Caroline Poirrier

The Power of Social Accountability: Overcoming bottlenecks to accelerate family planning

More than 220 million girls and women in developing countries who need modern contraceptives, information and services are unable to access them. This results in more than 60 million unintended pregnancies every year and puts girls and women at serious risk of death or disability during pregnancy and childbirth, and unsafe abortion.

This is why the London Summit on Family Planning in July 2012 was a transformative moment. At the summit, new financial and policy commitments were made by global leaders, including an additional $2.6 billion to enable 120 million more women to access family planning services and resources by 2020. These commitments have produced progress to date – donors have disbursed more funds for family planning programs, countries have started to address barriers to family planning access, and a rigorous measurement and evaluation agenda has been established.

These advances are remarkable. However, substantive and sustained family planning progress requires that commitments made are fulfilled, that national family planning programs are well-designed and implemented, and that services respect women’s rights and needs.

Each of these conditions is susceptible to breakdowns. Financial commitments can fail to materialize due to political pressures or competing priorities. Resources allocated may not be approved or spent at every step of the procurement or funding chain, meaning that supplies, commodities and staff do not reach facilities where they are needed. Service providers may fail to provide comprehensive counseling and accurate information to beneficiaries, leading to misuse or discontinuation of family planning methods.

Monitoring and accountability

To mitigate these breakdowns, the family planning community has prioritized the strengthening of monitoring and accountability (M&A). Monitoring (the collection and analysis of data for the identification of breakdowns) and accountability (the use of evidence to ensure that those responsible for breakdowns take action to remedy them) are essential to overcoming bottlenecks.

M&A can be led both by “implementers” themselves (donors, national governments and implementing organizations) and by local, national and international independent, non-governmental actors. Recent M&A initiatives around family planning include Track20, PMA2020 and Advance Family Planning (AFP), among others.

Power of social accountability for stronger design, implementation, rights and results

There is growing evidence from other health and education subsectors that M&A led by civil society, also known as “social accountability,” produces significant and long-lasting results. Civil society organizations (CSOs) have played a tremendous role in strengthening citizen voice, increasing the quality, appropriateness and utilization of public services, and ensuring equitable and efficient allocation and use of resources.

The move toward harnessing social accountability for family planning is intensifying, including with the Department for International Development’s expected tender to support civil society-led M&A around family planning.

Supporting social accountability for family planning

In a recently published report, my colleagues at R4D and I studied the bottlenecks described above and existing M&A efforts, and examined how social accountability can accelerate FP progress. We synthesized our learnings (based on field visits, stakeholder interviews and a benchmarking exercise) to develop three broad options to strengthen civil society-led M&A interventions around family planning in priority countries in Africa and Asia.

Option 1 focuses on M&A around national plans, funding commitments and policies affecting family planning efforts. Under this option, CSOs’ analysis and advocacy skills will be strengthened to support identification and resolution of discrepancies between FP needs and planned programs.

Option 2 focuses on M&A of program performance. As part of this option, CSOs will be supported to identify and remedy issues in the implementation of FP programs such as insufficient disbursements, interruption in funding flows to providers, breakdowns in the FP commodity supply chain, failure to train and supervise frontline FP workers, etc.

Option 3 focuses on building CSOs’ capacity to strengthen citizen voice, monitor service quality and user satisfaction, and to engage communities, government and service providers to improve the quality and appropriateness of FP service delivery, as well as respect for women’s rights.

Overall, the implementation of these options would contribute to making the family planning sector widely responsive to women’s and girls’ needs. They would lead to a vibrant global network of CSOs undertaking effective accountability work around family planning. This network would complement and augment government-led accountability efforts, monitoring and influencing national family planning policies and budgets, tracking the implementation of FP programs, service delivery and ensuring the protection of women’s rights. Where policies, programs and services are found lacking, civil society groups would engage communities and ensure that women’s voices are heard and advocate at the subnational, national and global levels for changes in policy and practice to improve access to and uptake of high-quality FP information, services and commodities.

The promise of family planning services has been made, but well-intended players must follow through to ensure that promises are truly kept.

Caroline Poirrier is a senior program officer at the Results for Development Institute.

Health Care
corporate social responsibility, public health, reproductive health