IDS Bulletin

Accountability for health equity: galvanising a movement for Universal Health Coverage

Photo: Student midwife and her patients in Bombali District, Sierra Leone. Credit: Abbie Trayler-Smith/H4+/Panos.

IDS Bulletin: 49.2

Editors: Nelson, E., Bloom, G., and Shankland, A.
Publisher: IDS
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Since the publication of the 2004 World Development Report, a range of different attempts have been made to make the design, prioritisation and delivery of health services more accountable to different stakeholders. However, complex politics and power dynamics can limit or skew people’s abilities to access services or hold them to account, particularly for poor and marginalized people.

In July 2017, the Institute of Development Studies (IDS) hosted a workshop in collaboration with Future Health Systems, the Impact Initiative, the Open Society FoundationUnequal Voices, and Health Systems Global, to develop new thinking and practical approaches to improving accountability relationships and processes in favour of greater health equity. 

This new issue of the IDS Bulletin, which draws on research enabled by the ESRC-DFID strategic partnership and beyond, focuses on three principal themes that emerged from this workshop as needing particular attention. First, the nature of accountability politics ‘in time’ and the importance of longitudinal approaches to change. Second, the contested politics of ‘naming’ and measuring accountability, and the intersecting dimensions of marginalisation and exclusion that are missing from current debates. Third, the shifting nature of power in global health and new configurations of health actors, social contracts, and the role of technology.

Read the articles by ESRC-DFID researchers:

For the first time in IDS Bulletin history, themes are explored not only in text but also through multimedia contributions. This expansion into other forms of communication is explicitly aimed at galvanising larger numbers of people in a movement towards Universal Health Coverage (UHC) and the linked agenda of accountability for health equity. The content of this issue reflects the fact that while the desired outcome might be the same – better health for all – accountability strategies are as diverse as the contexts in which they have developed. 

Denise Namburete, who leads the Mozambican study of the ESRC-DFID funded project Unequal Voices: The Politics of Accountability for Health Equity in Brazil and Mozambique, and Erica Nelson (IDS), made the following documentary:

Holding a Health System to Account: Voices from Mozambique (A Documentary)

Visit the IDS bulletin website and IDS website for further information.

Focus projects: 

A nurse explains clinic procedures to waiting patients

Health inequities - that is, unfair and avoidable difference in health arising from social, economic or political factors, and which disadvantage the poor and marginalised - are trapping millions of people in poverty.

flickr.com/photos/savethechildrenusa
Donors and international organizations involved in dispersing foreign aid now routinely employ contracts with service providers, in international health service development and delivery. The research aims to understand the nature of the impact these actors have in global health development objectives.
Chinese medicine, Edward N. Johnson, licensed under CC BY-SA 2.0
This multi-disciplinary project combines anthropological fieldwork with archival and interview-based research to investigate the conditions that make possible continuing inappropriate use of medicines in South Asia.
flickr.com/photos/asiandevelopmentbank
An exploratory qualitative study of three South Asian countries to illuminate how social forms and organisations in health are created, managed and sustained, including key roles in the development of medicine and health services knowledge.
A colorized scanning electron micrograph of Mycobaterium tuberculosis, the bacteria that cause TB.
Tuberculosis services were modified in response to the findings from Nepal, Yemen and Ethiopia to promote equitable and increased access to health services for under-served populations, with particular focus on impacts on women.
A health work in Bangladesh gives a presentation to women and children

The objective of this study is to examine how the spread of the mass media, increased access to the internet and high levels of mobile phone use are changing the ways that poor people seek health-related information and advice. In order to pick up new patterns of behaviour with the potential to spread rapidly, we will study health information seeking behaviour in one relatively remote rural area, one rural area with good transport links to Dhaka and one slum in Dhaka.