India’s Healthcare Delivery Can Improve If Frontline Workers Are Held Accountable

A central tenet of democracy is that it enables citizens to reward or punish their lawmakers for delivering, or failing to deliver, essential goods and services that contribute to a society’s health and economic well-being. In principle, lawmakers should be motivated to ensure that frontline workers such as teachers or health workers deliver these goods and services to citizens. However, as we in India know all too well, a large number of factors can get in the way of such accountability. But what if it was possible to implement a better, more direct system of accountability in a manner that is scalable nationally?

A  large study that we conducted in rural Uttar Pradesh shows that a system of “social accountability” can lead to significant improvements in key maternal and child health outcomes. Accountability of panchayat leaders and frontline workers was increased by informing citizens about services they were entitled to and by facilitating community meetings that brought them together. Over a period of 1-2 years, our study found that information provision combined with community engagement led to significant improvements in full immunisation rates among young children and higher institutional deliveries among pregnant women.

Social accountability is an innovation in governance that enables members of the local community to hold frontline service providers accountable. One key component of social accountability is providing information to citizens about their community’s health and education outcomes, their rights to receive public sector services, and the responsibilities of panchayat leaders and frontline workers. Another key component is providing citizens with a mechanism for redressal of their grievances, often through facilitated community meetings held on a regular basis. The idea to give power to the people isn’t new – a number of social movements, in India and globally, have been organising public hearings and transparency initiatives.

As part of the World Bank-supported Uttar Pradesh Health Systems Strengthening Project (UPHSSP), we collaborated with UP’s State Institute of Rural Development (SIRD) to help develop a social accountability intervention and rigorously evaluate its impact. The objective of the programme was to improve delivery of key maternal and child health and nutrition services in villages with poor underlying health outcomes and to reduce rates of childhood malnutrition.-The Print