Social accountability sourcebook - chapter 4: Social accountability in the health sector
2006
The World Bank
The 1993 World Development Report (WDR), Investing in Health,, described strengthening accountability as one of the core elements of health sector reforms. Since then, both participation and accountability have become increasingly popular and part of strategic plans for developing and transitioning countries’ health sectors. This popularity has been reinforced by pressure from civil society, bilateral and multilateral donors, and governments in the hopes of more effective, efficient and equitable access to health care. The WDR 1993 suggested competition, decentralization, community financing and oversight mechanisms as ways of strengthening accountability. However, a recent paper analyzed these suggestions and concluded that none of these initiatives had enhanced health service accountability and that participation and accountability in the health sector need rethinking.
Social accountability approaches operationalize and strengthen direct accountability relationships between citizens (the users of health services), policy-makers and service providers. They help to overcome significant challenges such as weak citizen’s voice and oversight, and lead to better informed policy decisions, responsible management and leadership, and more efficient and responsive investment decisions. The MDGs for health will succeed only if the business as usual strategy is changed and the right to demand health, as well as the capacity and willingness to respond to them, is strengthened.
Keywords: health services, health care
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