Building a transformative agenda for accountability in SRHR: lessons learned from SRHR and accountability literatures

Abstract

Global strategies and commitments for sexual and reproductive health and rights (SRHR) underscore the need to strengthen rights-based accountability processes. Yet there are gaps between these ambitious SRHR rights frameworks and the constrained socio-political lived realities within which these frameworks are implemented. This paper addresses these gaps by reviewing the evidence on the dynamics and concerns related to operationalising accountability in the context of SRHR. It is based on a secondary analysis of a systematic review that examined the published evidence on SRHR and accountability and also draws on the broader literature on accountability for health. Key themes include the political and ideological context, enhancing community voice and health system responsiveness, and recognising the complexity of health systems. While there is a range of accountability relationships that can be leveraged in the health system, the characteristics specific to SRHR need to be considered as they colour the capabilities and conditions in which accountability efforts occur.

Social accountability for reproductive, maternal, newborn, child and adolescent health: A review of reviews

“…The remaining two articles are a systematic review and a literature review focusing specifically on perinatal mortality audits [40,41]. To clearly distinguish between the two included reviews with Boydell as the first author, we refer to the Boydell et al review from 2019 as Boydell, Schaaf et al [17]).…”

“…Boydell, Schaaf et al (2019) [17] Accountability describes the processes by which government actors are responsible and answerable for the provision of high-quality and non-discriminatory goods and services (including the regulation of private providers) and the enforcement of sanctions and remedies for failures to meet these obligations.…”

“…Social accountability is gaining acceptance as a way to address health system inefficiencies and improve basic public health performance, including planning and service delivery, and to contribute to the attainment of the highest possible standards of health [17]. Social accountability approaches have been implemented by development agencies, under labels including "citizen participation," "community engagement," "citizen demand," "voice," "transparency and accountability," and "good governance" [18].…”

Politics, power, and sexual and reproductive health and rights: impacts and opportunities

“…In all of these areas, the authors find space for leveraging opportunities for improved financial, performance and political/ democratic accountability for SRHR, yet they note that there are characteristics specific to SRHR which need to be considered in accountability efforts, as they "colour the capabilities and conditions in which accountability efforts occur." 14 In some contexts, legal challenges can represent an important tool in the accountability toolkit, with civil society organisations, human rights organisations, and others using litigation, including public interest and strategic litigation, to hold power to account. However, legal decisions can also work to undermine SRHR.…”

Accountability strategies for sexual and reproductive health and reproductive rights in humanitarian settings: a scoping review

“…SRH and RR are differently complex than other areas of accountability work because of their intimate nature and relationship to deeply seated norms. Realizing accountability in these domains may require shifting social, religious, and political values relating to gender, reproduction, and power among affected populations, public and private sector providers, and humanitarian workers [10].…”