Community and Provider Driven Social Accountability Intervention (CaPSAI) Project: a study to evaluate how social accountability processes in family planning programs influence quality of care and client satisfaction and whether this results in increased contraceptive uptake and use

CaPSAI Project scales up existing Community and Provider driven Social Accountability Intervention where services users and providers assess the quality of local health services and jointly identify ways to improve the delivery and quality of such services, applying it to a family planning/contraceptive programme. Ghana and Tanzania were selected as the intervention countries based on a set of selection criteria that include: existence of a national civil society organisation (CSO) partner with local experience of delivering a social accountability intervention with the eight standard steps, low modern contraceptive prevalence rate, availability of family planning services at the point of contact by the client at no cost or where cost is not a barrier to access, an enabling environment in terms of the potential for the health system to respond to the social accountability activities, and the existence of formal structures linking the community with the health system (e.g. health committees). Ghana Integrity Initiate in Ghana and Sikika in Tanzania have previous experience implementing social accountability interventions that have the eight standard steps of the CaPSAI. The eight standard steps were distilled from community scorecards, citizen voice and accountability projects and citizen hearings which have been implemented and evaluated by other organisations as well as the formative phase of the UPTAKE and Evidence Projects. Details regarding the eight steps and the activities under each step, including communications activities and materials used are described below: Step 1. Introduction of the intervention to the community: The implementation partner (a civil society organization) meets with local leaders, identifies stakeholders and sets up the infrastructure to deliver the intervention. Step 2. Mobilization of participants for the intervention: Community members, service providers and other duty bearers are gathered by the implementing partner and introduced to the intervention. Community public address system will be used to mobilize participants to attend the community meetings. Flyers will be distributed to mobilize participation of stakeholders (individuals and organizations) to partake in the activities, and provide information about family planning. Step 3. Health, rights and civic education with community participants: The implementation partner shares information on health awareness and education, existing service standards and provides training on rights, good governance and accountability. The group begins to rate existing services against rights-based standards and generate discussion about local priorities. Pull-up banners will be displayed in the meeting venues to explain objectives of specific meeting/event being conducted as well as upcoming events. Posters developed from existing client charter and guidelines will be displayed to educate community members on their rights, roles and responsibilities as users of family planning services. Step 4. Prioritization meeting with community: The implementation partner distils themes and priorities raised by the community. The community groups then collectively score the issues and indicators and set priority areas for action. Pull-up banners will be displayed in the meeting venues to explain objectives of specific meeting/event being conducted as well as upcoming events. Step 5. Prioritization meeting with duty bearers: The implementation partner distils themes and priorities raised by the service providers. The providers then collectively score the issues and indicators and set priority areas for action. Pull-up banners will be displayed in the meeting venues to explain objectives of specific meeting/event being conducted as well as upcoming events. Step 6. Interface meeting and joint action planning: The implementation partner then holds a joint meeting between the community, the service providers and other duty bearers. Following the presentation of results from the prioritization meetings the community groups and the service providers will aim to reach consensus on the ranking of the priority items and the actions required to address them. An action plan with assigned roles and responsibilities will be developed for the following 6-12 month period. Pull-up banners will be displayed in the meeting venues to explain objectives of specific meeting/event being conducted as well as upcoming events. Posters with action plans resulting from the interface meetings will be produced for awareness promotion and for advocacy for inclusion in the planning and budgeting of the districts. Step 7. First follow-up meeting with community and duty bearers at three months: Priority areas and action items will be followed up with both the community and service providers. It is at this stage that change is anticipated on the part of health care professionals and remedial actions have taken place which should be demonstrated in the monitoring activities. For any unresolved issues these meetings present an opportunity to involve higher level duty bearers or third party pressure groups (media/ politicians) to increase the pressure to act. Pull-up banners will be displayed in the meeting venues to explain objectives of specific meeting/event being conducted as well as upcoming events Step 8. Second follow-up meeting with community duty bearers at six months: A second follow-up meeting will enable the monitoring of longer range outcomes and on the remedy of unresolved issues raised in the first follow-up meeting. The community and service providers will continue to monitor the action plan for changes in relation to agreed priority areas.Pull-up banners will be displayed in the meeting venues to explain objectives of specific meeting/event being conducted as well as upcoming events The intervention (one round of the eight steps) is conducted over the period of 12 months in selected districts in the catchment area of eight intervention facilities. A mapping of facilities in the selected districts was conducted to gather data on the demographic composition of the facility catchment areas, modern contraceptive rates and a number of new users (within past six months) and identify eligible facilities and match them. Data on facilities in the pre-selected districts, where there are no social accountability intervention in family planning currently taking place, were gathered. Eight intervention and eight control facilities were selected. The implementing partners document their plans prior to implementation and write up post-implementation reports following completion of each step. The plans and reports are reviewed as part of the process evaluation: document review. The research partners also conduct process evaluation activities in four of the eight facilities in each country, such as non-participant observations and in-depth interviews to assess and monitor content fidelity across the two country contexts.