Metrics details. Social accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services.
In many countries, health facility committees HFCs provide the accountability interface between health providers and citizens or users of health services. The paper is based on a cross-case comparison of 11 HFCs across the three countries. The HFCs were purposefully selected based on the past presence of community participation support programs. The cases were derived from qualitative research involving document analysis as well as interviews and focus group discussions with health workers, citizens, committee members, and local authorities.
Most HFCs facilitate social accountability by engaging with health providers in person or through meetings to discuss service failures, leading to changes in the quality of services, such as improved health worker presence, the availability of night shifts, the display of drug prices and replacement of poorly functioning health workers. Social accountability practices are however often individualised and not systematic, and their success depends on HFC leadership and synergy with other community structures.
Most HFCs in this study offer a social accountability forum, but the informal and non-systematic character and limited community consultation leave opportunities for the exclusion of voices of marginalised groups. More inclusive, coherent and authoritative social accountability practices can be developed by making explicit the mandate of HFC in the planning, monitoring, and supervision of health services; providing instruments for organising local accountability processes; strengthening opportunities for community input and feedback; and strengthening links to formal administrative accountability mechanisms in the health system.
Peer Review reports. Since the Alma-Ata Declaration on Primary Health Care, participation has been a central theme of health policy and programming. Health service users are increasingly seen as citizens who should be allowed to voice their concerns actively, to shape health services and policies in the public interest and hold health providers and policymakers accountable [ 2 , 3 ]. The expectations of this form of accountability referred to as social accountability are high, in particular in countries where health systems face persistent service delivery failures [ 4 ].
