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Social Accountability Approaches: Supporting CSOs to realise better UHC health outcomes


Societal consensus on the goals of Universal Health Coverage (UHC)
provides communities ‘left behind’ with a potential space to have representation at all levels, and advocate for better health and well-being. Conceptually, this advocacy is not restricted to a single program or dimension of health. Current Global Health Initiatives (GHIs), however, are often program or disease specific, and correspondingly promote Civil Society Organizations (CSOs)’s work in these areas, to the detriment of issues that cut across the health system.

Program and disease focus is totally rational and understandable from the perspective of development assistance for health aiming to maximize measureable results. Further down the health systems pyramid, challenges, demands and resources become unavoidably more integrated. Frontline health workers tackle a vast demand and negotiate the resources of multiple fragmented programs. Overworked and overwhelmed CHWs already deal with more than they can manage in a timely fashion. Finally, communities and households rarely have a say in which health threat
needs to be addressed and where resources best serve them.

Ensuring platforms for the voice and collective action of service users is central to improving the performance of frontline service provision. It helps to redress power asymmetries and has positive system strengthening effects. It provides critical intelligence to guide investments that equitably strengthen systems. There is growing consensus that social accountability can provide these platforms for global health’s ultimate customer (communities left behind living in fragile, rural remote or urban poor
contexts or affected by stigma and discrimination that are at the heart of the UHC).

On behalf of Gavi, GFATM, GFF, UHC2030 and SUN CSO constituencies, we are asking GHI donors to consider country based social accountability approaches as a transformative mechanism to strengthening community engagement, empowerment and service delivery outcomes during replenishment and funding commitments. With quality design and implementation, this can offer redress to policy blind spots, improve service and even potentially provide actionable signals to build PHC systems more holistically, beyond individual GHI program needs.

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