Strengthening participation and accountability

Actively involving marginalised groups in decision making processes at all levels, and providing them with the opportunity to hold service providers and policy makers accountable for discriminatory practices, corruption or poor quality services, helps to redress inequalities in access to SRH services and ensure that they are acceptable and appropriate.

In practice, representation in the planning processes for SRH services has been limited. A review of community participation and (public) SRH service accountability across developing countries found that participation was restricted to service delivery, and was not extended to the design of policies, legislation and allocation of budgets. Marginalised groups including adolescents, the elderly and the very poor, were not consulted as much as mainstream health organisations. This may be because, even within the forums for participation, they lack the skills, information or representation to have a voice amongst more powerful participants.

To improve their influence on SRH legislation, policy and spending decisions at all levels, it is necessary to strengthen the capacity of marginalised people and of other civil society organisations concerned with SRH including women’s groups, health and human rights groups and elected representatives so they can better negotiate for their demands. Civil society groups should collect evidence to support these demands, support marginalised people to express their concerns, and form alliances to strengthen their representation. The creation of more opportunities and spaces for people to engage in policymaking processes such as independent courts, media and councils can also strengthen participation and accountability.