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Grievance redress mechanisms (GRMs) in the public sector are institutionalized processes designed to enable people to complain about and seek redress for services they rightfully should have received. This paper reviews evidence on GRMs from around the world, focusing on mechanisms attached to public services and programs in the Global South, where they are relatively new and emerging fast. GRMs matter in particular in the Global South because they are increasingly widespread and found in...

In the last 20 years, social accountability initiatives have facilitated the inclusion and participation of marginalised groups in governance processes. This Policy Briefing focuses on how and what factors prove effective in strengthening women’s voice in processes holding public service providers accountable. We argue that initiatives must: (a) build technical and other forms of capacity amongst women; (b) change formal rules on women’s inclusion; (c) apply political economy analysis to...

In this paper, we explore the use of a governance diaries methodology to investigate poor households’ interactions with authority in fragile, conflict and violence-affected settings in Mozambique. The research questioned the meanings of empowerment and accountability from the point of view of poor and marginalised people, with the aim of understanding what both mean for them, and how that changes over time, based on their experiences with governance. The study also sought to record how poor...

This paper aimed at estimating the resources required to implement a community Score Card by a typical rural district health team in Uganda, as a mechanism for fostering accountability, utilization and quality of maternal and child healthcare service.

Abstract: The central aim of this text is to show the impact institutions have on the performance of the health sector in Mozambique. The text shows that of the social determinants of health, institutions play a central role in the performance of the Mozambican health sector—and, through it, economic and social development—particularly for the poorer and more vulnerable, such as children, women, the disabled, and the elderly. It is also argued that the deficiencies and inefficiencies of the...

Este texto tem por objectivo central mostrar o impacto que as instituições têm no desempenho do sector da Saúde em Moçambique. No texto demonstra-se que, de entre os Determinantes Sociais da Saúde, as instituições têm um papel central no desempenho do sector da Saúde — e, por seu intermédio, no desenvolvimento económico e social — dos moçambicanos, em especial dos mais pobres e mais vulneráveis, como as crianças, as mulheres, as pessoas com deficiência e os idosos. Argumenta-se também que as...

Background: Legal empowerment and social accountability are two strategies that are increasingly used to address gaps in healthcare in low- and middle-income countries, including failure to provide services that should be available and poor clinical and interpersonal quality of care. This paper is an explanatory case study of a legal empowerment effort that employs community paralegals and trains Village Health Committees (VHCs) in Mozambique. The research objective was to explore how...

Background How do governance interventions that engage citizens in public service delivery planning, management and oversight impact the quality of and access to services and citizens’ quality of life? This systematic review examined high quality evidence from 35 citizen engagement programmes in low- and middle-income countries that promote the engagement of citizens in service delivery through four routes: participation (participatory priority setting); inclusion of marginalised groups;...

Inequality is a key political issue of our times. It has political consequences, fuelling conflict and raising legitimacy chal‑ lenges for regimes around the world, in democratic and non‑demo‑ cratic settings alike. At the centre of these challenges is the question of accountability: who can be held accountable, on what basis, how and by whom for tackling or failing to tackle which inequalities. In the field of global health, inequality has long been a key issue. A significant body of work —...

This article aims to understand the inversion of roles between the state and citizens, by exploring its historical roots and current implications for processes of social accountability in Mozambique, particularly in the health sector. This is a practice-based reflection grounded in the evidence collected through the implementation of Community Scorecards in the health sector in 13 districts of Mozambique. The evidence has revealed a transfer of responsibilities from local governance...

Social accountability in the health sector has been promoted as a strategy to improve the quality and performance of health providers in low- and middle-income countries. Whether improvements occur, however, depends on the willingness and ability of health providers to respond to societal pressure for better care. This article uses a realist approach to review cases of collective citizen action and advocacy with the aim to identify key mechanisms of provider responsiveness. Purposeful...

Empirical evidence of tangible impacts of social accountability initiatives is mixed. This meta-analysis reinterprets evaluations through a new lens: the distinction between tactical and strategic approaches to the promotion of citizen voice to contribute to improved public sector performance. Field experiments study bounded, tactical interventions based on optimistic assumptions about the power of information alone, both to motivate collective action and to influence the state. Enabling...

The Citizen Engagement Program (CEP) in Mozambique is an empowerment and accountability program aiming to improve the quality of health and education services through supporting citizens to monitor them. The program supports citizens to engage with service providers to address identified problems; it also aims to generate evidence for policy and program improvement at the local and national levels. This case study is structured in three main sections. The first section provides a background...

Since its emergence from a brutal, 17-year civil war, Mozambique’s process of political reform has faced a number of challenges. The first has been to empower ordinary Mozambicans by allowing them to participate in a democratic system and enabling them to voice their demands to the state and hold it accountable. The second has been to rebuild a state with the capacity to respond to citizen demands effectively. And given the long history of violent division, a third challenge has been to...

The IDS Participation and Health and Social Change Groups convened a workshop in October 1999 to share experience with the use of participatory approaches in enhancing accountability in the health sector, and to explore some of these challenges. The articles in this bulletin reflect some of the richness of experience on the ground in building effective participation, as well as some of the many issues that arise in moving towards more active citizen engagement with service provision. They...