Rationale and design of a complex intervention measuring the impact and processes of social accountability applied to contraceptive programming: CaPSAI Project

Abstract

Background: There are numerous barriers leading to a high unmet need for family planning and contraceptives (FP/C). These include limited knowledge and information, poor access to quality services, structural inefficiencies in service provision and inadequately trained and supervised health professionals. Recently, social accountability programs have shown promising results in addressing barriers to accessing sexual and reproductive health services. As a highly complex participatory process with multiple and interrelated components, steps and actors, studying social accountability poses methodological challenges. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project study protocol was developed to measure the impact of a social accountability intervention on contraceptive uptake and use and to understand the mechanisms and contextual factors that influence and generate these effects (with emphasis on health services actors and community members). Methods: CaPSAI Project is implementing a social accountability intervention where service users and providers assess the quality of local FP/C services and jointly identify ways to improve the delivery and quality of such services. In the project, a quasi-experimental study utilizing an interrupted time series design with a control group is conducted in eight intervention and eight control facilities in each study country, which are Ghana and Tanzania. A cross-sectional survey of service users and health care providers is used to measure social accountability outcomes, and a cohort of women who are new users of FP/C is followed up after the completion of the intervention to measure contraceptive use and continuation. The process evaluation utilizes a range of methods and data sources to enable a fuller description of how the findings were produced. Conclusion: This complex study design could provide researchers and implementers with the means to better measure and understand the mechanisms and contextual factors that influence social accountability processes in reproductive health, adding important findings to the evidence base.

A summative content analysis of how programmes to improve the right to sexual and reproductive health address power

“…The most common organisational structure addressed was health facilities. For example, several programmes entailed health facility-led efforts to engage communities in expressing their priorities regarding quality of care; some of these had an explicit health facility accountability component 35 37 42 85–88. Other health sector programmes aimed to create change in the way organisations operate, including health facilities89–92; health and allied professional associations and other organisational stakeholders in SRH, including law enforcement93–95; schools96; and factories 97.…”

Unpacking power dynamics in research and evaluation on social accountability for sexual and reproductive health and rights

“…However, it is important to note that practitioners and researchers have developed quantitative tools to assess individual or group empowerment; these may be used in a quasi experimental design to detect change over time. Measures assess phenomena such as group efficacy, agency, and action among women and health providers in the context of reproductive and maternal health social accountability programming [ 25 – 27 ]. Regardless of the tools used, explicit consideration of power dynamics is essential to understanding the contextual factors that shape the implementation of social accountability programmes, as well as understanding their impact.…”

Impact of community and provider-driven social accountability interventions on contraceptive uptake in Ghana and Tanzania

“…The study was designed according to the Medical Research Council (MRC) guidance on complex interventions based on a theory of change (ToC) (Fig. 1) using a co-designed intervention to account for the complexity of SA processes [20][21][22][23]. It accounts for the multiple components required to track the different levels and interrelated outcomes and includes a process evaluation component [20].…”

“…1) using a co-designed intervention to account for the complexity of SA processes [20][21][22][23]. It accounts for the multiple components required to track the different levels and interrelated outcomes and includes a process evaluation component [20].…”

“…The CaPSAI Project ToC (Fig. 1) was developed after a review of the literature and findings from the formative phase research [10,20,24]. Firstly, the descriptions, evidence, and programme report from SA interventions applied to health were gathered to understand the common steps being used [9].…”