While observations of the intervention in Indonesia and Tanzania revealed that communities took steps to design and lead social actions to improve health, we also observed that community representatives largely did not engage with government officials outside of the village level to support their efforts. In the second phase of the project, we worked with CSO partners in three countries (Ghana, Malawi, and Sierra Leone) to redesign the community-led transparency and accountability approach by providing both information and discussion spaces for citizens and sub-national governments to help facilitate more collaboration between the two.
Building on the intervention from Phase One, we worked with our implementing partners (Center for Democratic Development in Ghana, Malawi Economic Justice Network in Malawi, and WASH Network Sierra Leone) to add to new components to the community-led transparency and accountability intervention. First, we added a light-touch health rights and governance literacy element, providing information to community representatives about the rights of citizens and policies within the health system, as well as the roles of government officials in making and upholding these policies. Second, we identified government champions, sub-national government officials who would meet with community representatives to learn about their social actions and, potentially, provide support for their work.
The evaluation of Phase Two is designed to explore, through small-scale experimentation, the differences between interventions in a small number of communities within each country. We are collecting data regarding how the intervention works using focus group discussions, facility surveys, meeting observations, and action tracing for social actions that communities choose to undertake. Ultimately, the approach to the three small-scale trials in Ghana, Malawi, and Sierra Leone is designed to identify plausible hypotheses and eliminate implausible hypotheses regarding the effectiveness of the intervention and the role of context. A more detailed description of the evaluation plan for Phase Two can be found here.