What it really takes to scale accountability: practical tools and lessons from eight countries
1
Global Programs & Operations, Children International, Kansas, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
A growing body of global evidence shows that Social Accountability (SA) improves service quality, governance, and responsiveness within public systems, making it a critical contributor to health systems strengthening1,2,3,4,5. Building on this evidence, Children International (CI) has implemented a global SA approach since 2018 to enhance primary health care (PHC) delivery and equitable access to quality services for all. CI’s model has evolved through pilot testing in the Dominican Republic and Guatemala, global rollout across eight countries, and subsequent adaptation for education systems.
METHODS:
CI adapted CARE’s Community Score Card (CSC) methodology to convene youth, caregivers, providers, community leaders, and government representatives to jointly assess services, identify gaps, and co-create action plans. These scoring and dialogue cycles repeat every six months. Between 2018 and 2026, SA expanded across CI countries and extended into education systems in Zambia, the Philippines, and Ecuador. CI also developed a monitoring and evaluation toolkit measuring facilitation quality, community voice and empowerment, facility level improvements, and most significant change outcomes.
RESULTS:
SA implementation strengthened service responsiveness, community involvement, medicine and personal availability, and respectful care indicators across PHC sites. Youth led accountability promoted adolescent friendly services. CI’s nine year experience highlights key lessons related to strategies to effectively engage youth, smart scaling, tradeoffs around aggregation within M&E systems, and sustainability. By 2025, SA efforts reached over 1.49 million community members across 50 global sites.
CONCLUSIONS:
Community driven accountability is a scalable, equity enhancing strategy for strengthening PHC. Through this session, practitioners will receive practical frameworks, implementation manuals, tools, specific case studies and candid lessons learned to build knowledge and support adaptation of the CSC methodology across sectors and contexts, equipping them to institutionalize participatory governance and strengthen health systems and community capacity.
A growing body of global evidence shows that Social Accountability (SA) improves service quality, governance, and responsiveness within public systems, making it a critical contributor to health systems strengthening1,2,3,4,5. Building on this evidence, Children International (CI) has implemented a global SA approach since 2018 to enhance primary health care (PHC) delivery and equitable access to quality services for all. CI’s model has evolved through pilot testing in the Dominican Republic and Guatemala, global rollout across eight countries, and subsequent adaptation for education systems.
METHODS:
CI adapted CARE’s Community Score Card (CSC) methodology to convene youth, caregivers, providers, community leaders, and government representatives to jointly assess services, identify gaps, and co-create action plans. These scoring and dialogue cycles repeat every six months. Between 2018 and 2026, SA expanded across CI countries and extended into education systems in Zambia, the Philippines, and Ecuador. CI also developed a monitoring and evaluation toolkit measuring facilitation quality, community voice and empowerment, facility level improvements, and most significant change outcomes.
RESULTS:
SA implementation strengthened service responsiveness, community involvement, medicine and personal availability, and respectful care indicators across PHC sites. Youth led accountability promoted adolescent friendly services. CI’s nine year experience highlights key lessons related to strategies to effectively engage youth, smart scaling, tradeoffs around aggregation within M&E systems, and sustainability. By 2025, SA efforts reached over 1.49 million community members across 50 global sites.
CONCLUSIONS:
Community driven accountability is a scalable, equity enhancing strategy for strengthening PHC. Through this session, practitioners will receive practical frameworks, implementation manuals, tools, specific case studies and candid lessons learned to build knowledge and support adaptation of the CSC methodology across sectors and contexts, equipping them to institutionalize participatory governance and strengthen health systems and community capacity.
| eISSN: | 2654-1459 |
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