A strategic approach to social accountability: Bwalo forums within the reproductive maternal and child health accountability ecosystem in Malawi

Abstract

Background: The majority of documented social accountability initiatives to date have been 'tactical' in nature, employing single-tool, mostly community-based approaches. This article provides lessons from a 'strategic', multitool, multi-level social accountability project: UNICEF's 'Social Accountability for Every Woman Every Child' intervention in Malawi. Methods: The project targeted the national, district and community levels. Three Civil Society Organisations (CSOs) were engaged to carry out interventions using various tools to generate evidence and political advocacy at one or more levels. This article focuses on one of the social accountability methodsthe bwalo forum (a meeting based on a traditional Malawian method of dialogue). A detailed political economy analysis was conducted by one of the co-authors using qualitative methods including interviews and group discussions. The authors conducted incountry consultations and analysed secondary data provided by the CSOs. Results: The political economy analysis highlighted several ways in which CSO partners should modify their work plans to be more compatible with the project context. This included shifting the advocacy and support focus, as well as significantly expanding the bwalo forums. Bwalos were found to be an important platform for allowing citizens to engage with duty bearers at the community and district levels, and enabled a number of reproductive, maternal, newborn, child and adolescent health issues to be resolved at those levels. The project also enabled learning around participant responses as intermediate project outcomes.

Stakeholder engagement in the health policy process in a low income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi

“…To facilitate the engagement of stakeholders with different levels of education, policy literacy and in marginalised groups, including socioeconomically disadvantaged and rural communities, comprehensive stakeholder engagement will always require the deployment of multiple techniques. In this, guidance and resources developed by NGOs, donors and academics for use in LMICs could prove valuable [ 3 , 45 ], such as toolkits to enable effective engagement with stakeholders and the use of engagement techniques such as Bwalo forums and CARE scorecards which have been used successfully in Malawi and Kenya [ 10 , 21 , 46 – 51 ]. There are also lessons on how to increase citizen engagement in policy-making from the Mwananchi project which sought to enhance social accountability to deliver pro-poor policy changes in six African countries, including Malawi, by changing citizen-government relations [ 52 ].…”

A summative content analysis of how programmes to improve the right to sexual and reproductive health address power

“…The most common organisational structure addressed was health facilities. For example, several programmes entailed health facility-led efforts to engage communities in expressing their priorities regarding quality of care; some of these had an explicit health facility accountability component 35 37 42 85–88. Other health sector programmes aimed to create change in the way organisations operate, including health facilities89–92; health and allied professional associations and other organisational stakeholders in SRH, including law enforcement93–95; schools96; and factories 97.…”

“…Most of the community-focused activities included community mobilisation and/or dialogue 38 42 71 83 87 89 97 103 105–109. In some cases, this mobilisation and dialogue was described as the community component of a programme trying to impel health system responsiveness to community SRH concerns 37 38 42 85–87 89 103 105…”

Stakeholder engagement in the health policy process in a low income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi

“…To facilitate the engagement of stakeholders with different levels of education, policy literacy and in marginalised groups, including socioeconomically disadvantaged and rural communities, comprehensive stakeholder engagement will always require the deployment of multiple techniques. In this, guidance and resources developed by NGOs, donors and academics could prove valuable (3,28), such as toolkits to enable effective engagement with stakeholders and the use of engagement techniques such as Bwalo forums and CARE scorecards (9,17,(29)(30)(31)(32)(33)(34). There are also lessons on how to increase citizen engagement in policy-making from the Mwananchi project which sought to enhance social accountability to deliver pro-poor policy changes in Africa by changing citizen-government relations (35).…”