title: Scorecards and social accountability for improved maternal and newborn health services: A pilot in the Ashanti and Volta regions of Ghana.
abstract: BACKGROUND
  With the limited availability of quality emergency obstetric and newborn care (EmONC) in Ghana, and a lack of dialogue on the issue at district level, the Evidence for Action (E4A) program (2011-2015) initiated a pilot intervention using a social accountability approach in two regions of Ghana.
  
  
  OBJECTIVE
  Using scorecards to assess and improve maternal and newborn health services, the intervention study evaluated the effectiveness of engaging multiple, health and non-health sector stakeholders at district level to improve the enabling environment for quality EmONC.
  
  
  METHODS
  The quantitative study component comprised two rounds of assessments in 37 health facilities. The qualitative component is based on an independent prospective policy study.
  
  
  RESULTS
  Results show a marked growth in a culture of accountability, with heightened levels of community participation, transparency, and improved clarity of lines of accountability among decision-makers. The breadth and type of quality of care improvements were dependent on the strength of community and government engagement in the process, especially in regard to more complex systemic changes.
  
  
  CONCLUSIONS
  Engaging a broad network of stakeholders to support MNH services has great potential if implemented in ways that are context-appropriate and that build around full collaboration with government and civil society stakeholders.
authors: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland. Electronic address: carolyn.blake@unibas.ch.
authors: Carolyn
authors: C
authors: Blake
authors: Alliance for Reproductive Health Rights, Accra, Ghana.
authors: Nii Ankonu
authors: NA
authors: Annorbah-Sarpei
authors: Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
authors: Claire
authors: C
authors: Bailey
authors: School of Public Health, University of Ghana, Legon, Ghana.
authors: Yakubu
authors: Y
authors: Ismaila
authors: Ghana Health Service, Accra, Ghana.
authors: Sylvia
authors: S
authors: Deganus
authors: School of Public Health, University of Ghana, Legon, Ghana.
authors: Samuel
authors: S
authors: Bosomprah
authors: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors: Francesco
authors: F
authors: Galli
authors: School of Public Policy, University College London, London, UK.
authors: Sarah
authors: S
authors: Clark
mesh_terms: D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D005869:Ghana; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D015931:Intensive Care, Neonatal / Q000592:standards*; D016015:Logistic Models; D008427:Maternal Health Services / Q000592:standards*; D010865:Pilot Projects; D011247:Pregnancy; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000592:standards*; D012941:Social Responsibility
keywords: Emergency obstetric and neonatal care (EmONC); Evidence for Action (E4A); Ghana; Maternal health; Neonatal health; Quality of care; Scorecards; Social accountability