South Asia is home to nearly a quarter of the world’s population and is a region of dynamic economic growth, yet it performs relatively poorly on health and nutrition indicators. As a potential route towards addressing this poor performance, a range of accountability initiatives has been implemented to improve service delivery in the health and nutrition sectors.
The project synthesised in this report started from the overall premise that studies of accountability initiatives should be rooted in an understanding that the state is not distinct from society but is embedded in prevailing power dynamics and social relations. The report sketches some of the accountability issues facing the health and nutrition sectors in India, Pakistan and Bangladesh, before homing in on social accountability practice in the three countries.
The authors narrow down to micro-level the political processes at play within community-based interventions and actions. This proves useful in drawing out some of the key considerations for the design and analysis of such programmes, and highlights four factors:
- the need to understand community heterogeneity (rather than assuming homogeneity, as many interventions do)
- the role of community collective action and/or its role in coercion or ‘noisy protest’ in effecting change
- the ways in which cooperation, capacity and commitment affect the community and frontline provider relationship, and the ability and willingness to deliver to meet demands
- the ways in which clientelism and other such extant local political structures form the backdrop against which accountability actions play out