• Strengthening participation and accountability

Strengthening participation and accountability

This policy brief, published by the Initiative for Sexual & Reproductive Rights in Health Reforms, examines the ways in which community participation and accountability have been implemented in developing country health sector reforms, focusing on sexual and reproductive health services. Findings include that community participation has usually been restricted to health programme management and service delivery, and has not been extended to the design of policies, legislation, and allocation of budgets. Community representatives have at best been consulted, but have not had decision-making powers. Marginalised groups, and sexual and reproductive rights groups, have not been consulted as much as mainstream health organisations.

The brief argues that the World Bank, national governments and donors need to move beyond paying lip service to issues of community participation and service accountability in health sector reforms. It recommends setting up new structures to strengthen participation and accountability mechanisms within policy, planning and implementation. Such structures could be either independent commissions, which might have more scope for promoting participation and accountability, or task forces within governments, which would be easier to set up. Participants should include women’s health and rights groups – especially those led by marginalised groups; health researchers; progressive members of professional associations; consumer rights groups; and health policy makers.

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