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Cross-learning in the accountability of public health and nutrition services in South Asia

Institute of Development Studies

Project type Research 

Country Bangladesh  Pakistan 

Support £31,520

Start date
April 2015
End date
December 2016
Period: 20 months


The health and nutrition accountability sector in South Asia is a rich and vibrant field, with a great deal to offer in terms of innovation and best practice – but it still performs relatively poorly on health and nutrition indicators.

A range of accountability initiatives have been implemented in the health and nutrition sector, including techno-managerial, transparency oriented, participatory and collective or social accountability initiatives, but there is little work yet that is taking both a comparative and theoretical perspective to ground existing and future initiatives on accountability, and accountability in health in particular.


IDS are undertaking a comprehensive and comparative review, based on work in Bangladesh and Pakistan, but drawing from on lessons from wider afield in the region. The review will:

  • Trace the emergence of ‘accountability’ as a crucial theme in the health and nutrition sector of the South Asian region.
  • Develop a typology of the accountability initiatives discovered in practice.
  • Identify, through case studies, the impact of accountability initiatives on the performance of public health and nutrition services.
  • Explore how the politics and power dynamics within communities influence their participation in these initiatives and the impact of the initiatives.
  • Drawing from existing MAVC concepts and research, examine whether particular types of accountability initiatives have greater potential to foster social change and drive health outcomes within communities – and consider the missing capacities and incentives of both government and citizens to speak out and translate demands into action.
  • Recommend strategies for enhancing accountability initiatives in this field.


Nicholas Nisbett is a research fellow and leader of the Health and Nutrition cluster at the Institute of Development Studies (IDS). He is an anthropologist and geographer with research and policy experience in nutrition, poverty and food security.


In March 2016, in partnership with the Community of Practitioners on Accountability and Social Action in Health (COPASAH), the project convened an online expert discussion which brought together 49 practitioners involved in improving health and nutrition services in South Asia. They shared their experiences on community participation and engagement, negotiating with the state, private sector accountability, and how to define and measure impact.

The learning they shared included the following:

  • A ‘culture of questioning’ is crucial to mobilising communities around social accountability in healthcare.
  • The effectiveness of social accountability tools – online or offline – depends on the way they are used. Part of their value is that they create an environment where people can sit together and start talking about healthcare issues.
  • Clear, attainable goals are essential to ensure community participation.
  • When locally-collected data are used to push for better service delivery at ‘higher’ levels of government, the voice of community members becomes more legitimate.
  • Lack of regulation in the private sector means there is no effective framework for accountability in service delivery.
  • It is essential to put politics and power at the centre of the accountability discourse, to make sense of the changes we seek to create.

Download the report here and view a presentation of the findings here.


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    Social accountability initiatives in health and nutrition:…