Effective accountability is essential to drive the change needed to achieve the Sustainable Development Goals and improve health outcomes, especially for women and children. Our approach to accountability has evidence at its core. We use sound evidence to develop a common understanding with the people and communities we work with, and then jointly determine appropriate actions to achieve change. The responses of governments and health partners, including civil society, are monitored and reported, forming of a continuing cycle of evidence gathering, use and action.
We have applied this approach at global, regional, national, sub-national and community levels to achieve better health outcomes. For a truly accountable system to be in place, all of the following components need to work together, driven by health partners:
Accessible evidence; the availability of sound and usable evidence is at the core of our approach.
- Accountability structures; evidence alone is not enough to bring about effective decision-making. The process requires an accountability structure to review and scrutinise data and build relationships between key partners including civil society.
- Open discussion of evidence; effective scrutiny of evidence requires open and transparent discussion between different groups focussed on finding a solution.
- Advocacy; action is supported by advocacy which actively engages those affected by a particular issue. Advocacy can take the form of public facing campaigns, media engagement, and political messaging which harnesses public opinions and puts pressure on decision-makers to act.
- Monitoring and reporting; commitments and responses need to be monitored and reported to complete the accountability cycle.
The Africa Health Budget Network (AHBN) is a coalition of organisations and individuals which came together in 2014 to strengthen civil society engagement in health budget processes in Africa. We support the AHBN to pull together data relating to health budgets from a range of sources to produce scorecards, infographics, briefs and other accessible materials to advocate for better health spending. In 2016 we supported AHBN to launch the campaign #ValueOurHealth which calls on African governments to increase access to budget information. In Uganda, the #ValueOurHealth campaign contributed to a 43.73% increase in the 2016/17 health sector budget.
Our E4A-MamaYe programme supported civil society and government partners to build on existing networks and create a State-Led Accountability Mechanism in Bauchi State, Nigeria (BASAM) to hold the state government to account for commitments to increase the health budget allocation. Based on evidence, BASAM called for at least 15% of budget allocation and release of funds to be directed at health in 2016. As a result, Bauchi is one of the first states in Nigeria to fulfil the 2001 Abuja Declaration commitment of 15% budget allocation to health.
Facility Health Committees (FHCs) in Nigeria and Malawi have been formed with support from Options across more than 862 communities. FHC volunteers work collaboratively with staff to improve quality of care, access and community involvement in decision-making. 90% of FHCs across eight states in Nigeria are now improving facility management.
In Uganda, the #ValueOurHealth campaign contributed to a 43.73% increase in the 2016/17 health sector budget
E4A-MamaYe supported Bauchi state to become one of the first states in Nigeria to fulfil the 2001 Abuja Declaration commitment of 15% budget allocation to health
90% of FHCs across eight states in Nigeria are now improving facility management
Dr Babatunde SegunDr Babatunde Segun is a public health physician with over 22 years' experience, particularly in adolescent reproductive health, and maternal and newborn health. He is Country Director for the Evidence for Action (E4A) programme in Nigeria, responsible for the effective coordination of efforts across evidence, advocacy and accountability in maternal and newborn health. Tunde has worked in collaboration with WHO, UNFPA, UNICEF, the World Bank, and various government ministries, as well as national and local NGOs. He is a member of various national coordinating bodies on maternal and reproductive health in Nigeria.
Sara Bandali, DrPHSara Bandali has over 15 years’ experience in health sector development, including research, policy development and programme design and implementation. She has worked within government, for implementing organisations and the UN. Sara has expertise in maternal and child health, HIV/AIDS, malaria, community health, health systems strengthening, and water supply and sanitation. She has facilitated policy dialogue on cross-sectorial initiatives including HIV/AIDS and gender and early childhood development. Sara is a leading expert on use of evidence and development of accountability mechanisms to advocate for better maternal and newborn health services.
Rachel CullenRachel Cullen is a population and health specialist with 20 years’ experience providing monitoring, evaluation and research support to international and UK health sector organisations. She has skills in methodological design, data collection and analysis for the evaluation of studies ranging from small-scale pilots to large district-wide quantitative and qualitative surveys. She combines technical monitoring and evaluation skills with practical experience as a UK NHS commissioner, performance manager and trustee of health services and applies her understanding of the challenges in health service delivery in the UK to promoting improved quality of care in Africa and Asia.