Building a meaningful evidence base about what works

Accountability is a field of growing interest to AMDD and to maternal health advocates more broadly. AMDD’s ability to span the fields of human rights, policy analysis, and public health research offers a broad and unique perspective on the challenges of promoting accountability in program implementation and in ensuring equitable access in maternal and newborn health. 

Accountability and transparency are increasingly evoked in global health, as evidenced by statements in the Countdown 2015 reports, the UN Commission on Information and Accountability, reports of the UN High Commissioner for Human Rights, and resolutions of the UN Human Rights Council.   

AMDD’s challenge is to push for the conversion of this high level commitment into meaningful programs and initiatives on the ground. While many other programs to promote accountability are focused on ensuring compliance with broad national commitments or global level targets, AMDD’s focus is on operationalizing accountability at the local level. Accountability should be meaningful to poor women seeking needed services in their local health facility.

AMDD is engaged in several research activities to document the relationship between accountability and health system access and effectiveness. Its contributions include: 

  • Working with the Ifakara Health Institute of Tanzania to test approaches to reduce disrespectful and abusive treatment of women giving birth in public facilities in Tanzania. For more on this issue, click here.

  • Supporting SAHAYOG, a grassroots women’s health rights organization, to conduct a pilot project using interactive voice technology and geographic information systems to track in real time requests for illicit fees for maternal healthcare in Uttar Pradesh, India. View a technical brief detailing the setup and management of the Mera Swasthya Meri Aawaz (My Health, My Voice) project here. View a blog post authored by AMDD and SAHAYOG staff on social accountability vs. government monitoring in maternal health here.

  • Working with international and grassroots NGOs to understand how and in what contexts health systems become more accountable in response to citizen demands. This has included collaboration with CARE on their Community Score Card program, with World Vision International on Citizen Voice and Action, with Center for the Study of Equity and Governance and Health Systems (CEGSS) in Guatemala, with Namati in Mozambique, and with Nazdeek in Assam, India.  Through this collaborative research and documentation, we hope to learn how communities and organizations can better encourage and collaborate with their governments to improve health services.  Read an abstract with preliminary data from Zambia here.

  • Examining accountability within the systems for assigning posts and granting transfers to healthcare workers and administrators as part of its “Accountability at the Frontlines” project.

  • Hosting a ‘think-in’ on “Community Health Worker Voice, Power, and Citizens’ Right to Health” in collaboration with the Accountability Research Center (ARC) at American University. Read more about the workshop, which explored CHWs' potential to serve as accountability agents, in this blog authored by meeting participants.

For more on AMDD’s perspective on accountability, please see the following publications authored by AMDD staff:

  • Freedman, L. P., & Schaaf, M. (2013). Act global, but think local: accountability at the frontlines. Reproductive health matters, 21(42), 103-112. Available here.

  • Schaaf, M., Topp, S. M., & Ngulube, M. (2017). From favours to entitlements: community voice and action and health service quality in Zambia. Health Policy and Planning. Available here.


Making Change

Using research to inform our advocacy

We advocate for a human rights-based approach to address problems within the health system that limit access to life-saving care for women and newborns.

Our research activities in emergency obstetric care (EmONC), human resources for maternal survival, and other areas of the health system help form the evidence base we use when advocating for policy and program change. We also draw upon real world experiences in service delivery from our earlier field projects that focused on improving access to EmOC in 18 developing countries.