South Asia is home to nearly a quarter of the world’s population and is a region of dynamic economic growth, yet it performs relatively poorly on health and nutrition indicators. As a potential route towards addressing this poor performance, a range of accountability initiatives has been implemented to improve service delivery in the health and nutrition sectors.
This is a rich and vibrant field, with a great deal to offer in terms of best practice; but there is little work that focuses on South Asian innovation and practice generally, and takes a comparative and theoretical perspective to ground existing and future accountability initiatives in health and nutrition specifically. This report fills this gap.
It highlights a set of four key considerations for the design and analysis of such programmes:
- the need to understand community heterogeneity (rather than assuming homogeneity, as many interventions do)
- the role of community collective action and/or its role in coercion or ‘noisy protest’ in effecting change
- the ways in which cooperation, capacity and commitment affect the community and frontline provider relationship, and the ability and willingness to deliver
- to meet demands the ways in which clientelism and other such extant local political structures form the backdrop against which accountability actions play out.