Assessing voice and accountability in Health, Population and Nutrition Sector Development Programme in Bangladesh

At a recent seminar, Mike Naylor, a Principal Consultant for OPM and Director of HEART, presented the findings of an assignment report to DFID. The report was titled ‘Assessing voice and accountability in Health, Population and Nutrition Sector Development Programme (HPNSDP), 2011–2016’. Its purpose was to provide input to the HPNSDP Annual Programme Review in September 2013 on opportunities and options to enhance ‘voice and accountability’ (V&A) in the health sector programme. The work was undertaken between June and August 2013 through a review of international and national literature, a semi structured set of visits, meetings, and key informant interviews, and an iterative process of report development particularly with DFID Bangladesh health, governance and social development staff.

Mike presented the report and the findings to a team of health advisors at DFID head office in London on 10 June 2014. The following video is of his presentation:

The slides from this presentation are available to download here.


The following recommendations were made based on the findings of the report:

Recommendations to government:

  • To maintain a vigorous approach to completing the programme of establishing a comprehensive network of Community Clinics (CCs) and associated Community Clinic Management Group (CCMGs) and Community Support Group (CSGs).
  • To work closely with Ministry of Local Government (MOLG) to continue strengthening the links between CCMGs, union parishads, and upazila councils.
  • To undertake operational research and implement effective measures for using new technologies to provide a route for community organisations to provide structured feedback about quality and utilisation of services.
  • To review the operation of Hospital Management Committee (HMCs) and adopt a more rigorous approach to monitoring their effectiveness and taking remedial measures when performance is not effective.
  • To strengthen the Gender Equity Voice and Accountability Task Group (GEVA-TG) through the inclusion of line directors involved in major initiatives in V&A.
  • To consider how the views of women users can be heard and incorporated into the design of voucher schemes and monitoring of implementation recommendations to DFID and Development Partners (DPs).

Recommendations to DFID and DPs:

  • To establish through the pooled funds a Community Health Development Fund to provide funding for third-party support to CCMGs and CSGs; block grants to provide for small discretionary expenditure based on the Local Level Plan (LLP); and capacity strengthening of local government chairmen and councillors.
  • To provide support through the pooled funds for a scheme to revitalise and strengthen schemes for hospital accountability to communities served. This should include technical assistance and capacity strengthening for the operation of HMCs and small grants to recognised hospital user forums and similar bodies.
  • To provide financial support to think tank-style organisations proposing and then implementing schemes for providing expert knowledge support to community-level organisations and facilitating the exchange of information and good practices between such organisations.
  • To work with the Line Directors of the Management Information System (LD-MIS) to explore and fund promising innovations in the use of new technologies to strengthen citizen voices.
  • To explore options for improving the expert knowledge of health specialising journalists so that they are better informed of best practices and international experience.

Recommendations to NGOs and civil society organisations:

  • Based on the learning from experiences so far, design low-cost but effective means of providing support to citizen groups.
  • To explore means of collaboration, information exchange, and sharing of good practices in citizen participation in health.

The final version of the assignment report is available for download here.

A helpdesk report was also completed to identify useful resources on the assessment of V&A and to give examples of V&A in the context of the Bangladesh health sector. Different models of V&A were also listed and described.

Useful resources on assessment of voice and accountability (V&A) include: a systematic review on health facility committees, a review of community accountability at peripheral health facilities, a technical brief on strengthening V&A in the health sector, and assessment of health centre committees on performance and resource allocation.

Assessment of specific initiatives include: schemes in Burundi, health facility committees in Kenya, a community-based monitoring project in Uganda, and a female community health volunteer programme in Nepal.

Examples of V&A in the Bangladesh health sector include: a Maternal, Neonatal and Child Health Committee, the use of SMS for monitoring hospital services, and stakeholder committees for essential service package users.

The final version of the helpdesk report is available for download here.


Mike Naylor is a Principal Consultant for OPM’s Social Policy Programme and the Director of the DFID funded Health & Education Advice & Resources Team (HEART). He is a highly experienced health professional with over 30 years’ experience in advising donors, recipient governments and health service providers on how to make health services work for the poor through being more efficient, effective and equitable. He has worked extensively with senior management, identifying key organisational and management issues and bottlenecks and innovative ways to address them. He has also managed several large and complex technical assistance projects for DFID and other donors, both as a provider of technical assistance himself and a manager of technical assistance procurement, in countries including Georgia, Cambodia and Afghanistan.

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