How can we empower citizens and help to facilitate communities to take actions to improve health and other outcomes? This is the question that we sought to answer in co-designing an effective citizen-led intervention for the T4D program.
In Tanzania and Indonesia, the T4D intervention builds on a set of common elements that are shared by many existing transparency and accountability interventions:
- Information Gathering to identify local problems with service delivery and development outcomes;
- Information Sharing to provide that local information to communities to achieve local transparency and action for accountability; and,
- Social Action by which citizens and communities seek to overcome the service delivery and development problems identified, in part by holding those responsible accountable. Decision making on the social action is facilitated by the implementing CSO partner; however the action itself is undertaken fully by the community.
The intervention was designed together with implementing civil society organization partners CHAI (Tanzania) and Pattiro (Indonesia) in partnership with the T4D core team. With this design, we build on the experience of CSOs working on transparency and accountability and a growing literature on what works – and what does not work – with community-led transparency, participation, and accountability. The intervention involves facilitators from the T4D implementing partners leading the four key activities.
First, implementing partners select Community Activists/Representatives to spearhead the design and implementation of social actions. After selecting representatives, CSO facilitators collect and share a Community Scorecard on maternal and newborn health intermediate outcomes (including birth in a facility, birth preparedness planning, and proper prenatal and postnatal care) and the barriers to these outcomes. Third, CSOs facilitate the design of Social Action Plans by the Community Activists/Representatives to address these barriers. Finally, the facilitators return to the village at key moments to facilitate Follow-up Meetings with the Community Activists/Representatives to assess successes and challenges in implementing the social actions and adopt changes to the social action plans.
Design Principles of the Intervention
In designing the T4D intervention, the T4D core team and implementing partners were guided by several key principles:
- Co-designed – our design process ensured that the intervention was designed with CSO partners that could build local knowledge and experience into the intervention design.
- Locally relevant – the design provides flexibility to communities to address barriers to maternal and newborn health that are most important to each individual community, rather than a standard set of barriers for all communities.
- Problem-driven and Improvement-focused – the intervention was designed to identify real problems with maternal and newborn health that, if acted upon, have the potential to result in real improvements in health outcomes.
- Non-suggestive – the intervention does not prescribe specific actions that communities should undertake and instead provides more open information about problems with health and different approaches that other communities have used to solve problems.
- Community-driven – the intervention was designed deliberately to ensure that decisions and actions would be driven by the community rather than external donors, researchers, or even civil society organizations.
- Free of outside resources – while civil society organization facilitators help guide communities through decisions about social actions, no material or technical resources are provided to communities to undertake these social actions. Further the facilitators do not utilize any relations they have with district officials, village heads, or other leaders to set up meetings or other itneractions between citizens and stakeholders.
- Adaptable across contexts and potentially scalable – rather than design an intervention that had a high potential to work in one context but not another, we sought to design an approach that was flexible enough that it could be adapted and potentially scaled to very different environments.
The materials designed for the interventions in Tanzania and Indonesia are available here.