Table 2 Project (“technician”) approach to social accountability: an example from Uganda

In Uganda, the Community and District Empowerment for Scale-up (CODES) project launched in 2015 for a 3 year period with the aim of strengthening the management of district-level health systems to improve child survival. CODES was implemented through health districts in partnership with UNICEF and Makarere University, and community-based organizations (CBOs) engaged in health services monitoring and social accountability processes (one of three pillars of the intervention strategy). Health districts were encouraged to solicit feedback from communities related to issues of health services quality and coverage as they related to an identified set of priority health issues. This feedback was organized by CBOs through Community Dialogues, Citizens Report Cards, and SMS surveys of community member perspectives [34, 35]. A cluster randomized trial design was able to show improvements over time in the treatment of malaria, pneumonia, diarrhea, and stool disposal. Though the results of the intervention were positive, the short-term nature of the study left often questions of sustainability and potential institutionalization of social accountability mechanisms. One key learning that emerged was the important role of traditional and social media in shifting institutional norms related to the value of collaborative and community-engaged accountability. However, long-term impact may demand different intervention and institutionalization timeframes particularly where community engagement in social accountability processes and mechanisms for political accountability are less developed.