Impact of community and provider-driven social accountability interventions on contraceptive uptake in Ghana and Tanzania

Abstract

Background Social accountability, which is defined as a collective process for holding duty bearers and service providers to account for their actions, has shown positive outcomes in addressing the interrelated barriers to quality sexual and reproductive health services. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project contributes to the evidence on the effects of social accountability processes in the context of a family planning and contraceptive programme. Methods A quasi-experimental study utilizing an interrupted time series design with a control group (ITS-CG) was conducted to determine the actual number of new users of contraception amongst women 15–49 years old in eight intervention and eight control facilities per country in Ghana and Tanzania. A standardized facility audit questionnaire was used to collect facility data and completed every year in both intervention and control groups in each country from 2018–2020. Results In Ghana, the two-segmented Poisson Generalized Estimating Equation (GEE) model demonstrated no statistically significant difference at post-intervention, between the intervention and control facilities, in the level of uptake of contraceptives (excess level) (p-value = 0.07) or in the rate of change (excess rate) in uptake (p-value = 0.07) after adjusting for baseline differences. Similarly, in Tanzania, there was no statistical difference between intervention and control facilities, in the level of uptake of contraceptives (excess level) (p-value = 0.20), with the rate of change in uptake (p-value = 0.05) after adjusting for the baseline differences. There was no statistical difference in the level of or rate of change in uptake in the two groups in a sensitivity analysis excluding new users recruited in outreach activities in Tanzania. Conclusions The CAPSAI project intervention did not result in a statistically significant increase in uptake of contraceptives as measured by the number of or increase in new users. In evaluating the impact of the intervention on the intermediate outcomes such as self-efficacy among service users, trust and countervailing power among social groups/networks, and responsiveness of service providers, cases of change and process evaluation should be considered. Trial registration The CaPSAI Project has been registered at the Australian New Zealand Clinical Trials Registry (ACTRN12619000378123, 11/03/2019).

A qualitative exploration of how a community engagement approach influences community and health worker perceptions related to family planning service delivery in Togo

“…However, additional research is needed to understand if the WABA approach has contributed to increases in contraceptive uptake. Previous studies have shown mixed results regarding the implementation of similar approaches and improved health outcomes ( 33 – 36 ) . Additionally, given the limited adherence to community action plan activities that address structural challenges at the facility level, there may be limits in the extent to which this approach can be used to address broader health system improvements outside provider behavior and community engagement, particularly in low-resource settings ( 37 , 38 ).…”

The Methodological Approach to a Process Evaluation of a Community and Provider-Driven Social Accountability Intervention to Increase Contraceptive Uptake and Use

“…During CaPSAI, they implemented their social accountability process in districts where they did not have an active programme taking place. More details of the intervention (McMullen et al, 2022; Steyn et al, 2022; Steyn et al, 2020 (a); World Health Organization, 2021) and the role of the implementation teams in CaPSAI (Cordero et al, 2022) have been published elsewhere.…”

“…The process evaluation data has been used to contextualise and understand the causal pathways explaining the main outcomes of CaPSAI (Steyn et al, 2022). Several manuscripts are being written up to report on these findings and will be published separately.…”

“…The process evaluation in this study built on the evidence on the effects of social accountability and participatory processes in the context of family planning programmes (Steyn et al, 2019). The study looked at several outcomes – service utilization, continuation rates and attitudes and behaviours (Steyn et al, 2019; Steyn et al, 2020 (a)). As per MRC guidance on studying complex interventions (Medical Research Council, 2006), the project included a process evaluation composed of qualitative methods (Moore et al, 2014; Moore et al, 2015).…”

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

“…Descriptive and analytic work on implementation is further complicated by the broad and interrelated set of outcomes that together facilitate change. Outcomes may include both routine health and service delivery outcomes [ 4 ], alongside changes in self-efficacy, social cohesion, trust, and responsiveness [ 5 ]. Even when the outcomes are delineated, it may be difficult to attribute them to a specific part of a multi-component intervention.…”