Act global, but think local: accountability at the frontlines

Area of Science:

• Public Health
• Health Systems Research
• Social Sciences

Background:

• Discrepancy exists between global advocacy framing and patient experiences in sexual and reproductive health services.
• Current accountability approaches in advocacy overlook frontline power dynamics, limiting transformative change.

Purpose of the Study:

• To propose a revitalized accountability framework for sexual and reproductive health and rights.
• To address the gap between global advocacy and local health service realities.

Main Methods:

• Analysis of accountability approaches in global and local advocacy.
• Drawing insights from implementation science, systems science, political economy, ethnography, and organizational change management.

Main Results:

• Conventional accountability methods fail to address frontline power dynamics in health systems.
• A new approach is needed that centers the experiences of individuals interacting with health providers and institutions.

Conclusions:

• Reinvigorated accountability must begin with frontline power dynamics.
• Understanding health systems as complex adaptive systems within political contexts is crucial.
• Interdisciplinary insights can uncover and tackle power dynamics for more effective accountability and meaningful change in sexual and reproductive health and rights.