESRC-DFID researchers:

Accountability and Generating Evidence for Global Health: Misoprostol in Nepal - Raj Sharma Jeevan, Rekha Khatri, Ian Harper
Key Considerations for Accountability and Gender in Health Systems in Low- and Middle-Income Countries - Linda Waldman, Sally Theobald, Rosemary Morgan
Reducing Health Inequalities in Brazil’s Universal Health-Care System: Accountability Politics in São Paulo – Vera Schattan Coelho

Multimedia:

For the first time in IDS Bulletin history, themes are explored not only in text but also through multimedia contributions. This expansion into other forms of communication is explicitly aimed at galvanising larger numbers of people in a movement towards Universal Health Coverage (UHC) and the linked agenda of accountability for health equity. The content of this issue reflects the fact that while the desired outcome might be the same – better health for all – accountability strategies are as diverse as the contexts in which they have developed.

Denise Namburete, who leads the Mozambican study of the ESRC-DFID funded project Unequal Voices: The Politics of Accountability for Health Equity in Brazil and Mozambique, and Erica Nelson (IDS), made the following documentary:

Holding a Health System to Account: Voices from Mozambique (A Documentary)

Visit the IDS bulletin website and IDS website for further information.

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Focus projects:

A nurse explains clinic procedures to waiting patients

The accountability politics of reducing health inequities: Learning from Brazil and Mozambique

Principal Investigator: Alexander Shankland. Lead Organisation: Institute of Development Studies

Co-investigators: Gerald Bloom; Vera Coelho; Denise Namburete; Hayley Nan MacGregor; Rosemary McGee; Anuradha Joshi

New norms and forms of development: brokerage in maternal and child health service development and delivery in Nepal and Malawi

Donors and international organizations involved in dispersing foreign aid now routinely employ contracts with service providers, in international health service development and delivery. The research aims to understand the nature of the impact these actors have in global health development objectives.

Chinese medicine, Edward N. Johnson, licensed under CC BY-SA 2.0

Tracing pharmaceuticals in South Asia: regulation, distribution and consumption

This multi-disciplinary project combines anthropological fieldwork with archival and interview-based research to investigate the conditions that make possible continuing inappropriate use of medicines in South Asia.

Biomedical and Health Experimentation in South Asia: Critical Perspectives on collaboration, governance and competition

An exploratory qualitative study of three South Asian countries to illuminate how social forms and organisations in health are created, managed and sustained, including key roles in the development of medicine and health services knowledge.

A colorized scanning electron micrograph of Mycobaterium tuberculosis, the bacteria that cause TB.

Identifying barriers to TB diagnosis and treatment under a new rapid diagnostic scheme

Tuberculosis services were modified in response to the findings from Nepal, Yemen and Ethiopia to promote equitable and increased access to health services for under-served populations, with particular focus on impacts on women.

A health work in Bangladesh gives a presentation to women and children

ICTs and the changing health knowledge economy: how people find health information in Bangladesh

Principal Investigator: Gerald Bloom. Lead Organisation: Institute of Development Studies

Co-investigators: Simon Batchelor; Abbas Bhuiya; Linda Waldman; Nigel Scott; Sabrina Rasheed

IDS Bulletin