Maternal, Newborn, and Child Health
MNCH Health Systems Strengthening Interventions
Maternal, Newborn, and Child Health
MNCH Health Systems Strengthening InterventionsCommunity Accountability
Communities Holding Leaders Accountable for MNCH
Community accountability in maternal, newborn, and child health (MNCH) refers to the structures, mechanisms, and processes through which communities actively participate in the planning, implementation, monitoring, and evaluation of health services. By creating avenues for feedback, oversight, and shared decision-making, community accountability ensures that services are responsive to local needs, promote transparency, and improve trust in the health system.
When communities are empowered to hold health providers and local governments accountable, it leads to improved service quality, more equitable access, and greater sustainability of health interventions. Accountability is especially important in MNCH, where timely, respectful, and culturally sensitive care can be the difference between life and death. Community accountability not only addresses service delivery gaps but also fosters ownership and collective responsibility for health outcomes.
**This lesson is intended for local government leaders, facility managers, and health workers seeking to strengthen community feedback loops and improve transparency in MNCH service delivery.**
What Are the Benefits of Community Accountability?
How to Implement
1. Establish or strengthen community health committees
Include diverse members (women, youth, traditional leaders) and clarify roles in monitoring MNCH services.
2. Facilitate community scorecards or report cards
Allow users to rate services, identify gaps, and propose improvements through structured dialogue with providers.
3. Organize Regular Community Dialogues
Create safe spaces for honest discussion between community members, health staff, and local leaders.
4. Create Accessible Feedback Mechanisms
Use suggestion boxes, SMS platforms, and hotlines to gather continuous input.
5. Integrate Accountability into Supervision and Review
Include community feedback in performance appraisals and health facility assessments.
6. Promote social audits and public expenditure tracking
Empower communities to follow the flow of funds and monitor how resources are used.
7. Train Providers on Respectful Care and Client Rights
Ensure providers understand the value of patient-centered care and their role in building trust.
Key Indicators
- Number of functional community health committees.
- Percentage of health facilities conducting community scorecard exercises.
- Proportion of feedback resolved within a given timeframe.
- Number of community dialogues held per quarter.
- Community satisfaction scores.
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Tips
- Use culturally appropriate tools and language to foster inclusion.
- Ensure that feedback results in visible changes to avoid disengagement.
- Prioritize participation from marginalized and underserved populations.
- Recognize and compensate community volunteers where feasible.
- Document and share success stories to maintain momentum.
Challenges
- Limited Community Capacity: Address through training and mentorship.
- Fear of Reprisal: Ensure anonymity in feedback tools and create a safe, non-punitive environment.
- Lack of Follow-up: Assign clear responsibilities and timelines for responding to feedback.
- Weak Governance Structures: Advocate for political support and policy alignment at higher levels.
Key Resources
- Accountability and Health System. WHO 2020
- The Community Scorecard Toolkit. CARE 2013
- Community Engagement and Accountability. Â UNICEF 2022
- Pregnancy, childbirth, postpartum and newborn care: A guide for essential practice. WHO, UNFPA, & UNICEF 2015
- WHO recommendations on health promotion interventions for maternal and newborn health. WHO 2015
- Caring for the sick child in the community. WHO & UNICEF 2011
- Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic. IFRC, WHO, & UNICEF 2020
