Transparency for Development: Do Transparency and Accountability Interventions Improve Health Outcomes?

The Challenge

Recent decades have seen vast expansions of public health services across much of the developing world.  But the quality of these services is often lacking, limiting their ultimate impact on the world’s poor.  Transparency and accountability (T/A) techniques—such as social audits, public expenditure tracking surveys, citizen report cards, absenteeism studies, and community scorecards—are increasingly seen as one potential solution to some of these problems in that they allow communities to identify breakdowns and hold responsible agents or decision makers to account.  Yet the evidence about the effectiveness of these interventions is frustratingly mixed.  Further, evidence on successful interventions provides few insights into why these interventions worked, what aspects of the context played a role, and whether they truly empowered poor communities or were largely irrelevant to the deeper problems of power inequity, institutional failure, or social conflict that often foster slow and uneven development.

The Opportunity

A major opportunity exists to develop a more nuanced and action-oriented understanding of whether and in what context T/A interventions work – and to provide evidence that can be useful both to academics and to those working on the ground to improve health, accountability, and citizen participation.  Specifically, such evidence could be used to:
  • Provide CSOs and practitioners with actionable information about intervention design features that are more and less effective in different contexts;
  • Reveal information for donors about T/A interventions that have a high potential for impact on health and other development outcomes;
  • Provide evidence for health sector experts and policymakers regarding whether T/A practices can impact health outcomes and how to undertake T/A work to strengthen health service delivery; and
  • Highlight research lessons to motivate the research questions and agenda of the next generation of academics and others undertaking research in the areas of transparency, accountability, and community participation.

Our Results

The Transparency for Development (T4D) project is designed to investigate the questions of whether well-designed T/A interventions improve health outcomes and under what conditions.  The overriding goal is to generate actionable evidence for practitioners, researchers, and other stakeholders working to improve health, accountability, and citizen participation.

R4D — in partnership with the Harvard Kennedy School — is undertaking the following:

  • Design, pilot, and rigorously evaluate a series of T/A interventions across several countries and contexts carefully selected to allow maximum potential for producing generalizable results about whether, where, and why T/A interventions improve development outcomes.
  • Develop and widely disseminate the project’s findings along with concrete recommendations for donors, policymakers, practitioners, and other stakeholders on how to apply the findings to future work in transparency and accountability.

The project is generously funded jointly by the William and Flora Hewlett Foundation, the U.K. Department for International Development, and the Bill and Melinda Gates Foundation and is brokered under the Transparency and Accountability Initiative.


Download the 1 pager

Read the T4D Accountability for Health Policy brief

Read the working paper: Can Transparency and Accountability Programs Improve Health? Experimental Evidence from Indonesia and Tanzania (Harvard Kennedy School Faculty Research Working Paper Series)

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