Innovative model for promoting citizens voice and enabling greater accountability in marginalized and low resource settings

Studies have shown that citizen’s participation in health service planning, delivery and monitoring is valuable in improving service quality and utilization. In many Nigerian communities however, mechanisms are not in place for citizens to adequately participate in healthcare service delivery. Channels for communicating needs and dissatisfaction are poorly structured, with few health committees that are largely dominated by elites. Advocacy efforts for health were insensitive, non-inclusive and ineffective, owing to low awareness of health rights and uncoordinated means of engagement.

The Partnership for Transforming Health Systems in Nigeria adapted the World Bank’s Accountability Triangle in strengthening citizen’s voice and participation while taking into account relationships between the client, provider and policymakers. The programme trained, mentored and provided consistent support to 600 Facility Health Committees (FHCs) in five states along the three operational areas of facility management, community involvement in health decision making and mobilization for health service uptake.

Following a three-year interface, an average of 95% improvement was recorded against all three operational areas in the five supported states while 77.8% issues raised with health facilities and 84.4% issues advocated with government received positive actions. Responses by government include increased coverage for free services to pregnant women  and children under five, improved allocation and implementation of free health care programmes and reversion of a policy which required women to present their husband’s tax clearance certificate before accessing healthcare.

The FHC model is essential in promoting citizens’ voice and enabling greater accountability of government and health providers to service users.