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Enhancing voice and accountability in health


Health professionals are increasingly accountable for the way they use resources, the services they provide to people and, more generally, the results they deliver. In the wake of the Arab Spring and the progress of democracy across Africa, citizens’ voices are amplifying this trend.

In response, the African Development Bank engages with African governments to enhance voice and accountability. It is preparing a second budget support operation of US $500 million for Tunisia, which will help to create mechanisms for citizen participation and better access to information, among other things.

Various tools are available to give a voice to people in the design, management and monitoring of the services they receive – and Africa’s experience is promising. One such tool is citizen report cards, which are often used in Africa and show good results. In Uganda use of citizen report cards reduces waiting times at health facilities and lowers staff absenteeism by more than 25%. Similarly, treatment practices have improved in the areas where citizen report cards have been introduced (for example, blood pressure equipment has been used more systematically by health personnel). People are also better informed about health services. They are thus more inclined to use them, with the number of those who use outpatient, antenatal and family planning services rising 20%.

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