Strengthening voice and accountability in the health sector

Cathy Green with Mini Soyoola, 2008

Voice and accountability are vital if health services are to be improved. Citizens need to be able to claim improvements in services while providers and policy-makers need to be accountable for their decisions and actions. Also, services need to respond to the ideas, concerns and suggestions of clients.

Awareness of rights was low among the general public when the Partnership for Transforming Health Systems (PATHS) programme started working in Nigeria in 2002. Mechanisms that allowed clients to challenge poor quality health services were largely absent, and health providers and policy-makers lacked incentives to respond appropriately to client needs. The result was very low utilisation of public health facilities and a breakdown in the relationship between health facilities and communities.

This paper looks at how seven different systems strengthening and service delivery improvement initiatives helped strengthen citizen participation and voice, and enhanced accountability in the PATHS states from 2003 to 2008. The brief also discusses the findings of a review of these initiatives carried out toward the end of the PATHS programme.

Produced as part of the Partnership for Transforming Health Systems (PATHS) programme.