Community-driven approaches are often used to encourage citizen involvement in improving public health; however, evidence of impact of such approaches is mixed and incomplete. The T4D project seeks to fill this knowledge gap, testing whether community-led transparency and accountability can improve health in multiple countries – and when and how improvements occur.

Many of the persistent problems in maternal and newborn health occur at the local level, and many have touted the potential of community-led approaches such as community scorecards and social audits to overcome many of these health system breakdowns.

Adapted scorecards to encourage participation and actions to improve health

In this project, we seek to identify the impact of an adapted community scorecard on health outcomes and citizen empowerment, the mechanisms through which these citizen actions effected health services and outcomes, and the role of context.  

Utilizing a mixed methods approach, the T4D intervention is conducted in across Indonesia and Tanzania (in 200 villages in each country) and evaluated using randomized control trials to measure the intervention’s effects on health outcomes and citizen empowerment.  Extensive case studies utilize direct observation, focus groups, informant interviews, systematic coding of meetings, facilitator assessments, and ethnographic methods in a subset of treatment and control communities to address the issues of mechanisms and context. This information is used to trace the process by which the interventions triggered—or failed to trigger—improvements in outcomes.  A Phase 2 is currently underway in three additional countries (Ghana, Malawi, and Sierra Leone) to test the potential of government champions in improving the impact of citizen-led accountability.
 

Research Partners:
Ash Center at the Harvard Kennedy School
Results for Development Institute
University of Washington Evans School of Public Policy and Governance
PATTIRO (Indonesia)
CHAI (Tanzania)
JPAL Southeast Asia (Indonesia)
WASH-NET and MoPADA (Sierra Leone)
Ghana Center for Democratic Development (Ghana)
Malawi Economic Justice Network (Malawi)

Data Collection:
Economic Development Initiatives (Tanzania)
Ideas in Action (Tanzania)
SurveyMETER (Indonesia)
Innovations for Poverty Action (Tanzania and Sierra Leone)

This research is supported by
The Bill and Melinda Gates Foundation
The Hewlett Foundation
The UK Department for International Development
Transparency and Accountability Initiative