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Table 1 Social accountability programs addressing SRHR

From: Social accountability as a strategy to promote sexual and reproductive health entitlements for stigmatized issues and populations

Country and Implementing NGO

Key SRHR Focus

Population

Social Accountability Program Description

India, SAHAJ

SRHR information

Access to adolescent friendly SRH services

Adolescents and young people – urban poor, tribal, rural, Dalit, living with disability, and sexually diverse peer leaders in selected districts of Gujarat State

Despite commitments made in the National Adolescents’ Health Programme and the Adolescent Reproductive and Sexual Health strategy of the Government of India, health services are generally not adolescent friendly.

SAHAJ’s programme aims to support leadership development, inclusion and solidarity among adolescents and young people, in part so that they can effectively demand accountability form duty bearers.

The community monitoring program engages adolescents, with special efforts to involve Dalit, LGBTQ+, and adolescents with disabilities. The adolescents use health service delivery monitoring tools, and hold dialogues and public hearings with service providers and district and state officers to discuss the findings of the community monitoring efforts. They also support participating adolescents and youth to develop relationships with other stakeholders to form coalitions for engagement in national planning fora.

Nepal, Ipas and local partners

Access to abortion and contraceptive services

SRHR information for community and local government members

Women of reproductive age, young women, women living with disabilities, and adolescent girls in 2 rural districts

Community members, local civil society organizations, and men

Pursuant to a policy of decentralization, the constitutionally protected right to health is now the primary responsibility of the local government. To ensure that access to SRHR, including safe abortion services, is fulfilled, Ipas Nepal is working with local civil society actors on a social accountability effort that supports and mobilizes women from the community to use community scorecards (a type of community monitoring), participatory planning and budgeting with local health authorities, and social audit (public hearings). These local civil society actors make particular efforts to engage adolescents and women/girls with disabilities.

Northern Uganda (humanitarian setting), CARE International in Uganda and Center for Reproductive Rights (CRR)

Access to comprehensive sexual and reproductive health and rights services and information

Refugee and host community women and girls of reproductive age (15–49 years) residing in one northern Uganda district

Human rights standards and principles apply in humanitarian situations, including the right to the highest attainable standard of SRH. Humanitarian actors and community women and girls in northern Uganda affirmed that existing accountability mechanisms (e.g. feedback boxes, hotlines) at refugee settlement and district level were inaccessible and/or unresponsive to issues relating to SRHR. Thus, CARE and CRR initiated a social accountability program with a three-pronged structure that includes a community council for SRHR, a third-party ombudsperson, and community monitors. The monitors collect SRHR complaints, which are then reviewed by the Council, and if needed, ombudsperson. The Council and ombudsperson engage duty-bearers (i.e. district government, refugee and local councils, and humanitarian health service providers) to ensure access to an effective remedy if rights to SRH are not respected.

Zambia, Copperbelt Province, Ipas and local partners

Youth access to contraceptive services

Youth members of youth-led and youth-serving organizations; SRHR clubs in tertiary education (male and female) in 2 districts

There is a high rate of unintended pregnancies among adolescents and youth in rural and urban areas of Zambia. Yet, adolescent SRH is not prioritized in National Health Strategic Plans and Budgets; and there is limited provision of adolescent-friendly SRH services. Moreover, adolescents and young people themselves have little knowledge of their SRHR entitlements and limited voice in public and governmental fora.

Using a user-centered design process, Ipas facilitated the development of a community score card. The score card delineates governmental obligations related to adolescent SRHR. Members of youth organizations then monitor and document service delivery using these score cards, and dialogue with representatives of the local government to discuss results.