Citizens driving change


Progress has also been made by supporting women as autonomous agents and enabling them to drive change for themselves. This includes enhancing their ability to participate in decision-making, investing in them as individuals, building confidence, facilitating collective action and raising awareness of rights.

It is widely acknowledged that the greatest obstacles to better health for women are not medical in nature, but are largely determined by their social, political and economic conditions. Studies have consistently shown that socioeconomic differentials are the clearest indicators of the status of women’s health. These factors significantly influence women’s ability to participate in their own health-care decision-making, health-care access and health outcomes (Box 13).


We must ensure that every woman, child and adolescent is empowered to become what they choose to be. Building partnerships and working at the local level will be key if we are to achieve real results and build a better future for them.

H.E. Ms Marie-Claude Bibeau

Minister of International Development and La Francophonie of Canada
Member of the High-Level Steering Group for Every Woman Every Child

64 %

Now in Bangladesh, people bear 64% of the expense for health services, which often pushes people below the poverty level.

Dr Arefin Omar Islam

Chair of the Executive Committee of White Ribbon Alliance, at the National Citizens’ Hearing, Bangladesh

Supporting women’s empowerment involves fostering an environment that enables them to access resources, through employment opportunities or loans, as well as focusing on the broader multidimensional nature of women’s autonomy, including skills development and participation.

Box 13.

Increasing uptake and use of services through women’s empowerment

In Cameroon’s Far North region, the poorest in the country, H6 has supported efforts to address the root causes of low utilization of health facilities and lack of health-seeking behaviour since 2014. More than 70 women’s groups received technical and material support to develop income-generating activities and to promote RMNCAH. The women’s groups carried out activities such as awareness-raising on RMNCAH and the importance of accessing services, counselling for women, and financial support to women who cannot afford to access services. This approach catalysed the women’s financial empowerment, and also facilitated their access to health services, particularly for childbirth in health facilities.157



There is growing recognition of the potential for citizen-led accountability. Both the SDGs and the EWEC Global Strategy call for accountability frameworks to be inclusive, participatory, transparent and people-centred. However, for citizen-led accountability initiatives to thrive, deliver results and be incorporated into broader accountability frameworks operating at national and global levels, a concerted effort must be made to engage citizens and inform them of their rights. Such efforts are also essential for ensuring that citizens’ voices are heard by decision-makers at all levels of government: local efforts operating in isolation have limited reach and potential, resulting in “a voice without teeth”.158 With the support structures and amplification of voice provided by a wider network, duty-bearers are more receptive to citizens’ asks and demands.

World Vision, Save the Children, International Planned Parenthood Federation and White Ribbon Alliance (WRA) formed a partnership in 2015, pooling their social accountability-related networks to reduce duplication and achieve more effective work jointly. This partnership works collaboratively with state and government institutions and decision-makers to foster trust between duty-bearers and rights-holders. The partners have launched a number of highly successful initiatives, including the following.

The partnership has coordinated citizens’ hearings around the world, at which thousands of citizens and community groups, including children’s, adolescents’ and women’s rights groups, have engaged with decision-makers and service-providers to discuss health services and identify strategies for immediate improvements in their local area. Citizens’ hearings provide opportunities for citizens to shed light on SRMNCAH issues, seek solutions, set priorities, and monitor and review progress.

In 2015 and 2016, citizens’ hearings were held in more than 20 countries in Africa and Asia (Afghanistan, Bangladesh, Cambodia, Ghana, India, Indonesia, Kenya, Lesotho, Malawi, Mali, Mauritania, Nepal, Niger, Nigeria, Pakistan, Sierra Leone, South Africa, Sudan, Uganda, Tanzania, Zambia and Zimbabwe). Citizens’ hearings have helped to identify priorities for the SDGs and the updated EWEC Global Strategy, and to persuade governments to establish accountability frameworks.159

In Tanzania, in order to address the lack of investment in comprehensive emergency obstetric and newborn care (CEmONC), WRA Tanzania and its members advocated for an increase in and ring-fencing of the budget allocation for CEmONC. WRA Tanzania worked with member organizations, religious leaders and village health teams to raise awareness among citizens of the CEmONC funding gap. Through media partnerships, WRA Tanzania ensured that health officials and other government leaders heard the stories and evidence collected from mothers and their families, and that community demands were discussed and addressed. On a regional level, citizen-led efforts in Rukwa region contributed to the creation of five health facilities providing CEmoNC services, each serving between 7000 and 15000 people.

It is important to involve citizens when addressing their needs, and when implementing plans. They are the ones who know exactly what they need. Involve them.

Senior Chief Somba

at the Blantyre District Citizens’ Hearing, Malawi

Similarly, key advocacy and accountability activities at the national level helped to amplify citizens’ voices and so increase government officials’ awareness of their responsibilities as duty-bearers. Policy-makers responded by increasing the 2017/18 budget for maternal and newborn health by 53% over the previous year, with plans to upgrade 150 health centres to provide CEmONC.

In Uganda, Advocacy for Better Health, a five-year USAID project implemented by PATH and Initiatives Inc, has since 2014 used advocacy capacity building, community mobilization and social accountability to amplify citizens’ voices. The project engages communities in the planning and monitoring of health services, and strengthens the capacity of local CSOs to represent citizens’ interests and advocate for health policies, budgets and programmes. Advocacy for Better Health and 20 CSO partners have mobilized 429 community groups in 35 districts to hold duty-bearers accountable for health-related goals and commitments.

Engaged by the programme’s partners, the media have provided invaluable help in amplifying the voices of citizens demanding accountability, enabling them to reach decision-makers at subnational, national and global levels. For example, the National Citizens’ Hearing in Uganda was broadcast on national television. Print and electronic media have also devoted significant space and attention to citizens’ demands. Radio, television and newspapers have provided opportunities for citizens and other stakeholders to highlight key issues and inform citizens of their rights to take action on those issues.

These examples of the partnership’s work illustrate the critical impact of citizen-led accountability efforts on improving services and outcomes for women, children and adolescents. However, much more work needs to be done to support, and gather evidence of, successful citizen-led accountability mechanisms, led by a range of partners across countries.

Citizens driving change
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