Table 3 Differences between two concepts of social accountability (drawing on [36,37,38,39])
Social accountability “activist” approaches | Social accountability “technician” approaches | |
|---|---|---|
Relation to government | Direct demands, politically and power-aware, informed by local contexts, often community-led and responsive to change | Negotiated demands, likely consensus oriented or veering towards politically “neutral”, more tightly tied to project objectives and accountability to funders |
Expected results | Sustained engagement to achieve change with moments that are “seized” when advantageous | Short time frames with measurable outcomes, but aspiring to contribute to sustainability/institutionalization |
Relation to people | Organizing citizens and community members (including non-citizens) to hold duty bearers to account | Organizing health service beneficiaries or “users” to become more active participants in accountability processes |
Financial resources | Fragmented and/or inconsistent levels of funding to support activities, both endogenous and exogenous financial resources | Financing attached to project life cycle or a contained program of work; predominantly exogenous financial resources |
Technicity (definition of services and metrics) | Diverse forms of expertise and knowledge, including experiential and indigenous, not necessarily recognized or valued within global health | Professionalized, in certain instances regulated (e.g. medical training), forms of expertise that are rewarded and valued within global health |
Power Awareness | Explicit concern | Often secondary to demonstrating effectiveness or impact |
Accompanying measures (service standards, system support, capacity building, etc.) | Can rely on system’s own resources and organization, though cross-border/international cooperation and learning a common element | Supportive external investment |