Strengthening accountability: A mapping of studies in Sub-Saharan Africa

This is the first paper in the MamaYe - Evidence for Action (E4A) maternal and newborn health (MNH) accountability series and provides a structured review of types of MNH accountability mechanisms implemented and evaluated in Sub-Saharan Africa.

This paper describes the types, implementation, effectiveness and future potential of MNH accountability mechanisms in Sub-Saharan Africa, for improving MNH outcomes in the 2030 development agenda. 

The review provides a conceptual framework presenting types of accountability and the mechanisms through which they operate, which are:

Performance Accountability: eg. implemented through maternal and perinatal death surveillance and response (MDSR), professional associations or the use of assessment tools and scorecards.

Political/Democratic Accountability: eg. through social accountability mechanisms (e.g. through civil society campaigns), political accountability (through tracking government commitments)  and human rights (eg. treaties).

Financial Accountability: feg. through use of financial and budget tracking mechanisms and performance-based financing and vouchers.

The authors conclude that the most effective approaches involve collective implementation of performance accountability, reinforced through social and political advocacy and financial accountability. Efforts were found to be most successful when they:

  • worked through local stakeholders
  • were evidence based
  • were context specific
  • had clear social and political aims for action
  • involved multiple stakeholders; and
  • had locally defined outcomes.
Martin Hilber, A., Blake, C., Bohle, L.F., Bandali, S., Agbon, E. & Hulton, L. (2016). Strengthening accountability for improved maternal and newborn health: A mapping of studies in Sub-Saharan Africa. International Journal of Gynecology and Obstetrics, 135: 345-357.
Strengthening accountability: A mapping of studies in Sub-Saharan Africa