ÌÇÐÄvlog¹ÙÍø

How effective are community-led transparency and accountability programs in improving maternal and newborn health outcomes in Indonesia and Tanzania?

Key Findings:

• Community participation in both countries was substantial and sustained, and the meetings created space for participants to leverage local knowledge and collectively plan diverse courses of action for improving their maternal and newborn health care.
• No measurable impact on health service use or quality: Despite widespread community participation, the intervention did not significantly improve maternal or newborn healthcare service utilization, quality of care, or infant health outcomes in the average community that received the program.
• Sustained participation but limited impact: Participants engaged actively in the program, planned various activities to improve MNH services, and implemented some of them. However, only a minority of communities achieved tangible improvements, with just 35% of communities recalling a concrete success 1.5 years later, and even fewer achieving multiple improvements.
• Challenges in achieving systemic change: While participants attempted actions such as awareness campaigns and facility improvements, these efforts were often too small, indirect, or fragmented to lead to measurable improvements in service delivery or health outcomes. In many cases, participants lacked the resources or political influence to effect meaningful change.
• Pre-existing health improvements may have masked effects: Both Indonesia and Tanzania experienced secular improvements in maternal and newborn health during the study period, making it difficult to detect any additional impact from the intervention.

Impact and Relevance:

This study contributes to the growing literature on social accountability and community-driven development, highlighting the limitations of light-touch, community-based interventions in improving public service delivery. While transparency and participation are often promoted as mechanisms for improving governance and health outcomes, this research suggests that information alone is insufficient to drive systemic change without complementary resources, stronger institutional support, or enforcement mechanisms. 
 
The findings raise important questions about how and when community-led interventions can be effective. Unlike past studies that found positive effects of social accountability on service provision, this study suggests that success may depend on local political conditions, pre-existing institutional capacity, and the degree of government responsiveness to citizen demands. 
 
More broadly, the results highlight the complexity of translating citizen engagement into measurable health improvements. While the intervention fostered civic participation, it struggled to bridge the gap between community action and structural health system improvements. Future efforts may need to incorporate stronger linkages to government accountability, financial support, and targeted technical assistance to achieve sustained health outcomes.