How to strengthen accountability for universal health coverage
Accountability is a key determinant to advancing universal health coverage (UHC). A well-functioning accountability system is associated with improved health system performance and faster progress toward UHC goals. Among many advantages, effective accountability in UHC ecosystems can:
- Reduce information asymmetries between government and civil society as well as between health service providers and their clients regarding UHC-related rights;
- Clarify responsibilities and hold each stakeholder answerable for UHC goals;
- Help identify and fill gaps in the availability of essential resources (money, health supplies, personnel);
- Contribute to improving the quality and coverage of health services.
On this page you will find conceptual framing and analytical resources and tools to deepen understanding of how accountability works within a country’s UHC ecosystem, developed and tested by the African Collaborative for Health Financing Solutions (ACS) program.
Key resources and how they can be used:
The following resources can help stakeholders understand the motives, principles, and mechanisms of accountability in UHC ecosystems; accountability strategies; and practical tools that can be used to enhance accountability in UHC processes.
“Heaven and Hell” Theory for Accountability in UHC: The Heaven and Hell Theory is a starting point for countries to conceptualize what accountability looks like and how it works within a UHC ecosystem. The theory is built on the triangular relationship among policymakers, health care providers, and the public (health service users). Each binary relationship is conditioned by various components, including the health system architecture, laws and rules, voice and participation tools, and information and intelligence. These components can generate accountability if they are grounded in clear expectations, the actors’ capabilities to deliver on those expectations, effective measurement of results, effective feedback processes, and clearly articulated consequences for the success or failure to deliver on the expectations. Users can use The Heaven and Hell Theory to assess and improve the design and implementation of accountability in the health system, specifically for UHC. The framework can easily be used at all health system levels.
- Compendium of resources to support accountability in UHC, including an explanation of The Heaven and Hell Theory
Accountability mapping: Accountability mapping can be used to identify key stakeholders (government, private sector, CSOs, youth, etc.) involved in promoting accountability, identify strategies to promote accountability, including capacity gaps among stakeholders. Various methodologies can be used, including desk reviews of literature, qualitative data collection such as key informant videos and data analysis. The following resource can support accountability mapping efforts
- A study on accountability mapping in Botswana (sample interview guides included)
- A study on accountability mapping in Benin (sample interview guides included)
Social accountability approaches used in Burkina Faso and Kenya.
- The role of social movements in promoting accountability in the health sector
- Perceptions of health and the pathways to safeguard or restore it
- Structural barriers to achieving universal health coverage
These resources and many more appear below in English and in French.