Abstract
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. While many factors contribute to service delivery problems, one important factor is governance. The incentives that shape frontline service provider performance, training, oversight, and management all play an important role in the quality of healthcare provided by any health system. 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. Some studies of T/A interventions show tremendously positive effects on community empowerment and health and education outcomes, while others show no impact. 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. One consequence of this evidence gap is that reformers, policymakers, donors, and other practitioners lack clear guidance on whether any T/A interventions can ultimately empower poor populations and improve service delivery to them and on what sorts of T/A interventions should be pursued in different contexts.
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.
The Transparency for Development project will:
1. 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
2. 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.