Improving Maternal Health through Social Accountability in Burundi and DRC


By using participatory research, this project investigates if and how social accountability mechanisms improve responsiveness and performance of maternal health services in Burundi and the Democratic Republic of Congo (DRC). It further assesses in which contexts these mechanisms are successful and why, leading to policy recommendations for maternal health in both countries.

Intervention planning and evaluation

Reducing maternal mortality ratios and morbidity rates requires that maternal health services are responsive to citizens’ needs. Countries, donor agencies and NGO’s are seeking ways to improve responsiveness and performance of maternal health services; if citizens take part in decision-making, there is a better chance that maternal health services are adapted to their needs.

One way of achieving this is to develop mechanisms enabling citizens to hold policy-makers and health workers in maternal health services accountable for their performance and to evaluate performance against perceived needs of citizens. This is referred to as social or political accountability. Especially in fragile states like Burundi and DRC, citizen involvement is important because government services are generally weak.

The research is action-oriented and involves health service users, health service providers, policy makers and researchers. It is implemented using the following steps:

Preparation and exploration (6 months)

1. Situational analysis of existing social accountability mechanisms for maternal health services.

2. Selection and planning social accountability interventions in Burundi/Congo. Development of monitoring and evaluation framework.

Implementation and evaluation of the intervention (24 months)

3. Descriptive case studies of experiences on social accountability mechanisms for maternal health services in 4 other fragile states.

Reflexive learning and developing policy advice (48 months)

4. In close collaboration with local partners we will perform comparative analysis of results in Burundi/Congo and other fragile states. We will translate results into relevant policy advice. Lastly we will develop a conceptual framework for political accountability for maternal health in fragile states in general that can be used in other contexts.

Policy advice for DR Congo, Burundi and other fragile states

It is expected that lessons drawn from baseline and intervention research in Burundi and DR Congo, complemented with case studies in other fragile states, will provide policy advice on the use of social accountability mechanisms to improve maternal health services in fragile states. We are eager to share our experiences and help others to improve social accountability mechanisms for maternal health.