Encouraging Participation

Abstract

Can civic engagement that is encouraged by a development program be empowering and helpful for improving public services? Transparency and accountability or social accountability programs are a popular approach to improving the responsiveness and effectiveness of health care, education, and other public services, but evidence of their effects is mixed. We ask whether participants in 200 randomly selected communities in Indonesia and Tanzania engaged with an experimental community-led scorecard program they were offered and whether they found the experience to be empowering and helpful for improving their maternal and newborn health care. Interviews, focus groups, and observations of program meetings before, during, immediately after, and two years after the program all indicate from complementary perspectives that in almost all communities, participants engaged in sustained and largely self-directed discussions about how to improve their care and tried the approaches they designed. Although their experiences were far from uniform and some grew skeptical of their efficacy, most who participated throughout eventually described their activities as having improved their care and as being as or more confident in their capacities to improve their communities than when they began. On average, their efforts were not sufficient to add significantly to measurable health outcomes in their broader communities two years after the program, relative to 200 other communities who were not offered the program. Thus participants’ perceptions of the efficacy of their efforts might stem in part from attribution bias. Yet the evidence also suggests that in a substantial minority of communities, participants had been willing to continue their efforts long after the program ended, and that their efforts had led to changes in their care that, although they may have had limited effects on average community-level outcomes or substituted for others’ efforts, were noticeable and memorable to them and others in their community. Altogether a wide range of observations and reflections all suggest that for most who participated throughout the program, the experience sustained or improved their perceptions of civic efficacy.