At the interface between the formal and informal, the actual and the real: a realist study protocol for governance and accountability practices in urban settings focusing on adolescent sexual and reproductive health and rights

Abstract

Background This paper presents the protocol of a study that aims at exploring how different multi-level governance arrangements impact on sexual and reproductive health of adolescents living in informal settlements. The overall objective of this study is to contribute to a better understanding of the causal chains underlying accountability in sexual and reproductive health for adolescent girls and young women living in urban informal settlements in low-and middle-income countries. Methods The overarching methodology is realist evaluation. The study adopts a case study design, through which governance and accountability practices in Mumbai, Delhi, Cotonou and Kampala will be examined. Different social science methods to develop and test a programme theory will be used. Heuristic tools for the analysis of the accountability ecosystem and mapping of governance arrangements, drawing from contextual political analysis and critical realism, will be developed in order to identify the intervention-context-actor-mechanism-outcome configurations. Discussion The methodological approach is geared towards building robust case-based explanation with due attention to context and the roles of different actors. The combination of different social science methods will lead us to a better grasp of the inherently political nature of social accountability.

Realist evaluation of maternity waiting home intervention models in Inhambane, Mozambique: protocol for a comparative embedded case study, the Mozambique-Canada Maternal Health Project

“…Thus, the evaluation represents a move from a global, that is, MWH implementation in LMICs, to a country-level, that is, the Mozambican context. Figure 1 provides an overview of our adaptation of the realist evaluation research process to this study 17 20 21…”

“… Realist building and refinement cycle. Adapted from Pawson et al , 17 Van Belle 20 and Marchal et al . 21 CMOCs, context–mechanism–outcome configurations; LMICs, low-income and middle-income countries; MWH, maternity waiting home.…”

Social accountability and sexual and reproductive health—implications for research and practice

“…Van Belle details how realist evaluation can be used to answer not only questions of effectiveness but also the causal questions ‘how, why, in which conditions and for whom’ [ 9 ]. Van Belle shares a protocol of a proposed study that use different social science methods to explore the effect of multi-level governance arrangements on sexual and reproductive health of adolescents living in informal settlements in Mumbai, Delhi, Cotonou and Kampala.…”

How to develop a realist programme theory using Margaret Archer’s structure–agency–culture framework: The case of adolescent accountability for sexual and reproductive health in urban resource-constrained settings

“…We adopted RE as the methodological approach. The IPT will be ‘tested’ in four different urban settings in three countries (Benin, Uganda and India) (Van Belle, 2022).…”

“…A nongovernmental organization may organize protests in front of a local council, while organizing a dialogue between health providers and adolescents on adolescent-friendly sexual and reproductive health and rights (SRHR) services. For a more detailed discussion of the application of the theories of Habermas and Mouffe, we refer to earlier work (Van Belle, 2014;Van and Belle, 2022).…”